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Debbie Abbott Resolution Int Pty Ltd - Case Study: Auditing for the Future - What Can We Learn?

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Information about Debbie Abbott Resolution Int Pty Ltd - Case Study: Auditing for the...
Health & Medicine

Published on February 24, 2014

Author: informaoz

Source: slideshare.net

Description

Debbie Abbott, Health Information Consultant & Director, Resolutions(Int) Pty Ltd presented this at the 5th Annual Clinical Documentation, Coding and Analysis Conference. This event is the only case study led conference in Australia looking solely at clinical documentation, coding and analysis.

For more information, please visit http://www.healthcareconferences.com.au/clinicaldocs
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Debbie Abbott Resolutions (Int) Pty Ltd

 Why Audit? ◦ Compliance ◦ Quality ◦ Revenue

AUDIT TYPE •Amount •Size •type

ABF Trim points •Diabetic ulcer

SEPSIS

  ENDOSCOPY CODING Gastroscopy and Colonoscopy ◦ ◦ ◦ ◦ ◦ DOCUMENTATION PROCESS FOR CODING REFERRAL WRITTEN PROCESS DRG CHANGE

Coding standards

DATA ITEMS

•Cosmetic vs medical •Type C •Type changes •Underfunded

ORTHOPAEDICS MEDICAL NECESSITY CARDIAC SURGERY

PROCESSES

Internal audit PROCESSES

Education Documentation Auditing

EDUCATION Abstraction skills

TESTING •KPIs •Speed •Accuracy

CODING • Guidelines • Documentation • Coding clinics

FRAUD  Health insurance  Family  Edits  Records  HIPAA

TOOLS • ENCODER • PLUG IN HOSPITAL REIMBURSEMENT • WAGE INDEX • DOCUMENTATION GUIDELINES • SPREADSHEET

BILLS • Codes • Eg. Chest x-ray • System issues • Wrong order

Billing Documentation

•SPECIALTIES •BUNDLING •OVERSERVICING

TRENDS •Aust •US •What

•DRG CHANGE •Results •benchmark

Benefits Issues Revenue Compliance Quality 

DOCUMENTATION FOLLOW UP Treatment

• 450 records ($700,000) • 200 records ($250,000) • 50 records ($28,000)

      Consideration of your auditing role Documentation, documentation Education – how do we address levels? Selection of new coders Trends Coding audit outcomes – do we learn??

Contact Information: • Debbie Abbott Debbie@resolutionsint.com Phone: 61 413 018775 61 7 3849 6885 http://www.resolutionsint.com

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