University of Pittsburgh Medical Center to deploy system aimed at capturing reimbursement for services
BALTIMORE, MD -- Inaccurate and cumbersome paper-based patient record systems are responsible for sizable financial losses at America's hospitals. Large and small facilities alike are seeking better ways to capture patient documentation in order to get more accurately reimbursed from insurance companies. A new software system launched today at the University of Pittsburgh Medical Center (UPMC) may be just what the doctor ordered to help hospitals improve patient revenue.
The new software system, "Compliance+TM", is the latest offering from the healthcare engineers at Baltimore-based Salar, Inc. (www.Salarinc.com). Salar develops products that improve healthcare quality through secure, paperless transactions and electronic medical records.
Deployment at UPMC
Executives at UPMC have announced they are implementing Compliance+TM in their Medical Procedures Unit (MPU) at UPMC Presbyterian Hospital (http://presbyterian.upmc.com/). Some 60 physicians and nurses will use the system with patients to document care. Initially, Compliance+TM documents will be printed and scanned into the hospital's document imaging and chart completion system. Over time, as Compliance+TM is expanded to additional areas within the hospital, UPMC plans to integrate it with their electronic medical records (EMR) and ancillary systems.
UPMC is the first hospital in the nation to use Compliance+TM after it had been pilot tested. The results of the pilot, conducted at another leading academic medical center, showed an increase of 12 percent in case mix index, a leading determinant for inpatient revenues.
How It Works
Compliance+TM helps build hospital revenue using a patent-pending technology that enables "Remote Concurrent Coding" (RCC). RCC leads to more comprehensive and accurate documentation, which is the key to hospital revenues.
Under the current system, hospitals review patient charts and charges, and submit their claims to Medicare, Medicaid and private insurers for services rendered only after the patient has been discharged. The physician's diagnoses, tests, medications and other services are "coded" by hospital coders based on the data in the chart, and a bill is generated. Once a patient has been discharged the coding is rarely amended.
Coding and billing are highly labor intensive. Hospital coders spend about 20 minutes reviewing and coding each patient chart. More experienced coders will spend approximately one hour on charts that are more complicated and extensive. As a result, if documentation is incomplete, or if tests, medications or other services are not captured from the chart and included in the billing, the hospital suffers the financial loss. Compliance+TM significantly reduces this risk of human oversight with a "remote concurrent coding" system, the first such system ever to be developed for the hospital market.
With Compliance+TM, physicians begin the inpatient process as usual: by starting a patient chart. Rather than writing patient information on standard paper, it is written on "electronic paper." The electronic paper is a tablet personal computer (PC). The tablet PC captures clinical documentation immediately by software that is incorporated into the workflow practices of physicians. Compliance+TM immediately transmits the physician information throughout the hospital system to those individuals who benefit from real-time review, such as the nursing, pharmacy and billing staff.
Building Revenues Through Explicit Documentation, Better Workflow
Hospitals also miss significant opportunities to accurately code and bill because only a general diagnoses may be made at the time of admittance, or the paperwork justifying the diagnosis is incomplete and therefore rejected by the insurer. For example, if a physician writes "pneumonia" as the diagnosis in the patient's chart, the hospital can code for "simple pneumonia." If, however, a physician more accurately writes the diagnosis as "pneumonia cased by staphylococcus aureus" the hospital can legally code for a higher reimbursement. In this case, the difference in reimbursement between "pneumonia" and "pneumonia caused by staphylococcus aureus" could be thousands of dollars.
Integration with Other Hospital Information System Vendors
Compliance+TM can be integrated with a variety of other existing hospital information systems.
Benefits to Physicians and Patients
Compliance+TM benefits also extend to physicians and their patients. In addition to being physician-friendly, the system automatically transcribes critical patient data from other parts of the hospital system – such as lab results and medication orders – and "writes" them into the physician's documentation. This feature dramatically reduces the amount of time that physicians waste searching for patient data to make important clinical decisions.
The degree to which Compliance+TM will help a hospital improve its coding and billing procedures will differ depending upon the hospital. Nevertheless, hospital executives can expect to see increased operating efficiencies within months of installing the system in an environment where the aphorism "time is money" is, without a doubt, appropriate.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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