• 14,203 claims review
• 1,503 recommended changes
• 89% coding accuracy
• $835,310 financial impact (recoup of lost revenue)
 "The experience gave us an excellent blueprint and provided a game plan to take a more granular approach to train and vetting coders to address specific areas needing reinforcement and cross-train when needed."

Coding Review: A Case Study
Level One Trauma Center

Challenge
 
A multi-hospital system, including research and teaching facilities, faced challenges associated with complex coding and reoccurring inaccuracies. As a Level One Trauma Center, the severity of illness level was typically high, equating to high dollar claims, which resulted in inaccurate payment and or denials compromising data integrity and the hospital bottom line.
 
The Healthcare organization engaged Axea Solution to conduct a coding audit to verify internal audit findings, proactively identify any problem areas, and develop a move-forward plan to monitor coding performance and eliminate issues.
 
Approach
 
By first identifying the root cause for coding errors, the coding review served as the benchmark for the organizations’ coding accuracy and a valuable tool to gauge progress. The Axea team understood, and by pinpointing the strengths and weaknesses of coders, our review experts could better help with education and training goals. We studied the performance of coding teams to address errors, denials, and quality issues.
 
We focused on the financial concerns related to coding as well as data integrity. The accuracy of coding directly affects reimbursement, Quality Scores, representation of the patient population to which the organization serves Quality Scores are indicative of the quality of care a hospital provides. If Quality scores suffer, a patient may choose to go elsewhere for services, impacting the bottom line. This aspect of coding accuracy is often overlooked. The overarching function of the revenue cycle and the accuracy to which claims data is process will have a direct impact to the overall patient experience.
 
The coding review by Axea culminated in a follow-up meeting to discuss the revie findings, opportunities for improve, and a road map for improvement. Final findings were provided to the client, who, in turn, shared findings with each original coder for review and rebuttal. Axea outlined a strategy to get training in place, put it into practice, and a plan for consistent reevaluation.
 
Results
 
Axea developed and successfully facilitated a coding accuracy improvement plan to accomplish a long-term and short-term scalable increase in accuracy and coder retention and efficiencies. We offered a strategy for a continual education and improvement program and a working plan tailored to specific coders, with consistent feedback on performance.
 
Integrating this process into standard procedures was received positively by coders as it was an addition to current methods and not perceived as an interruption of work. In an exit survey, responses showed changes were welcomed by coders, viewed as a positive function, yielding long term coding improvement.
 
Axea reviewed 14,203 claims and provided 1,503 recommended changes at completion. Results showed an overall accuracy rate of 89% and a financial impact of $835,310 of lost, recouped revenue.  
"We faced an overwhelming task in addressing coding errors and resolving claim denials. When we partnered with Axea, they provided immediate management and support from their highly credentialed team, who worked cohesively with our HIM Leaders to design an aggressive plan to meet our goals."
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