Midway Health System Marion Ohio Revenue Cycle Management

Midway Health System Marion, Ohio

Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Our Mission… Midway Health System’s mission is to provide comprehensive coding quality for productivity improvement, while providing superior patient satisfaction. Our coding process evaluates and identifies areas where improvements are needed. We strive to obtain timely and accurate reimbursement for our customers in lieu of services provided. This is accomplished by practicing the highest level of integrity, compliance and ethical standards. We use up to date resources within our facility for ongoing staff development, the enhancement of the medical revenue cycle management, and optimal reimbursement. Sharon Brown

Our Vision… The Health Information Management Department of Midway Health System will strive to deliver correct and complete coding for all medical records and assist in improving the outstanding quality care to all patients. Sharon Brown

Main Functions • • Admitting, patient access management Case management Charge capture Health information management Patient financial services, business office Finance Compliance Information technology Sharon Brown

Revenue Cycle Indicators to Analyze • Value and volume of discharged, not final billed encounters • Number of accounts receivable days • Number of bill-hold days • Percentage and amount of write-offs • Percentage of clean claims • Percentage of claims returned to provider • Percentage of denials • Percentage of accounts-missing documents • Number of query forms • Percentage of late charges • Percentage of accurate registrations • Percentage of point-of-service collections for elective procedures • Percentage of increased DRG payments due to improved documentation and coding Sharon Brown

Coding Compliance Plan • • Code of conduct Policies and procedures Education and training Communication Auditing Corrective action Reporting Sharon Brown

Customers External Customers- Internal Customers- end users of our service that work outside of the facility. those individuals or departments within the organization to whom we provide a service • Patients • Physicians • Third-party payers • Employees • Administration • Registries Sharon Brown

Purposes of AHIMA’s Code of Ethics • • • Promotes high standards of HIM practice. Identifies core values on which the HIM mission is based. Summarizes broad ethical principles that reflect the profession's core values. Establishes a set of ethical principles to be used to guide decision-making and actions. Establishes a framework for professional behavior and responsibilities when professional obligations conflict or ethical uncertainties arise. • Provides ethical principles by which the general public can hold the HIM professional accountable. • Mentors practitioners new to the field to HIM's mission, values, and ethical principles. Sharon Brown

Summary of Audit Sharon Brown

Criteria Used for Audit • • • MRN number Date of service Type of encounter ICD-9 diagnoses codes ICD-9 procedure codes CPT-4 procedure codes 1 = correct 0 = incorrect Sharon Brown

Sample of Audit Results Sharon Brown

ICD-9 Diagnoses Codes (182 Codes) 21% Total Correct ICD-9 Codes (144) 79% Sharon Brown

ICD-9 Procedure Codes (18 Codes) 17% Total Correct Codes (15) Total Incorrect Codes (3) 83% Sharon Brown

CPT-4 Codes (127 Codes) 25% Total Correct CPT-4 Codes (95) Total Incorrect CPT-4 Codes (32) 75% Sharon Brown

E/M Codes (78 Codes) 5% 26% CPT-4 E/M Correct Codes 54 CPT-4 E/M Incorrect Codes 20 Missing Dates 4 69% Sharon Brown

Pathology Codes (44 Codes) 20 19 18 16 15 14 12 10 8 6 5 4 4 2 1 0 0 ICD-9 Diagnoses Codes Correct Incorrect ICD-9 Procedure Codes ICD-9 Procedure codes Correct Incorrect CPT-4 Codes Correct CPT-4 Codes Incorrect Sharon Brown

Procedure (Surgery) Codes (46 Codes) 16 15 14 14 12 10 8 7 6 6 4 3 2 1 0 ICD-9 Diagnoses Codes Correct Incorrect ICD-9 Procedure Codes ICD-9 Procedure codes Correct Incorrect CPT-4 Codes Correct CPT-4 Codes Incorrect Sharon Brown

Radiology Codes (25 Codes) 9 8 8 7 6 6 6 5 4 4 3 2 1 1 0 0 ICD-9 Diagnoses Codes Correct Incorrect ICD-9 Procedure Codes ICD-9 Procedure codes Correct Incorrect CPT-4 Codes Correct CPT-4 Codes Incorrect Sharon Brown

References • Johns, Merida L. , (2011), Health Information Management Technology, An Applied Approach, Chicago, IL, AHIMA • http: //www. asha. org/uploaded. Files/aud/Cust. Sat 11 v 6 n 2. pdf • http: //wiki. answers. com/Q/Who_are_the_external_and_internal_customers_in_health_car e • http: //library. ahima. org/xpedio/groups/public/documents/ahima/bok 1_024277. hcsp? d. Doc Name=bok 1_024277 Sharon Brown