Let iData Dictate your Discharge Summary Reports and Reduce your Discharge Not Final Billed (DNFB) Rates
Reduce your Inpatient Discharge Not Final Billed (DNFB) rates and see increased revenues using iData’s plug-and-play workflow process. iData has combined its 3-prong knowledge of medical transcription, coding, and EMR-based Discharge Summary Reports (DSR) to offer your facility an opportunity to potentially capture hundreds of thousands of dollars in lost or delinquent revenue. Check out our simplified workflow process which exploits existing client EMR and system data to dictate and complete a DSR, transcribe it, and code it. Returned DSRs enable physicians to review, sign off, and decrease a facility’s DNFB rates without virtually lifting a finger. Want to learn some more? Call iData at 410-212-7935 and talk to us about your DNFB rates, DSRs, or any other of iData’s suite of medical documentation services. We would love to help you!
The World of Medical Transcription and Speech Recognition (SR) according to iData
Speech recognition. You’ve thought about it. Maybe you’ve tried to use it commercially several years ago with frustratingly mixed results. Nuance Dragon made it available beginning with an App for the 1st generation iPads. You got choppy, inaccurate, and hard-to-edit speech-to-text conversion. Then you gave up.
That was 6+ years ago. The technology, along with facial recognition, music, image, and video recognition software has emerged and has rapidly improved, yielding better and better user-interface results. Consider the following:
Instagram, Facebook, Snapchat, Google, Android phones, iPhones and other Apple products, camera software and Apps can now identify faces and assign names. Products like Shazam can “listen” to sounds or videos and identify music, songs, or movies playing on TV. Google image search and Pinterest can find exact or similar images to an image you upload or photograph. Google search and the emerging Big Data markets do the same thing, but on an exponentially more complicated paradigm. And now we have “Hey Siri”, “OK Google” and “Hi Galaxy” to ask our phones just about any question with reliable results.
Behind these technologies lie very similar algorithms and input-output engines that collect data, compare the data, process the data, and spit out results. And so it is with Speech Recognition in the healthcare and medical transcription world. In the interest of expediting reports or reducing costs, a physician or other medical staff records information into a device or phone. The software transcribes the audio in real time (instant TAT, right?).
So it’s easy to see, if you haven’t already, that SR is here and here to stay. The technology is getting exponentially easier to use, with lighting fast results, more accurate, and (importantly) increasingly attractive cost-effective way to do business.
iData, LLC, is a U.S.-based medical documentation service provider in the transcription and coding space. We have over 10 years of experience with national and global clients and have now, more than ever, immersed our business in the SR realm to help clients achieve their business goals with fast (TAT), accurate (quality), and cost-effective solutions. Whether you are new to this technology and considering to flip your medical practice to speech recognition, or already are integrated into platforms like Nuance’s Escription, or M*Modal’s Fluency, iData can assist you in designing a work flow, integrate your current business, and implement an SR solution that keeps more dollars on your Balance Sheet. iData is experienced with these and other SR platforms and can offer recommendations depending on your scope and KPI’s. Both Nuance and M*Modal have pros and cons, although both have bragging rights, awards, and years of market leadership. They dominate in the US healthcare market.
So whatever your speech recognition needs, contact iData at (410) 212-7935 today to discuss your next steps. Have you “recognized” that speech “recognition” may be your solution to better transcription?
Forget October 1, Are You Ready For October 16?
We were all focused on the start of ICD-10, but in a few short weeks healthcare organizations will begin to see the impact of the transition on their bottom lines. Here are some tips on how to mitigate the ICD-10 impact.
ICD-10 implementation and planning has been a like a dust storm looming on the horizon: swirling, unpredictable, and a somewhat painful experience. Because of its erratic nature, for the most part, we have all been focused on the challenges of meeting the deadline. We’ve been preparing, planning, allocating resources, testing, tweaking, and testing again. But what most of us haven’t been planning for are the days and weeks post October 1.
A few weeks into October, organizations saw the positive and negative impact of the new coding practices and outcomes on their revenue cycle. With a large-scale transition like ICD-10, and the massive volumes of cases now being coded using the new system, there will be gaps — no matter how well prepared your organization is, we all must carefully examine our plans and processes.
This is the time to embrace ICD-10 in terms of people, process, and technology. Re-examine your workflow and plans to measure the accuracy, quality, and productivity around the new code set. Here are some recommended steps for mitigating the ICD-10 impact and maintaining data integrity post October 1.
All Codes Are Not Equal
Hospitals and providers need to implement regular audits to evaluate the accuracy of the ICD-10 codes and determine the areas of greatest impact on their organization. With this auditing schedule (I suggest daily and weekly at the beginning, and then transition into monthly), you should also define your metrics for monitoring, as well as a project plan that includes resources and tools, timelines, and specific reports or deliverables. You can use these audits to determine the areas of highest impact, and create a plan for prioritizing and targeting those key areas that are causing the most concern: clinical specialty, physician, CDI needs, or coders to mention a few.
Work With Your Physicians
Once you’ve identified the key areas of high-impact denials, meet with your physicians and clinical documentation specialists to review the required clinical documentation needs for ICD-10 coding best practices. Targeted training and increased awareness about enhanced specificity on a patient’s current conditions reflected in the clinical documentation, or the tests and procedures being performed as a result, can have a profound outcome — both on the continuity of care as well as on compliance, quality scores, and reimbursement. For instance, improving the appropriate and precise clinical documentation for a patient with congestive heart failure will not have the same impact as documenting a patient admitted with severe nausea and vomiting. Reporting and analytics tools can be helpful for identifying clinical specialties and/or particular physicians whose documentation may be lacking the proper levels of specificity.
Measure, Measure, Measure
While some clinical documentation improvement metrics are available, currently there are no industry benchmarks for ICD-10 productivity and/or accuracy. Meet with your team of coders, coding trainers, auditors, and clinical documentation specialists (CDSs) and determine your expected turn-around times for discharge processing and coding, discharged but not final billed (DNFB), and days in medical accounts receivable (AR). Create your own ICD-10 accuracy and productivity targets and metrics and be sure to share with the coding team so everyone is well informed of the evaluation and auditing methods that you will be deploying under ICD-10. Infuse continuous quality improvement (CQI) into your cycle of identifying, reviewing, and evaluating each step; and use your reporting tools and audits to track progress, identify areas for further improvement, retool remediation strategies, and share feedback. This is in addition to tracking metrics such as your diagnosis-related groups (DRGs), case mix index (CMI), and severity of illness (SOI), of course!
There undoubtedly will be hiccups here and there, but having pertinent clinical documentation appropriately entered by physicians at the point-of-care is still the best way to tackle ICD-10-related challenges, in addition to providing tremendous relief to both coders and CDSs, and simultaneously reducing physician frustration levels associated with the querying process. Tools such as computer-assisted physician documentation (CAPD) and computer-assisted clinical documentation improvement (CA-CDI) can be extremely useful, particularly if your organization has narrow bandwidth of staff. The outcome that results from having technology-enabled solutions of real-time specificity physician prompting can help to improve clinical documentation integrity and boost your outcomes reporting that can have a real impact on institutional as well as professional credibility.
While October 1 was an important day for us all, what is even more significant is what will happen in the days and months following the compliance date. ICD-10 is a powerful reporting system that will help improve the accuracy of the patient record and ensure quality care. Making sure your organization has a post-transition strategy in place will help you quickly address any unplanned associated complications.
4 Tips for Success – ICD-10 Conversion and Implementation
From Cedars Sinai presentation at the AHIMA conference, the following lessons learned are keys to success in your ICD10 conversaion and implementation! With ICD-10 being implemented this week, are you ready? Here we go!
- Provide ongoing education and re-education for coders. ICD-10 has 68,000 diagnostic codes compared with 13,000 for ICD-9. Even coders with decades of experience are in many ways ‘beginners’ with ICD-10. Initial training will give them the knowledge to start coding in ICD-10, but only hands-on experience and educational feedback will give them the expertise to reach pre-implementation levels of productivity and accuracy.”
- Conduct proactive coding audits and assessments. Don’t wait until you start to get coding denials before you audit your coders. It’s important to proactively identify errors and take steps to correct them as they occur.
- Increase hiring of inexperienced coders. Traditionally, we’ve been hesitant to hire coders who have completed their education but have no previous experience. Take advantage of the training programs already in place for ICD-10 to recruit coders without real world experience, train them and move them along a career ladder that will build loyalty and reduce turnover.
- Evaluate procedures for professional fee coding. With ICD-9, physicians and other professionals at Cedars-Sinai were responsible for entering the diagnostic codes for the services they rendered. We are looking at the commitment required of physicians to learn the new ICD-10 coding system to decide whether that’s the best use of their resources. First and foremost, we want our physicians to be focused on providing patient care. The medical center is exploring the possibility of using coders to do pro-fee coding and training physicians and other professionals in how best to document patient care so as to facilitate accurate coding.
Be sure to contact iData for your direct or supplemental medical documentation needs. Whether you need coders, transcription, back-office support, or catastrophe planning, be sure to contact iData!
Supplemental Discharge Summary Report Services
- Lack of qualified coders (now more than ever with ICD-10)
- Bills held up for reviews and audits
- Poor internal review systems between the departments that code records and the clinicians who complete pathology and operative reports.
“Also, develop a collaborative team within the organization that includes representatives from HIM, coding, quality assurance, and others that meets on a regular basis to discuss ongoing issues. In the beginning, this group may meet weekly, and then taper off to a monthly meeting once improvement is seen. In the end, assign the responsibility of the DNFB monitoring to one individual and ensure that they have the tools and resources to review the report, identify process issues, and make corrections.”
In most situations, the CEO or CFO has the HIM director deliver the DNFB rates. Ultimately, the HIM director should lead the effort to improve DNFB rates and should work with representatives from across many groups: business office, coding, charge-master, admitting, case management or utilization review, quality management, and HIM.
Successfully monitoring and controlling DNFB lies within understanding its cause, says Darice M. Grzybowski, MA, RHIA, FAHIMA, founder and president of HIMentors, LLC, in Westchester, IL.
A HIM department may struggle with getting records coded, Grzybowski says, while other times it may attempt to code the medical record, but find that key information such as a pathology report or dictated operative report is missing.
- Investing in an HIM operational assessment to identify causes of DNFB and possible solutions
- Putting an ongoing tracking mechanism in place to monitor DNFB
- Ensuring the Patient Financial Services (PFS) department and HIM teams agree how DNFB will be defined and measured
- Enforcing record-completion policies
- Ensuring that deficiency analysis takes place before coding (within the first 24 hours post discharge) to identify missing data earlier in the life-cycle of record processing, and to improve coder productivity to avoid them spending time searching for missing information
Be aware that a shortage of qualified, credentialed, and experienced coders can make your organization’s DNFB rise. A lack of an adequate staff working seven days a week in the scanning, analysis, and coding areas could mean higher rates, Grzybowski warns.
- Create a queue/ work-list
- Responsible/attending physician would need to be specified. This will be the physician who has to eventually sign off on the discharge summary document.
- Defined time-frame (i.e., day of discharge, day after discharge, etc.)
- Identifies any issues or need for clarification (i.e., conflicts, specificity, missing/incorrect info, query opportunities)
- Discharge summary report now available in EHR in draft (unsigned) status
- Any issues/discrepancies -> report sent back to iData to be addressed
- No issues/discrepancies -> report signed by physician and finalized in HER
Part 3 – ICD-10 is now down the stretch… now what does your practice do?
Continuing with our Series about what medical practices and hospitals should be doing now that we are slowly running out of time to design and implement an ICD-10 compliance strategy. For other Parts in this series, please refer to related blogs.
5. Master the codes that matter
While many physicians have memorized the codes they use in ICD-9, which is harder to do in ICD-10, because the system is more elaborate. Instead, experts recommend focusing on learning the codes relevant to your specialty, rather than all 155,000 codes. “Make a short list of the codes you have to be good at,” says Lance. Place the list for you, your team members, and other staff all over your practice. Until ICD-10 takes hold, challenge each other with ICD-9 to ICD-10 conversion codes quizzes – “Hey, if I have an ICD-9 code for X, what is the ICD-10 up-code or equivalent?”
For practices and specialties that have complicated coding, use a medical documentation service like iData’s coding process – coding expertise using a mature coding workflow that is topped with a sprinkle of subject matter expertise.
6. Diminishing efficiency and productivity
Be prepared for changes to your coding affecting other aspects of your practice’s operations—and divert resources, dollars, and staffers from other tasks and budget items. Look at where your workflow is going to have to change. ICD-10 is no longer about an “if”; rather it is about a “when” and the sooner your practice gets ready and is positioned well at the starting gate, the less impact to productivity (and commensurate revenue) you will experience.
Consider that many taken-for-granted task such as referrals, supply orders, equipment and service orders that were handled within the ICD-9 world, will now need to contemplate how they are created and generated in the ICD-10 world. Be sure that your entire workflow has contemplated the wide-ranging effects of ICD-10.
7. Quality, quality, quality
Every practice should have a point person assigned to regularly check coding to make sure there are no errors that are costing the practice money—and identify staffers who need more training, say experts. The stakes are high for practices that don’t get it right because errors may lead to delayed or denied claims.
No practice can afford to make big mistakes that affect cash flow today, especially in the financially and regulatory tightened and rapidly changing medical field.
Whether small, up-and-coming- or large practice, or if you are the HIM or CIO or a local or large hospital, contact iData to assist you with resourcing a team of expert ICD-10 leaders and coders. iData will readily demonstrate the efficacy of our process, offer free pilot-scale tests, help your transition, and Go Live sooner than you can imagine.
Part 1 – ICD-10 is now down the stretch… now what does your practice do?
Okay. Take a deep breath. Exhale. Doesn’t that feel good?
As many of us in the medical documentation world feel, this is becoming more and more the scene of uncertainty, anxiety, and “could we just get this ICD-10 over with?” feelings. How soon we forget.
Remember Y2K? The build up. The hype. Fear mongering. Predictions of end-of-world scenarios with images of digital and financial world implosions. Armageddon.
None of it materialized. But – and this is important – it didn’t materialize because redundant planning and execution of intelligent strategies were implemented at the strategic, tactical, and technical levels. Neither will any of the hyper-sensationalized scenarios about ICD-10 – from regulations to promulgation to implementation.
As a medical documentation organization, we here at iData, LLC have our own considerations and anxieties. iData engaged and employed national experts and is now wrapping up its preparation to handle large volumes of inpatient and outpatient coding. The good news is we can now share with you some strategies to help you prepare your practice for ICD10:
1. Your Practice is coming down the “stretch” – don’t expect another delay
Many medical practices got lucky when the ICD-10 implementation deadline was extended because they had procrastinated on learning it. While it is statistically possible the deadline could be postponed again, all indicators now suggest it is unlikely. Hope was a strategy, but it wont is this time. While the time to invest time and dollars in a measured way is virtually vanished, you still have time, even though it may look like a mad rush. Believe it or not, there are a lot of physicians who have their head in the sand on this, and it’s going to come back to bite them.
For those of us just dipping our toes into this, you will quickly learn that it’s a radically different coding system from what ICD-9 is. There’s going to be a pretty steep learning curve, which will undoubtedly create an initial significant decline in productivity.
We at iData have been immersing ourselves over the last 2+ years in the ICD-10 world and have sadly endured the disappointment, costs, and frustrations related to the delays as well as the complicated labyrinth involved in implementation. iData has now evolved its coding process to take on virtually every type of ICD-10-CM/PCS challenge with a mature, quality-heavy workflow. At the core of our business model is the employment of nationally recognized ICD-10 subject matter experts that actively assert their quality expertise for the benefit of our clients.
2. Budgeting bandwidth
Complying with ICD-10 requires a substantial investment, so make sure you plan for outlays to cover training, additional software or upgrades to your existing programs, and other costs.
A small medical practice of 1-2 physician could expect to spend $5K-$15K to update their EHR system to manage ICD-10. If some members of your team have learned the system well, you may be able to offset some of the additional overhead by having them train others.
At the end of the day, you will pay now or later. Believe us, managing this too little too late will be orders of magnitude costlier for your business.
It’s how Wal-Mart discovered people buy more Pop-Tarts before a big storm. It’s how researchers in Canada discovered when vital signs are unusually stable there is a correlation to a serious fever 24-hours later. It’s how air traveler’s can determine which flights are likely to arrive on time. What is it? Big data. And it’s potential for tracking and predicting the future is, well, big!