Curing The Uncommon CodeBy David F. Carr | Posted 2003-10-01 Email Print
Re-Thinking HR: What Every CIO Needs to Know About Tomorrow's Workforce REGISTER >
The medical group turns notes into data that can be analyzed and compares results of its infant care facilities.
Curing The Uncommon Code
The system is having a bottom-line impact as well, thanks to the addition of a Visual Basic application called the Decision Tree, which uses data from the clinical record to suggest the standard insurance code to apply for each day of care. That's significant because disputes with insurers often revolve around the difference between codes for "evaluation and monitoring" and for "critical" care; the latter is reimbursed at a higher rate.
When Pediatrix's coding practices were scrutinized during a series of state investigations starting in 1999, jittery physicians became so much more conservative about using the "critical" codes that by the end of the year, revenues from comparable operations were down 5.3% despite an increase in services provided. Those investigations ultimately were resolved with minimal settlements, but after Pediatrix disclosed in June that it might face a similar review by the U.S. Attorney's office, stock analysts worried the phenomenon of shrinking revenues would recur. It didn't, largely because of the new software.
Programmers worked with physicians to identify circumstances that clearly justify a "critical" code and those that do not. By removing subjectivity from the process, Pediatrix wants to prove that its bills are appropriate, "neither going beyond what we should or under what we shouldjust what is right," Bryant says.
As Pediatrix founder and CEO Roger Medel noted in a recent earnings conference call, "Physicians are a lot more comfortable booking what the medical record recommends."