Case study: Creating a one touch process at Southcoast Health

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