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A prompt on a computer flagging potential coding errors

Case study: Creating a one touch process at Southcoast Health

  • Hospital

    Snapshot of Southcoast Health System

    • 3M technology used by Southcoast Health: 360™ Encompass™ Audit Expert System – Inpatient Prebill Review

    • Southcoast Health System is a not-for-profit community-based health delivery system with multiple access points, offering an integrated continuum of health services throughout Southeastern Massachusetts and Rhode Island.

    • Today, Southcoast Health provides advanced clinical services such as open heart surgery, angioplasty and heart rhythm services, comprehensive cancer care, neurosurgery, weight loss surgery, orthopedic surgery, advanced imaging services and is the only provider of maternity services in the region.


The challenge

  • Prior to working with 3M, Southcoast Health created a system to help with coding errors. This process utilized a third party vendor to identify potential coding errors (via flags) at the end of the coding session. The system then required a review process to determine if flagged errors should be sent to coding to correct or released for billing without review.

    The process was time consuming and cumbersome. With a range of 50 – 100 flagged encounters, the dedicated reviewer at Southcoast Health was under a lot of pressure to quickly review encounters and maintain a targeted release time for bill submission. This process left the organization vulnerable to delayed claim submissions, or errors leading to potential over coding, under coding, or worse case, denials.

    Looking for a solution, the Southcoast Health team identified the following goals to improve their process:
     

    • Identify and introduce a one-touch process, allowing coders to address coding issues at the point of coding
    • Reduce coding session holds and decrease AR days
    • Increase coding accuracy beyond the national standards
    • Decrease denials based on inaccurate code sets
    • Ensure data quality by identifying clinical trial encounters and assigning the correct performing provider
Target with an arrow in the bulls-eye

Find out how Southcoast Health created a new standard for coding, reviews and compliance.

READ THE FULL CASE STUDY (PDF, 82.1 KB)

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