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Lessons Learned Following Pathways Claims Validation

Robin Acino MPH, Julie Mason RVT, Todd Russell MD, Fedor Lurie MD PhD, Babatunde Oriowo, MD Jobst Vascular Institute ProMedica Health System Toledo, Ohio. Lessons Learned Following Pathways Claims Validation. Problem. 2017 Procedure Claims Validation

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Lessons Learned Following Pathways Claims Validation

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  1. Robin Acino MPH, Julie Mason RVT, Todd Russell MD, Fedor Lurie MD PhD, Babatunde Oriowo, MD Jobst Vascular Institute ProMedica Health System Toledo, Ohio Lessons Learned Following Pathways Claims Validation

  2. Problem • 2017 Procedure Claims Validation • 12.5% of VQI cases submitted improperly coded • CEA’s coded as percutaneous intervention • CEA’s coding referencing only common carotid artery • Peripheral Vascular Interventions coded as coronary arteries • Bypasses coded with wrong arteries involved • Open AAA’s billed at EVAR’s • Standard EVAR’s billed as fenestrated graft

  3. Goal • Review the results of the claims audit to identify: • Accuracy of coding • Impact to the organization • Opportunities for improvement • Action plan to address deficiencies • Continued QI project plan

  4. Results 2017 cases reviewed 6 DRG cases were incorrect Net Impact: $23,622

  5. Improvement Strategies • Collaborative approach to education • Health Information Management (HIM) team & billing/code staff assigned education from American Health Information Management Association (AHIMA) • HIM team reviewed/updated “auto-suggest” indicators for key procedures • 100% SMART review for all CEA and AAA repairs for 2019

  6. Improvement Strategies • Jobst Vascular Institute staff provided onsite lecture featuring anatomy and Q&A to 40 HIM staff

  7. Improvement Strategies • Physician Documentation • Feedback on errors • Challenges with learners • Goal to optimize EPIC

  8. Challenges & Lessons Learned • Challenges & Lessons Learned • Difficult specialty • Time and resources • System

  9. Success Factors • Success Factors • Collaboration among departments • Data supported need for education & EPIC development • Ongoing monitoring “His diagrams and information was shared in a way that it was very clear he was trying to make sure we not only understood but completely grasped the details of what he was explaining so when we are coding the procedures we comprehend the whole picture and can then accurately code them for billing purposes” “I have to say, this is one of the best education presentations I have received in all my years with ProMedica” “I was so very impressed with the presentation this morning. It was packed full of information and great drawings. Dr. Hariri and Dr. Afridi were both very clear and informative in the knowledge they shared with us.”

  10. Questions?

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