Ventus Intelligent Coding improves ED charge capture at WhidbeyHealth Medical Center

Photo: Altera Digital Health Team

WhidbeyHealth is a comprehensive healthcare system with a mission to be the healthcare provider of choice for the residents of Whidbey Island. The hub of the health system, WhidbeyHealth Medical Center, is a 25-bed fully licensed and certified Critical Access Hospital.

Situated on the largest island in Washington state, the medical center provides an array of inpatient and outpatient services to a diverse community, including a large population of retirees. Approximately 50% of its patient population is covered by Medicare, and 20%-25% is covered by Medicaid.

The organization handles a large volume of high-intensity emergency medical cases, as Seattle, the nearest metropolitan city, is located more than 30 miles away and is typically accessed by ferry. The medical center cares for 97% of emergency department (ED) patients and transfers 3% of patients requiring specialized treatment to other hospitals.

Leaders at the organization discovered discrepancies between the intensity of care provided in its ED and the Current Procedural Terminology (CPT®) codes documented by providers. "It was a constant struggle to get consistent documentation from our providers at the right levels," said Debra Tesch, manager of health information management and privacy officer at WhidbeyHealth Medical Center. Due to this pattern of undercoding, the organization was not being adequately reimbursed for services rendered.

Bringing consistency to coding across the organization

After a comprehensive solution vetting process, the team at WhidbeyHealth Medical Center adopted Ventus Intelligent Coding to bring order to its coding processes and, in turn, to strengthen its revenue cycle.

Intelligent Coding is a software tool that helps optimize revenue and reduce compliance risk for outpatient facilities and emergency care physicians through CPT charge capture, appropriate visit level evaluation and management (E&M) assignment and adherence to guiding principles from the Centers for Medicare and Medicaid Services (CMS). Intelligent Coding uses a straightforward data-abstraction process, combined with a rules engine, to determine codes.

The organization found that its different users, from physicians to charge team members, had success with Intelligent Coding because of its ease of use, combined with effective training. "Staff members love it," Tesch said. "It enables them to really understand the criteria and points them in the right direction. It's a really easy tool to use once you understand it. And, most importantly, it keeps a consistency between coders, which we obviously want from a compliance perspective."

"From a user perspective, the calculation of the hierarchy for drug administration coding and having the chargemaster built in for ease of charging services are very helpful," Malea Ivy, facility coding supervisor at WhidbeyHealth Medical Center, added. "From a management perspective, the reporting tools are very useful."

Leveraging reporting to drive continuous improvements

The reporting capabilities gave the medical center insights to better understand users' coding processes and are driving meaningful change. "Now that we have the data, we can work one-on-one with our providers to look at where they fall into their levels compared to their peers, as well as with critical care documentation," Tesch said.

Leaders at the organization are also using the solution's reporting functionality to continuously assess revenue cycle performance. "It lets us know every single week where we are with our claims. It allows us to look at our bell curve very effectively every month to see if we're shifting in the right areas," she shared. "From a financial perspective, it has helped us tremendously."

The financial impact of Intelligent Coding quickly became apparent. Ninety days after implementing the solution in its ED, the organization was able to increase its per patient visit charge by nearly 21%, or approximately $220. More than three years later, its E&M curve remains consistent.

Working together to maximize results

Beyond the product itself, WhidbeyHealth Medical Center has also had a positive experience working with the Intelligent Coding team. "The Altera team is very responsive to tickets and emails. They provide annual education prior to updates, so we feel well-informed of upcoming changes," Ivy said. "Altera provides good service to users and is always willing to answer questions."

"It's a very good partnership. If we need to change what we can for algorithms or criteria, we've been able to do that within reason," Tesch said. "We're building the product, and I anticipate we'll be doing even more with Ventus Intelligent Coding in the future."

To learn more, visit www.alterahealth.com