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From manual to automatic: The road to a streamlined review and audit process

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  • Snapshot of University of Utah Health

    Academic and trauma medical center with a tertiary referral base. Serves the intermountain West region.

  • A team of people with varying job roles

    An integrated auditing and coding team made up of nurses, coders, auditors, educators and quality liaisons.

  • The challenge

    University of Utah Health started the audit process in a spreadsheet-based world. The spreadsheet changed and adapted over multiple years, and grew when new information was added. Although the organization made it work, it was far from the most efficient or unified approach to manage audits. In addition to a manual process, each auditor had a slight variation in their approach.

    The ultimate outcome? A time consuming and inefficient way to understand and manage the data. As the team’s responsibilities continued to increase, they needed a better process and more supportive technology to make their audits more efficient.
     



  • Prospective prebill review process

    The new edit, review and audit solutions within the 3M Inpatient Prebill Review module enable actionable custom edits to identify errors at the point of coding, as part of the coder’s workflow. These custom edits were developed to specifically address the coding errors identified by the University of Utah Health coding and auditing management team. Coding errors are resolved within the coding workflow rather than placed on an additional hold, or worked on further downstream in the revenue cycle, which facilitates better coding accuracy.

    In addition to the actionable custom edits, 3M Inpatient Prebill Review prompts specific criteria to a second level review for additional analysis. According to Nancy Blattberg-Smith, MPH, RHIA, CDIP, CCS, manager of data integrity at University of Utah Health, “ultimately the additional review could eliminate rebills and enable coders and auditors to work together and provider quicker and more timely feedback.”

    The second level review process allows the auditors to take a deeper look at their mortality review gains and losses, identifying net dollar changes that could affect the facility’s revenue stream.
     


  • Retrospective audit process

    In addition to using actionable custom edits and second level reviews as part of the prospective coding accuracy process, University of Utah Health also integrated 3M Code Audit for retrospective reviews. Retrospective audits are completed within the 3M™ 360 Encompass™ System, referencing the codes and the documentation used to create the patient record and removing the manual methods required to create randomized audits previously managed via email.

    3M Code Audit provides a more efficient way to initiate retrospective audits, review the code set, provide two way communication and agreement between the coder and the auditor, and operationalize the overall process. The retrospective audit process also provides insight into coding errors and challenges. This helps direct targeted education and potential new custom edits and review opportunities that can be added to the prebill process– all within a single platform.


The University of Utah Health’s results with 3M

University of Utah Health took full advantage of not only changing a manual process for retrospective reviews, but also creating a standardized and more effective way to address potential issues at the front end of the coding session with a prebill process.

Ultimately, the integration of both 3M Inpatient Prebill Review and 3M Code Audit streamlined the coding accuracy and audit process, which is critical to University of Utah Health’s commitment to quality.

  • A clock with an arrow pointing down next to it

    Reduced rebill time from 30+ days to 3 days post-patient discharge with the prebill process

  • Magnifying glass

    DRG mortality review identified $210k potential undercoding

  • A gear with a check mark in it

    Issues resolved at the front end of the coding process

  • Arrow pointing up

    Audit output doubled from 5% to 10% per coder per month


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