1. Paving the Way to Single Path Coding
Carolinas HealthCare System
Ann Hubbuch, JD, RHIA

2. Carolinas Healthcare System
CHS
WHO WE ARE

3. WHO CHS IS
Carolinas HealthCare System, operating as a fully integrated system, connects and transforms care delivery throughout the Carolinas. Our overarching goal is to provide seamless access to coordinated, high quality healthcare – and provide that care closer to where patients live.
39 hospitals and 950 care locations in North Carolina and South Carolina, including one hospital in Georgia
Nearly 7,400 licensed beds
More than 12.5 million patient encounters in 2015
3,100+ System-employed physicians and ACPs; 15,000+ nurses; approximately 62,000 employees
Primary Care at more than 200 locations
More than $8.5 billion in annual revenue in 2015
The region’s only Level I trauma center
One of only five academic medical centers in North Carolina

4. WHERE WE ARE

5. Our Path to Single Path In 2014 a lot started happening:
Decision to migrate to ONE Revenue Cycle System (EPIC) from current disparate systems (IDX profee and McKesson STAR facility). Staying on Cerner clinicals.
Facility coding team centralized to ONE corporate center and
the Professional Coding Team began centralizing to ONE team
in same building together. Coincidence or fate?
ICD-10 readiness illustrated the need for ONE message to providers

6. Medical Group Operations
Who We Are
Health System CEO
Medical Group Operations
Professional coding
120+ coders
Information Services
Facility Coding
160+ coders
Laurie
Ann

7. What we found
WE WERE BOTH CODING I-10 CM AND CPT ON THE SAME CASES such as :
Cardiac Cath Lab
Vascular Lab
Sleep Lab
GI Lab
Wound Care
Outpatient Surgery

9. Serving Two Masters Professional Facility
However, Facility and Professional coding conventions have differences :
Professional
Code for each encounter-each note stands alone
Symptom-Chief complaint
Do not code rule out or suspected
Global surgical bundling
Facility
Code from entire chart
Probable
Rule Out/suspected
APC’s

10. What can we do now? Identify the Barriers and Silos

11. Focus on the Similarities
Provider Based Clinics
Heart Caths
Endoscopy
Wound Care
Outpatient Surgery
Sleep Medicine
Facility
Professional

12. The Worlds Are Intersecting (Or Colliding)
Why is MACRA important for what we are doing now?
It is forcing alignment between facility and physicians/providers
Focusing on comprehensive view of patient as opposed to the coding for “payment of least resistance”.
HCCs are blurring the lines
Professional coding now “in the game” for chronic conditions as well as reason for visit vs one dx to pass medical necessity
Medicare transmittal 540
Providers will begin to be impacted by what happens on the facility claim-they have to care $$

13. Our First Single Path Adventure
Cardiac Cath Labs

17. VSM Event Post proposed workflow
Cath lab enters supply charges only
Acute Coder assigns dx and cpt in 3M 360 / HDM edits
Finalizes to Star
Profee biller accepts Acute codes, keys into IDX and addresses any unique Profee characteristics.

18. Someday

20. Sounded Easy…..
So in interim:
Acute Coder reviews CPT accuracy assigned via charge entry process, correcting via CDM charge correction as needed, uses 3M 360 to code and edit.
Profee coders not coding from superbill any more. Get procedure list and code into IDX after accessing online op notes. Still book coding. Baby steps.
Run a report each week to assure no mismatches between two.
Teaming up with CAC/encoder vendor
Since charges and cpt attached to charge code, CDM and Star could not match back charges to a soft coded cpt. Debated for months. Cath lab lives by RVU’s and established reporting.
Due to rigidity of Star, decided to wait for EPIC go lives which is more friendly
I 10 was about to happen

21. Our Next Single Path Adventure
Provider Based Clinics

23. Provider Based Practices And Single Path Coding
Current State
Numerous touch points
Emphasis is on timeliness of charge entry rather than coding accuracy
Entry level staff members entering in 2 separate systems based on what is circled on encounter forms (process not changed in 20 years)
No ability to reconcile the 2 systems
What are we missing?
Facility
Edits and denials go to 3 different teams to be worked
Hospital billing office
Charge master
HIM coding team
All edits are pushed to back end
Professional
Edits and denials worked by entry level staff
Working from paper

24. Single Path Coding Options for PBB
Questions we are working through
Meaningful Use, CPOE and the conflicts that arise
Who should manage oversite of the work
HIM
Professional charge capture team
Shared governance?
Currently coders don’t know both sides
Who is most adaptable
Serving two masters-Pro and Facility Revenue How do you ensure that the interests of all are maintained
Still working on solutions…

25. What We Have Manual Charge Entry Muse Endoscopy NucVu Preventis
Provation
NucVu
Preventis
AS-OB
ARIA
Cerner
Virtual care
Wound Care
IHeal
STAR
Neo Data
Polaris
MedCon
CPOE
EPIC
Heart Caths
Merge
Somnoware

26. What we want Infrastructure and Technology
3M Listening-
Go To 60 Encompass Pro Session
Feeder Systems
Multiple
EPIC
One
Magic
1500
Cerner Clinical
EMR
3M encoder/
CAC (s) UB
2:1
1:2

27. The Road Ahead The Challenges That Await
Is Your Organization Ready?
Understand the importance of collaboration
Realize there is plenty of work to go around
Are Your Coder’s Ready?
New breed of coders needed
Most coders have a focused knowledge base on one side or the other
Make a Plan to develop them
Are The Payers Ready?
More work on the back end?
Develop a plan to monitor and be prepared to act quickly
Are The Systems Ready?
Partner with your current systems and look to partner with new ones