Curing The Uncommon Code

By David F. Carr  |  Posted 2003-10-01 Print this article Print

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 should—just 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."

David F. Carr David F. Carr is the Technology Editor for Baseline Magazine, a Ziff Davis publication focused on information technology and its management, with an emphasis on measurable, bottom-line results. He wrote two of Baseline's cover stories focused on the role of technology in disaster recovery, one focused on the response to the tsunami in Indonesia and another on the City of New Orleans after Hurricane Katrina.David has been the author or co-author of many Baseline Case Dissections on corporate technology successes and failures (such as the role of Kmart's inept supply chain implementation in its decline versus Wal-Mart or the successful use of technology to create new market opportunities for office furniture maker Herman Miller). He has also written about the FAA's halting attempts to modernize air traffic control, and in 2003 he traveled to Sierra Leone and Liberia to report on the role of technology in United Nations peacekeeping.David joined Baseline prior to the launch of the magazine in 2001 and helped define popular elements of the magazine such as Gotcha!, which offers cautionary tales about technology pitfalls and how to avoid them.

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