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Why is it important that the MRN connect the patient documentation to the services provided? Answer: Who should assign patient type to the patient?

Coding is a critical component of the Health Information Management Department and coders play an important role in the Revenue Cycle Management process.

"Revenue cycle management (RCM) is the process of managing claims, payment and revenue generation. RCM encompasses everything from determining patient insurance eligibility and collecting co-pays to properly coding claims. A well-designed RCM system is able to communicate with the EHR and accounting systems to streamline the billing and collection cycles." (HealthIT, 2015)

This activity will introduce you to RCM and the role coders play in this function.

Be sure to read the article from your assigned readings.

  • Coding Connections in Revenue Cycle Management by Ruth Cummins, RHIA, CCS and Julie Waddell
Why is it important that the MRN connect the patient documentation to the services provided? Answer: Who should assign patient type to the patient? Answer: Explain why coding staf should have access to source documentation. Answer: Why is it a good idea to have Front-line staf and coding staf working together? Answer: Can the revenue cycle process be afected by coding staf? Can you give a reason? Answer: In the hospital setting how are routine diagnostic services such as lab and radiology services charged to the patient? Answer: How do they determine which codes belong in the charge master and not coded by a coder? Answer: Why should concurrent clinical documentation management programs and query processes by implemented? List 2 reasons coding quality and productivity standards should be established: Answer: Why do revenue integrity teams need coding proFessionals? Answer: What are the 2 key revenue cycle components that occur in patient ±nancial services? Answer: Why is it important For HIM to have an efective DN²B Reporting tool? Answer: What Function do coders perForm that helps to reduce the number oF medical necessity denials? Answer: What are OCE and CCI Edits? Answer:
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Coding Connections in Revenue Cycle Management by Ruth Cummins, RHIA, CCS, and Julie Waddell Recently, there has been a significant amount of talk in the healthcare industry about revenue cycle improvement. So what is all of the excitement about? It is about the bottom line. Specifically, how we can improve our bottom line through more effective and efficient revenue cycle management. For hospitals to maintain financial viability under the pressures of the current healthcare environment, the revenue cycle must be a significant focal point, and HIM and coding professionals should play major roles in the process. This article will highlight many of the coding connections for the key revenue cycle processes within patient access, HIM, and patient financial services. The Coding Connection in Patient Access Services Critical revenue cycle processes that occur in the patient access department include initial data collection (e.g., name, date of birth, insurance information, reason for admission, patient type); medical record number (MRN) assignment; and medical necessity determination. Coding connects (or needs to connect) with patient access services in the following areas: MRN, patient type, source documentation, and medical necessity. The MRN is vital in connecting the patient documentation to the services provided to the patient. If an inaccurate MRN is used, complete and historical clinical information may not be available, resulting in potentially incomplete or inaccurate code assignment. Regular communication and collaboration between HIM and patient access to maintain accurate MRN assignment is imperative. The patient access department, in many facilities, is responsible for assigning the patient type (e.g., inpatient versus observation patient). It is very frustrating for the coding staff to have to alter a patient type post-service due to inappropriate assignment. This correction process slows down the revenue cycle. The coding staff should collaborate with patient access in identifying ways to resolve inaccurate patient type assignments. During the scheduling and patient registration process, test order documentation, including reason for the test, should be presented. Source documentation is critical for the final code assignment. Coding professionals should be involved in educating front-line personnel (i.e., those registering patients) regarding appropriate test order requirements. The coding staff should also have access to the source documentation when coding to ensure complete, accurate, and consistent coding.
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Hospitals and healthcare providers must determine if services will be covered based on the reason for the test prior to services being rendered. In most healthcare organizations, this is left to the front-line staff in patient access. Often, these individuals are in entry-level positions with little or no healthcare background. Connecting the patient access department with coding professionals is critical in complying with medical necessity requirements and reducing the risk of denials on the back end. Although it is not always feasible to employ a coding professional in patient access, healthcare providers should consider creating a coding liaison position to assist patient access in determining medical necessity and following up with physicians on proper test orders. Coding orientation courses should be provided as a requisite for patient access staff as well. The revenue cycle can be dramatically affected by connecting coding to the patient access process. Documentation, HIM, Coding, and Chargemaster Services Key focal points in documentation, HIM, coding, and chargemaster services that affect revenue cycle performance include who assigns the codes; source documentation; coding quality and productivity; and revenue integrity. Healthcare providers must determine where CPT and HCPCS codes will originate, or “who codes for what.” Information system requirements should be considered when determining whether a code will be generated with a charge (i.e., hard-coded in the chargemaster) or whether the code will be assigned by coding staff based on source documentation. Typically, routine diagnostic services such as lab and radiology are hard-coded in the chargemaster while surgical interventions are normally assigned by a coder. Lack of coordination between coding and chargemaster staff can cause conflicts, duplicative coding, and billing errors. When determining whether a code belongs in the chargemaster or if it should be coded by a coder, ask yourself the following questions: “Is the code always the same for the procedure or service provided?” If yes, then the code likely belongs in the chargemaster. “Is coding assignment variable, contingent upon site, method, or complication?” If yes, then the code should be assigned by a coder. “Are there variables inherent in the documentation that would modify the code?” If yes, then the code should be assigned by a coder. Equally important as who codes for what is the source documentation a coder uses to assign the appropriate ICD-9-CM and CPT or HCPCS code. As we all know, if it was not documented, it was not done. Whether the code is hard-coded in the chargemaster or is assigned by a coder, the source documentation must paint a clear picture of the clinical condition of the patient and the services provided. Often clinicians will witness services being provided; however, final dictation or documentation may omit specifics, which allow additional codes or charges to be added. Coding plays a critical role in validating source documentation for coding and billing purposes. Concurrent clinical documentation management programs and query processes should be implemented to ensure physician documentation appropriately reflects the clinical picture of the
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