Health Language Blog

How to Minimize Lost Revenue Associated with Inaccurate Clinical Documentation

Posted on 05/29/15


Healthcare providers depend on accurate diagnoses and procedure coding to bring in revenue for their services. 

Inaccurate clinical documentation, however, has been a problem organizations have grappled with for many years. A report published in Health Services Research, and available through the National Center for Biotechnology Information, reported diagnostic and procedure coding error rates as high as 80 percent.

Coding errors have a bottom-line impact on healthcare organizations. Inaccurate ICD coding can delay or stop payment to providers, skew reporting and pay for performance results, and lead to inaccurate analytics.     

“Coding accurately for what you do is essential,” according to an article in Family Practice Management, a publication of the American Academy of Family Physicians. “The typical family medicine practice generates the majority of its revenue by submitting CPT and ICD-9 codes to third-party payers. In physician-owned practices, lost revenue opportunities affect physician income directly.”

The article noted that employed clinicians also suffer from inaccurate coding. Reduced revenue, the article stated, can shrink physician compensation and decrease the number of support staff.

 Boosting Coding Accuracy

But the situation isn’t all doom and gloom . Workflow-Enhancing Search technology, a component of Health Language’s enterprise terminology management platform, can help healthcare providers boost the accuracy of their coding and limit the damaging effects of revenue erosion.

 Let’s follow an example to see how a Workflow Enhancing Search process might work in practice. If I were to see a patient with otitis media, I’ll need to add that ailment to the patient’s active problem list and associate that problem with the office visit for billing purposes. If I enter the abbreviation “OM” in the electronic health record (EHR), I may not be aware that “OM” isn’t a term that ICD recognizes and my search might end there. Workflow-Enhancing Search, incorporated within an EHR system, addresses the gap between an unrecognized term and the correct codified terminology standard. Entering “OM,” the solution might recommend terms including osteomyelitis, osteomalacia and otitis media. In this case, if I select otitis media from the results, the solution would automatically map to the default ICD-10 unspecified code. If my goal was to remedy the unspecified code, the workflow could prompt me to provide more specificity - for example, asking me to specific which ear is actually affected.  This search and refinement process leads to more precise documentation automatically by answering simple questions within the EHR.

Workflow-Enhancing Search handles the terminology content mappings and the prompting for additional documentation, so clinicians like me don’t have to memorize the coding complexities of SNOMED CT(R), ICD-9 and ICD-10. The matching of terms to the correct ICD codes all takes place “behind the scenes.” With this approach, as a clinician, I’m able to create accurate documentation seamlessly within the EHR using terms that I’m familiar - while the technology and content solution hides the underlying terminology complexities. 

The ability to automatically parse codes and come up with an accurate selection will only increase in importance. Under the current ICD-9 standard, healthcare providers only have to contend with 13,000 different codes. The upcoming ICD-10 standard, which goes into effect October 1, 2015, will introduce 68,000 codes and much higher levels of granularity. The potential for inaccurate clinical documentation becomes that much greater.

Reduce The Error Rate

As the number of codes grows so does the chance for error. Workflow-Enhancing Search can help healthcare providers and clinicians like me wade through the thousands of diagnostic and procedures codes and help them document and bill accurately -- and receive reimbursement -- for the services provided. The adoption of this technology can help providers make the most of their revenue opportunities.

Are you contending with lost or delayed revenue due to inaccurate clinical documentation? Leave your comments below.

Simplify problem and diagnosis search with your EMR.

Topics: innacurate clinical documentation

About the Author

Dr. Brian Levy, MD is Vice President and Chief Medical Officer with Health Language, part of Wolters Kluwer Health. He holds an MD and BS from the University of Michigan. Go Blue!