With today’s complex and evolving compliance requirements, your coding professionals need an easy-to-understand physician coding application that provides critical clinical, financial, and regulatory information essential for accurate reimbursement. Clintegrity Physician Coding, the professional fee coding solution component of Clintegrity Coding, combines an intuitive web-native workflow with reference materials to provide a world-class, single-platform solution. Clintegrity Physician Coding offers the knowledge base of clinical, financial, and regulatory information that coders need to meet today’s complex coding requirements for professional fee coding. The single platform solution allows your organization to store both facility and service encounters in one database even if you are using separate billing applications. This helps ensure coding consistency between facility and physician coding. It also increases efficiency and streamlines the physician coding process for your HIM staff, as does the ability to code, group, and edit in a single interface, from anywhere, at any time.
Clintegrity Physician Coding equips you to meet today’s OIG coding challenges, including the assignment of evaluation and management (E/M) codes and ensuring consistency between physician and hospital service codes. Clintegrity Physician Coding provides an E/M calculator to correctly identify the assignment of these codes. It also includes Medical Necessity Edits that utilize Medicare’s Local and National Medical Review Policies in determining any problems with diagnosis and procedure linkages. Lastly, Nuance Healthcare’s Resource-Based Relative Value Scale (RBRVS) reimbursement calculation provides the estimated reimbursement for the physician service provided. Additionally, your HIM staff will access the same official ICD-9 and ICD-10 codebooks and work from the same coding guidelines. This helps ensure data integrity and reduces errors that can lead to costly audits.
As more and more patients are admitted through your Emergency Department, accurate documentation is becoming critically important. Due to the complexity of ED cases, the hectic work environment and the need to make rapid decisions, in many cases patient acuity is inaccurately reflected by under-documentation of the patient's clinical situation. Staff may accurately document the injury that brought the patient in, but miss secondary diagnoses and/or pre-existing conditions. What's more, a problem list isn't usually created until the patient is moved onto the floor...if ever. Improving the quality of the clinical documentation promotes better communication and creates an opportunity to positively impact clinical outcomes.
Nuance has developed a powerful solution and a new clinical staff position to help you ensure better clinical outcomes and accurate reimbursement.
Because documentation of critical information starts in the Emergency Department, the Point of Entry program starts there too - evaluating the severity of illnesses, assessing present-on-admission (POA) conditions, determining patient status (observation or inpatient), ensuring compliance with quality core measures, creating a problem list at the point of entry, and enabling more accurate documentation. The Point of Entry program builds on the foundation of Clintegrity CDI; and takes it even further, providing comprehensive clinical integration management.
With this new solution comes a new clinical role - the Clinical Integration Specialist (CIS). This individual works closely with your clinical team to ensure all clinical observations are documented appropriately from the ED to discharge.