Coder Accuracy, Collaboration Vital to Value-Based Payment Success

Coder accuracy in ICD-10 may suffer if the focus is on productivity—and poor accuracy will hit hospitals’ revenue streams hard under value-based purchasing programs, experts at AHIMA’s 2016 convention agreed.

In September, Central Learning, a Pennsylvania-based online coder knowledge assessment and audit service, conducted a nationwide coding accuracy and productivity contest. Participants were asked to code 10 inpatient, 30 ambulatory, and 30 emergency department cases, and were advised that a winner would be chosen based on accuracy of coding. The results of the contest were announced by Central Learning CEO Manny Peña, RHIA, during the opening session of AHIMA October 16. The results drew a negative relationship between productivity and accuracy, Peña said. Participants with high productivity levels, compared to benchmarks set in ICD-9-CM, consistently scored lower in accuracy. Overall accuracy scores were low. The average inpatient coder accuracy was 55% but ambulatory coder accuracy was 46% and emergency department coder accuracy was only 33%.

But coder accuracy across settings will only become more important as CMS moves to primarily value-based purchased over the next year and continues to push out mandatory value-based bundled payment models such as the Comprehensive Care for Joint Replacement model (CJR). Accurate coding is key to succeeding under payment models such the CJR, Elaine O’Bleness, MBA, RHIA, CDIP, CHP, CRCR,  and Kim Fuller, MSW, MBA, CRCR, revenue cycle executives at Cerner Corp., said at an October 17 session. CMS’ new payment programs increasingly tie revenue to quality and hospitals must be ready to respond by increasingly collaboration between CDI specialists, who often focus more on quality measurements, and coders, who may be instructed to code to the highest compliant diagnosis-related group (DRG). Coders will need to be particularly careful, as inaccurate code assignment could incorrectly trigger a patient to be included in a program like CJR. HIM and case management are ideally placed to oversee this integration of quality and finances, O’Bleness and Fuller said.