A small community hospital with approximately 69 beds recently promoted its most experienced coder to Department Manager. Upon her promotion, she quickly discovered that multiple policies and procedures (P&P) were not being followed – impacting hospital and clinic coding and documentation. In addition, there was a six-to-eight week backlog, thus impacting the data quality and reimbursement of the hospital and their offsite clinic. If these coding issues were not addressed, the hospital might face financial penalties from the state or a Medicare audit due to non-compliance. An existing Oxford Global Resources partner referred this client to us due to our excellent past performance with them.
The Department Manager was still learning her role, and Oxford acted as an advisor to her throughout the project. In addition, we supplied two consultants to run a series of audits and perform inpatient and outpatient coding activities. The audits also required a level of change management — the physicians were slightly resistant to proper documentation procedures, so the consultants educated them on the benefits.
In addition, the consultants provided services at the health clinic — performing activities audits on the basic coding, behavioral health coding, and dental clinic procedures.
The coders also addressed the backlog by cleaning up the coding and training a new coder for the internal team.
The consultants completed an initial audit and addressed their findings with the client. In addition, the coding and documentation have increased in accuracy, and physician education around appropriate documentation has improved due to our professional approach and coding quality. The client had requested Oxford to perform a phased-in approach to the Rural Clinics in which an auditor was able to recommend several coding, documentation, and billing opportunities for improvement. We continue to support this client with additional audits and advice for the Department Manager.