1. Differing HIM Processes in Military and Civilian Health Care Facilities HCMT 2030 Michele Sutherland Fall 2015

2. Section I Introduction: General History and Overview of Navy Hospital Pensacola, Pensacola, FL. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

5. Section II Differing Focuses of Reimbursement Between Military Health Care Facilities and Civilian Facilities

6. Although the focus of healthcare delivery in both settings is to have the best outcome possible, there are pronounced differences in the area of reimbursement Military  The most significant difference in reimbursement is that in the military, there are no DRGs, and there are no RACs. In this case, it is one area of the government funding another area. Therefore, the pressure of fixed dollar amounts and concern of government funding audits is removed.  Providers are referred to as MC, or Medical Corpsman, and Nursing Corpsman Civilian  Particularly in cases of the elderly utilizing Medicare, and the uninsured utilizing Medicaid, fixed payment amounts are common place. Additionally, there is the added pressure that with an audit, a RAC may attempt to re- coup funds that had been previously paid for a case.  Providers are referred to as MD, or Medical Doctor, and RN, or Registered Nurse

7. Section III Comparisons in Coding

8. Coding: Vast differences between the two for utilization Military  D.O.D. policy takes precedence over CPT/ICD guidelines  Utilized primarily for statistical purposes  Impacts value unit based system  There is a specific code for convalescence (as opposed to observation) utilized specifically by military; and a new record must be created exclusively for this Civilian  Utilized primarily for reimbursement  Impacts direct payment to facility  Admittance for observation is included into patient encounter and billed along with other procedures during encounter  CCHMC allows for remote coding (as do many civilian facilities), and utilizes Sharepoint for this. NHP is significantly smaller, and only houses office based coding positions

9. Additional Coding Specifications Exclusive to Military  Extenders are utilized based on type of physical examination and the occurrence thereof  Additionally physicals may be repeated several times depending on nature of post/job title  Diagnostic coding must be critically observed with assignment (especially when coding depression as this can negatively impact and enlisted’s post/job assignment)

10. Section IV: Case Management Differences and Similarities Between Military and Civilian Health Care Facilities

11. Case Management Similarities

12. Differences in Case Management for Military vs. Civilian Health Care Facilities Where the differences begin is the nature of the diagnosis. If the diagnosis is stress/mental health, again, it is imperative that a case manger handle the case in question with sensitivity as it can detrimentally impact the post/job assignment. Additionally, the case manager must take into consideration special impacts if the enlisted is living in barracks as they may not have an adequate support group to care for them post discharge; the case manager would need to accommodate for this. Just as in the civilian world, case management is handled by nursing.

13. Section V: Quality Parallels of Quality Directives

14. Although most areas of quality initiatives hold similarities, there are some that differ between the two Military  H+P required for documentation with in 24 hrs. of admission  *If military corpsman is non- compliant usually penalties/discipline will not follow  Dictated documentation may take up to 30 days to be appended to a record  Military administration decisions come from BUMED (Bureau of Medicine and Surgery) Civilian  H+P required for documentation with in 24 hrs. of admission  *If physician is non-compliant financial penalties could follow  Documentation is generally expected the day following a procedure for dictated information  Civilian facility administration decision comes from individual boards exclusive to the facility

15. Additional comparisons:  Again, with military, the looming RAC is non- existent, however, there are monthly and annual internal audits  Per Joint Commission; Accreditation Participation Requirements (APR) covers the following areas of both mil. and civ. *Coding *Record Review *History and Physical *Surgical Master Notes *Clinical Records *Legally Documented Notations *Physician Progress Notes

16. Section VI: Record Analysis Similarities in Processes between Military and Civilian Processes

17. Parallel processes in record analysis Military  Records are reviewed by specific individuals as outpatient (APVs), and inpatient  APVs can included same day surgeries and colonoscopies  Deficiency sheet is filled out if part of record is found missing  Military systems are Essentris, CHCS and ALTA Civilian  Records are reviewed by records analyst; CCHMC has 3 individuals working simultaneously as inpatient review, outpatient review and deficiency review  Civilian record systems are often EPIC and /or Chartmaxx

18. Section VII: Risks of Project Unavoidable Risks of PPE

19. Risks of PPE in a Military Health Care Facility  Various individuals that I was able to shadow had a knowledge base of their job functions exclusive to the military  Per military security, I was never able to gain access to areas such as birth/death certificates, and was never able to gain system access  Statistical data was not utilized in traditional fashion as benchmarking between military facilities is non-existent

20. References Project Resources and References

21. Naval Hospital Pensacola Navy Base in Pensacola, FL | MilitaryBases.com. (n.d.). Retrieved November 22, 2015, from http://militarybases.com/naval-hospital-pensacola-navy-base-in-pensacola-fl/ (2015). Retrieved November 22, 2015, from http://health.usnews.com/best-hospitals/area/fl/naval-hospital-pensacola-6390840 Naval Hospital Pensacola | Pensacola News Journal. (2015). Retrieved November 22, 2015, from http://archive.pnj.com/videonetwork/3822400314001/Naval-Hospital-Pensacola Navy Hospital Pensacola, FL. Logo. (2015). Retrieved November 22, 2015, from https://sp.yimg.com/ib/th?id=OIP.Me7a3763c7b2167c37cac204e6662e398o0&pid=15 Cincinnati Children's Hospital Medical Center. (2014, June 11). Retrieved November 22, 2015, from https://en.wikipedia.org/wiki/Cincinnati_Children's_Hospital_Medical_Center Research Leads to Auditory Discovery. (2012, September 30). Retrieved November 22, 2015, from http://www.newsrecord.org/news/campus/article_231355d8-0b48-11e2-813e- 0019bb30f31a.html?mode=image&photo=0http://www.newsrecord.org/news/campus/article_231355d8-0b48-11e2-813e- 0019bb30f31a.html?mode=image&photo=0

22. Project Resources and References Kolwyck, CPC, CPMA, S. (2015, September 1). Shadowing in Compliance Auditing [Personal interview]. Swab, RHIA, A. (2015, October 1). Processes in HIM [Personal interview]. Salchi, RHIA, K. (2015, October 1). CCHMC observation [Personal interview]. Robbins, RHIA, R. (2015, October 1). CCHMC observation [Personal interview]. Leasure, RN, J. (2015, October 1). Case management [Personal interview]. Bestor, RN, C. (2015, October 1). Case management [Personal interview].