Over the last two decades, the revenue cycle and revenue capture have evolved dramatically. In the past, coding teams focused heavily on getting claims out the door. Today, there is greater emphasis on the quality of patient information and care. The emergence of electronic medical records and the growing importance of healthcare quality measures have transformed the way coders do their work.
Becker's Hospital Review recently spoke with Jann Owens, revenue cycle content manager at St. Paul, Minn.-based 3M. She discussed how factors like automation and richer patient data are expanding the role of the coder. Healthcare organizations that embrace education, technology and holistic approaches to coding enjoy cleaner claims, higher levels of productivity and better patient information.
"I've been in HIM [health information management] for over 20 years, and there have been many changes in the revenue cycle. We went through a period when coders only captured the codes that affected the DRG [diagnosis-related group]," Ms. Owens observed. “When a patient came in for an inpatient procedure, the coders coded the specific principal diagnosis, the secondary diagnoses and the procedures, etc. that impacted the DRG. On the outpatient side, coders coded the diagnoses that covered medical necessity. The focus was on getting the right payment.”
The world has changed. Coders today can no longer take a myopic view of patient information. Healthcare organizations must conform to additional measures like Hierarchical Condition Categories (HCCs), quality metrics and myriad other items including and within value-based purchasing. New state and national requirements are also shifting regularly. To ensure healthcare organizations capture the right measures in their systems, coders must be trained to code completely and correctly.
One organization Ms. Owens worked for discovered the hard way how important it is to look at the big picture. As the team was coding bowel resection procedures, coders accidentally miscoded part of the Procedure Coding System (PCS) code. It didn't impact the DRG, but it did affect certain quality measures, which had a negative impact on the facility's bottom line.
"The quality team asked the coders to review thousands of accounts and change the PCS code. In the old world, it wouldn't have mattered, but in today's world, that coding practice affected the bottom line in new, unanticipated ways,” explained Ms. Owens. “Coders can't worry only about the DRG or the APC [Ambulatory Payment Classification]; they have to take a holistic view."
The roles and responsibilities of medical coders often depend on the size of the organization they work in, as well as the clinical setting. Ms. Owens detailed two coder models based on her experience:
Some larger health systems have also deployed "float coders" who can code multiple patient types. "This approach is beneficial for healthcare organizations because they can provide float coders a broad variety of work. It's also good for the coders because they don't feel pigeonholed into a particular specialty," Ms. Owens explained.
Many healthcare organizations are also reexamining and redefining the role and support of coders, in light of ICD-10 (the 10th version of the World Health Organization's medical classification system) automation and organizational process improvement. Ms. Owens highlighted three examples:
As healthcare policies and the healthcare landscape become more demanding, organizations can adopt several best practices to optimize the revenue cycle through coding:
As the healthcare sector changes, the coding function must evolve along with it. "We can't stay stuck in the past, doing what we've always done," Ms. Owens said. "We need to look for new approaches, and we must break down silos. It's through communication and teamwork with our peers in different areas that we'll be successful."