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Midway Health System Marion, Ohio Sharon Brown

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Page 1: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Midway Health SystemMarion, Ohio

Sharon Brown

Page 2: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Revenue Cycle Management

Team Members

Chase Beekman

Sharon Brown

Brittany Edwards

Sharon Goin

Sharon Brown

Page 3: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Our Mission…

Midway Health System’s mission is to provide comprehensive coding quality for

productivity improvement, while providing superior patient satisfaction. Our coding

process evaluates and identifies areas where improvements are needed.

We strive to obtain timely and accurate reimbursement for our customers in lieu of

services provided. This is accomplished by practicing the highest level of integrity,

compliance and ethical standards. We use up to date resources within our facility for

ongoing staff development, the enhancement of the medical revenue cycle

management, and optimal reimbursement.

Sharon Brown

Page 4: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Our Vision…

The Health Information Management Department of Midway

Health System will strive to deliver correct and complete coding

for all medical records and assist in improving the outstanding

quality care to all patients. 

Sharon Brown

Page 5: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Main Functions

• Admitting, patient access management• Case management• Charge capture• Health information management• Patient financial services, business office• Finance• Compliance• Information technology

Sharon Brown

Page 6: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Revenue Cycle Indicators to Analyze

• Value and volume of discharged, not final billed encounters

• Number of accounts receivable days• Number of bill-hold days• Percentage and amount of write-offs• Percentage of clean claims• Percentage of claims returned to

provider• Percentage of denials

• Percentage of accounts-missing documents

• Number of query forms• Percentage of late charges• Percentage of accurate registrations• Percentage of point-of-service

collections for elective procedures• Percentage of increased DRG

payments due to improved documentation and coding

Sharon Brown

Page 7: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Coding Compliance Plan

• Code of conduct• Policies and procedures• Education and training• Communication• Auditing• Corrective action• Reporting

Sharon Brown

Page 8: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Customers

External Customers-end users of our service that work outside of the facility. • Patients• Physicians• Third-party payers

Internal Customers-those individuals or departments within the organization to whom we provide a service• Employees• Administration• Registries

Sharon Brown

Page 9: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Purposes of AHIMA’s Code of Ethics

• Promotes high standards of HIM practice.• Identifies core values on which the HIM mission is based.• Summarizes broad ethical principles that reflect the profession's core values.• Establishes a set of ethical principles to be used to guide decision-making and actions.• Establishes a framework for professional behavior and responsibilities when professional

obligations conflict or ethical uncertainties arise.• Provides ethical principles by which the general public can hold the HIM professional

accountable.• Mentors practitioners new to the field to HIM's mission, values, and ethical principles.

Sharon Brown

Page 10: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Summary of Audit

Sharon Brown

Page 11: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Criteria Used for Audit

• MRN number• Date of service• Type of encounter• ICD-9 diagnoses codes• ICD-9 procedure codes• CPT-4 procedure codes

1 = correct

0 = incorrect

Sharon Brown

Page 12: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Sample of Audit Results

Sharon Brown

Page 13: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

ICD-9 Diagnoses Codes (182 Codes)

79%

21%

Total Correct ICD-9 Codes (144)

Total Incorrect ICD-9 Codes (38)

Sharon Brown

Page 14: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

ICD-9 Procedure Codes (18 Codes)

83%

17%

Total Correct Codes (15)

Total Incorrect Codes (3)

Sharon Brown

Page 15: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

CPT-4 Codes (127 Codes)

75%

25%

Total Correct CPT-4 Codes (95)

Total Incorrect CPT-4 Codes (32)

Sharon Brown

Page 16: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

E/M Codes (78 Codes)

69%

26%

5%

CPT-4 E/M Correct Codes 54

CPT-4 E/M Incorrect Codes 20

Missing Dates 4

Sharon Brown

Page 17: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Pathology Codes (44 Codes)

ICD-9 Diagnoses Codes Correct

ICD-9 Diagnoses Codes Incorrect

ICD-9 Procedure Codes Correct

ICD-9 Procedure codes Incorrect

CPT-4 Codes Correct CPT-4 Codes Incorrect0

2

4

6

8

10

12

14

16

18

2019

4

0

1

15

5

Sharon Brown

Page 18: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Procedure (Surgery) Codes (46 Codes)

ICD-9 Diagnoses Codes Correct

ICD-9 Diagnoses Codes Incorrect

ICD-9 Procedure Codes Correct

ICD-9 Procedure codes Incorrect

CPT-4 Codes Correct CPT-4 Codes Incorrect0

2

4

6

8

10

12

14

16

15

6

14

1

7

3

Sharon Brown

Page 19: Midway Health System Marion, Ohio Sharon Brown. Revenue Cycle Management Team Members Chase Beekman Sharon Brown Brittany Edwards Sharon Goin Sharon Brown

Radiology Codes (25 Codes)

ICD-9 Diagnoses Codes Correct

ICD-9 Diagnoses Codes Incorrect

ICD-9 Procedure Codes Correct

ICD-9 Procedure codes Incorrect

CPT-4 Codes Correct CPT-4 Codes Incorrect0

1

2

3

4

5

6

7

8

9

6 6

1

0

8

4

Sharon Brown