Area of Excellence

CHRISTUS Health Northern Louisiana, Shreveport, a three-hospital, 650-bed regional health system owned and operated by CHRISTUS Health, Dallas, Tex., has held the percentage of late charges to its goal of less than two percent.

How They Did It

A coding project improved the quality of the bills for outpatient services going out the door. Software with medical necessity edits identified additional diagnostic codes that supported coverage for medical necessity. Review of present on admission and hospital acquired conditions (POA/HAC) was done at the time of coding as well as after discharge.

Key Steps

Step 1. Implementation of the outpatient coding project allowed coders to see preselected, problematic charges on outpatient accounts at the time of coding and ensure that documentation in the medical record supported the charges.

Step 2. Charge/coding audits identified opportunities to improve documentation, coding, and charging. Audit results were used to rebill when indicated but also to provide education going forward.

Step 3. Second-level review of POA/HAC was conducted at the time of coding to determine what led to the condition: was it a clinical issue, a coding, or a quality of care problem? Results were used to form performance improvement plans.

Step 4. Some facilities monitored batch charge rejections on a daily basis and followed up with departments to obtain corrections within the three-day bill holding period.

Step 5. Clinical documentation specialists worked with physicians on a concurrent basis to ensure documentation was clear and concise enough to facilitate detailed and accurate coding.

Step 6. A post-discharge query process was used to elicit clarifications in documentation from physicians as needed by coders.

Lessons Learned 

  • Push forward as much of the documentation improvement process as possible.
  • Make the POA/HAC process concurrent.
  • Conduct post-discharge query audits and use the information to improve documentation on the front end.
  • Hold charging departments accountable for denials.
  • Make sure you have a rock-solid advanced beneficiary notice process.