June 2018 | Volume 23 | No. 3
AHIMA 2018 BALLOT PG 8 | AHIMA 90 TH ANNIVERSARY PG 11 | UNTRADITIONAL JOB SEARCH PG 12
Help Drive a Robust
Accurate and complete coding has never been more critical as government and
commercial payers pilot value-based payment models. Thanks to an evolving
array of inpatient models like the Hospital Value-Based Purchasing (VBP)
Program as well as new payment systems in outpatient and post-acute settings,
HIM professionals are uncovering more opportunities to demonstrate how they
can help improve their organization’s clinical and quality metrics and strengthen
the revenue cycle across the continuum.
Moving from Transactional to Relational Coding
Although precise coding has always been important for reimbursement and data
collection, the emergence of value-based payment has fueled an even greater,
global need for accurate and complete data, says Daniel Land, RHIA, CCS,
director of revenue integrity and compliance review services, MedPartners,
Tampa, FL. As a result, the nature of coding has changed from having a primary
focus on the transactional nature of reimbursement to having a broader, relational
scope that considers the interrelated use of coded data by multiple stakeholders.
“HIM professionals are guardians of the patient’s story, and coded
data must accurately paint the clinical picture of a patient at any
given point in time,” says Land, who also co-chairs AHIMA’s
Clinical Terminology and Classification (CTC) Practice Council.
Telling that patient’s story with coded data can be difficult for
coding professionals who are navigating the dynamic relationship
between ICD- 10 and quality measures, and trying to understand
the potential impact on payment.
For example, the Centers for Medicare and Medicaid Services’
(CMS) risk adjustment model includes nearly 80 hierarchical
condition categories (HCCs), which certain Medicare plans require for
reimbursement. With HCCs, coding to the highest level of specificity possible
based on provider documentation is essential, whereas using coding shortcuts
could inadvertently omit an important code, Land says. This could lead to an
inaccurate portrayal of the patient’s severity of illness, an incorrect payment, or
both. (To assist coding professionals, AHIMA will release a practice brief on this
topic in the June Journal of AHIMA.)
Inaccurately coded data may also negatively influence consumer perception.
For example, the online consumer tool Healthgrades uses Medicare inpatient
data from the Medicare Provider Analysis and Review (MedPAR) database
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