CLINICAL IT
Improving reimbursement and efficiency with advanced clinical coding software
Ian Kent, senior marketing executive at 3M Health Information Systems, describes the challenges facing clinical coding and how to make improvements.
P
ayment by Results (PbR) seeks to ensure fair funding for hospitals for the work that
they do. Extending the PbR tariff system is a key government policy. PbR currently covers approximately £26bn of acute services, under this new plan most, or all, of the £51bn spent on acute hospital activity, as well as wider community and health services, will be subject to a PbR tariff.1
Clinical coding is central to the performance of an NHS trust. A report by the Audit Commission concluded that coding of diagnoses and procedures is particularly important under PbR, as these codes are two principal determinants of the HRG (Healthcare Resource Group) that the patient is assigned to, which in turn determines income.
The Commission also reported that incomplete coding translates to loss of income for trusts,
while inaccurate coding leads to inaccurate payments, which can impact negatively on the finances of providers and commissioners,2 reducing resources for patient care.
Advanced clinical encoders play a critical role in ensuring accurate, consistent and timely diagnostic and procedure coding, leading to increased depth of coding and reimbursement. Dedicated clinical coding software can help to ensure that national standards are applied consistently, supporting both clinical and information governance as well as accurate HRG assignment.
The Clinical Coding department at Sheffield Teaching Hospitals NHS Foundation Trust, one of the UK’s largest trusts, is responsible for coding approximately 280,000 in-patient episodes per year. The trust investigated coding specific applications to facilitate improvements to their clinical coding; they selected 3M’s Medicode Clinical Classification Encoder to help meet their objectives. One of the benefits this brought to the trust was the unique ‘Coding Signposts’ feature to guide coders away from poor coding practices. One such correction reduced lost income by around £80,000 a
month. And because the solution undertakes real-time analysis the trust were also able to reduce the number of 99Z HRG codes from around 75 per month to just 15. With reduction in lost revenue in the region of £100,000 a month, this is money that can then be invested in improving the quality of care.3
If the NHS is to meet the Government target of £20bn efficiency savings over the next four years then attention must be paid to ensuring that reimbursement accurately reflects the patient case mix. Accurate coding is central to this objective and with dedicated clinical coding software trusts can ensure that coding is as accurate and timely as possible.
References
1 Improving coding, costing and commissioning, Audit Commission, Sept 2011
2 Early lessons from payment by results, Audit Commission 2005, ISBN: 1 86240 513 1 3 Clinical Coding, Grouping & Auditing software case study, 3M Health Information Systems, May 2012
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50 | national health executive Jul/Aug 12
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