In a health care environment where everyone is looking for efficiencies to capitalize on, Wilshire finds Revenue Cycle opportunities that often go unrecognized. For example, it is common to see coders reworking accounts in workqueue’s (WQs) because build has not been analyzed with the purpose of reducing touches. They struggle routinely to adjust for inefficient workflows, and even when optimal workflows exists, there can be a lack of production standards adhered to with performance monitoring and feedback. It can be difficult to achieve coding efficiency gains that are supported by a model of strict coding guidelines, but the answers might be more obvious than you think!
Outlined are a few key areas Wilshire has been focusing on and resulting in metrics you can be excited to share with your Revenue Cycle leadership:
Use your EHR and Revenue Cycle system to the fullest!
- Where can the system do something a coder doesn’t have to? Have you explored full use of where you are and are not utilizing Simple Visit Coding (SVC)? The specific service lines (outpatient, ancillary) this workflow works well with can gain tremendous relief from a coding resource perspective, resulting in reallocating coding resources to work that actually requires coder intervention.
Do you regularly trend your Coding-related Edits and Denials?
- Focus your efforts on ensuring there are not WQ build fixes, documentation template design or other upstream variables causing edits to trigger in the first place. Maybe there are education opportunities for coders and/or physicians that can prevent unnecessary rework.
- Are there opportunities to optimize the use of another third-party product that has already been bought and paid for? It’s important to understand how your claims scrubber and clearinghouse interact with your EHR claim edits. Although tools are deployed, if everyone doesn’t understand how to utilize the functionality, edits are not addressed and the account/charge is just pushed to another user for resolution.
Monitoring through Dashboard Management and Trending:
- Does daily management include monitoring of dashboards to create consistency of expectations?
- Have productivity measurements been set to ensure optimal performance from all staff and provide the ability forecast FTE needs and source additional workload?
- Are appropriate owners for all work attributed to coding identified? We sometimes see WQs that are lost in the “shuffle” of go-live or upgrades - resulting in lack of ownership, but consistently showing up on weekly Coding CFB.
Computer Assisted Coding (CAC) Technology:
- Opportunities of 15-20% gains in Coding and CDI productivity with an equally exciting 10% increase in capture of secondary diagnoses, attributing to appropriate and steady CMI increase and quality indicator capture are real results when the system is used accurately. Wilshire is happy to share our experiences here!
- Commit to the project and make sure you are positioned with strong project and change management to ensure you are yielding these achievable results!
Focusing on these realistic opportunities and realizing “wins” will give you the traction you need to invest in the time and resources to move other efficiency projects forward. Wilshire shares our experience in this arena – our goal is to help our clients get the most out of the technology in which they have invested. As always, The Wilshire Group is here to help in any way you need. Learn more here, or get in touch with a member of our team. https://thewilshiregroup.net/