Recovery audit contractor (RAC) activity is picking up, but many healthcare providers are still waiting to see whether their preparations have paid off, according to a January survey of more than 400 healthcare providers conducted by MRB. Eighteen percent of survey respondents had received medical record requests (i.e., additional documentation requests) as of the time of the survey. Only 8% of providers received RAC denials.
Divisions between HIM and clinical documentation improvement (CDI) staff members are common. But in actuality, everyone needs to work together for the success of the whole. "It's not an us vs. them concept, it's a we concept,"
What is work flow? One of the most common questions I am asked when doing EHR implementation consulting is, "Can you define what work flow is?" I think part of the reason people ask me that question is because of the emphasis I put on the importance of work flow as part of any basic automation initiative. Good work flow support can make the difference between a successful project and one that fails, because it can make or break staffing-level projections due to being designed well (efficient work flow) or poorly (thus the "worry" flow).
Memorial Hermann Healthcare System (MHHS) in Houston includes nine acute care hospitals, one children's hospital, three long-term acute care hospitals, three specialty care hospitals, 21 regional affiliates, a home health agency, a retirement/nursing center, 10 ambulatory surgery centers, 21 imaging centers—and only one HIM department.
Prior to July 1, 2008, however, that was not the case. MHHS' medical records/HIM departments used to be facility- based. Each hospital had its own medical records department, its own coders, and its own vendors. But MHHS' leadership recognized that in an era when cost savings are a must, this model was not as efficient as it could be. A restructuring of the department was in order.
As recovery audit contractors (RAC) begin to roll out complex reviews and request medical record documentation, compliant coding will continue to take center stage. And although correct coding is vital, sequencing codes is equally important because it affects MS-DRG assignment and payment.