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MRA Thought of the Day-Expanding Coding Horizons: Three Healthcare Initiatives to Watch

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Luisa Dileso, RHIA, MS, CCS, Director of Coding Education

Luisa Dileso, RHIA, MS, CCS, Director of Coding Education

Clinical coders are often sequestered within health information management (HIM) and incented to only code…not expand their horizons by keeping abreast of nationwide healthcare initiatives. But is this the best management approach?

Situation:
Several coders were breaking for lunch and an important conversation ensued. The coders began discussing future health care initiatives, challenges impacting the coding profession, and how difficult it was to keep up-to-date.

Collectively the coders identified three key initiatives to watch, and web sites that they visited and reviewed periodically. These are valuable information sites. They provide useful information and perspective above and beyond the routine coding references.

My Thoughts:
Of course! We encourage all coders to keep abreast of national healthcare changes. Knowledge is power. Here is a list of alternative websites for clinical coders. Please share!

CMS – Accountable Care Organizations (ACOs)

http://innovations.cms.gov/initiatives/aco/pioneer/

http://innovations.cms.gov/Files/fact-sheet/Pioneer-ACO-General-Fact-Sheet.pdf

The CMS web site provides an overview of ACOs. Accountable Care is a new payment model that uses diagnostic codes in addition to other data elements. There are over 80 ACOs already in place.

Federal Register – Prospective Payment Final Rules (example FY2013 IPPS Final Rule)

http://www.ofr.gov/OFRUpload/OFRData/2012-19079_PI.pdf

Should coders read the entire Final Rule? Yes, ideally every year but at the very least once in their coding life time.

The final rule outlines MS-DRG structure, yearly changes, new codes and more. The rule also provides information on potential future changes, quality data initiatives, HAC considerations, and categories of clinical documentation concerns.

Medical Necessity

http://www.trailblazerhealth.com/ ( Trailblazer)

https://endeavor-am.noridianmedicare.com/ (Noridian)

In addition to local carrier web sites, it is helpful for coders to periodically review other national web sites. These sites provide valuable denial and documentation examples for both inpatient and outpatient coding.

Keeping on top of national healthcare issues lends perspective and context to every coder’s day-to-day job function. In-depth analysis of these websites gives coders a level of detail that can’t always be summarized in overview sessions. And for any insomniacs, the Federal Register can even promote sleep!

What are your thoughts? Do you find these websites helpful or have any others to share?

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