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Cracking the Code on Maximizing ED Payments in 2020


During the holidays and toward the end of the year there is a spike in emergency room visits.

The boost in patient volumes can either be a boon or bust for a hospital emergency department’s (ED) bottom line. One step EDs can take to ensure more year-end revenue and throughout the rest of 2020 is to have a reliable strategy for dealing with high patient volumes that takes into consideration clinical documentation accuracy.

“Documentation is one of the most crucial places EDs need to review when it comes to finding ways to maximize reimbursement dollars,” says Crystal Justice, MEDHOST Director of Clinical Strategy. “The challenge is that as time goes on coding systems become more specific.”

Justice adds that an EDs inability to add the level of specificity required by payers and regulatory bodies can lead to:

  • Billing errors
  • Denials
  • Payor down coding
  • Lost revenue

Almost three-quarters (72%) of healthcare leaders surveyed felt that clinical documentation and coding were key areas of weakness for lost or decreased revenue according to BESLER and HIMSS Media. To avoid lost revenues due to coding errors, EDs need a comprehensive view of patient data across the entire patient journey. Armed with precision search engine tools, this improved patient perspective can help them pinpoint relevant diagnostic codes.

Changing Clinical Codes

Not long ago, if you were asked to pick up a gallon of milk your choices were pretty straight forward. The chances of grabbing the wrong type of milk were minimal. Those days are gone.

Almond, soy, coconut, rice, hemp—navigating  modern-day milk needs a guidebook.

Healthcare clinical and diagnosis codes have also evolved. For example, between ICD-9 and ICD-10, 55,000 codes have been created. Roller skater run over your foot? There’s a code for that. Burnt by flaming water skis? There’s a code for that. Struck by a duck? You guessed it, there’s a code for that. While code granularity is good for healthcare, it can also lead to coding or billing errors.

Errors in coding can hurt hospitals in a variety of ways, but mostly in their bottom line. In 2018 hospitals nationwide lost $2,758 million due to incorrect coding, reported U.S. Department of Health & Human Services. Underpaid or denied claims not only result in lost revenues, but also create hours of additional work for hospital business offices.

As payment models continue to evolve, hospitals that want to cut waste and reduce lost revenues will need evolved clinician documentation tools and more comprehensive solutions.

Accurate Patient Data from Start to Finish

While search engines like Google have made finding and recording data among an ocean of content simpler, healthcare has evolved to need a similar tool.  For example, Health Language Incorporated (HLI) developed a diagnosis code “search engine” that can help hospitals more accurately identify, record, and update patient clinical documentation.

HLI’s clinical search and documentation platform can be integrated across the MEDHOST emergency department information system (EDIS) and enterprise electronic health record (EHR) systems. A cross-system integration, HLI improves visibility into patient diagnosis information and helps narrow search criteria. Armed with the patient’s full medical history and a current medical coding database, clinicians can pinpoint relevant diagnosis codes.

Improvements to clinical documentation can also help facilities reduce payer downcoding—a practice that sees payers lowering reimbursements, citing poor or inaccurate documentation as their justification.

For example, a patient who has a fracture in his or her back is not simply exhibiting “lower back pain.” Based on past and current diagnoses, clinicians can use the HLI integration to add detail to patient documentation. Instead of lower back pain, this patient is diagnosed with an unstable burst fracture of the fourth thoracic vertebra sequela — a very specific and more detailed diagnosis.

Documentation to Support Your ED Care Quality

Coding errors are an unnecessary liability for healthcare providers from both financial and patient safety perspectives. In addition to downcoding that can harm an ED’s service levels, documentation errors can also lead to mistakes in patient care. In some instances documentation errors can have severe consequences, so much so that they fall under their own ICD-10 code range.

When ED patient volume is high, focusing on accurate documentation can help reduce errors.  Precision clinical diagnosis and medical coding software through MEDHOST can help providers:

  • Maintain compliance with regulatory bodies like Centers for Medicare and Medicaid (CMS)
  • Avoid denials and re-billing
  • Ensure full reimbursements
  • And continue to offer patients top-grade service

Find out how MEDHOST can help your hospital get paid in full with more consistency. Call us at 1.800.383.6278.


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