September 12 2017 | 0 Comments | 137 reads Average Rating: 3

Fallible Humans and Four of Their Documentation Foibles

by Tom Peterson in Risk Adjustment

The Centers for Medicare and Medicaid Services is cracking down on documentation shortcomings – via risk adjustment data validation (RADV) audits. As such, payers are likely to see reimbursement dwindle if they don’t get their documentation ducks in a row.

Humans, however, are fallible. Indeed, care providers are falling short in this sphere as they:

1) Document in an incomplete or insufficient manner. Physicians typically learn how to fill out a chart or progress note while on the job. Therefore, they learn as they go – and often miss some of the subtleties such as how to link retinopathy to diabetes in a clinical note.

2) Use outdated tools. Documentation errors sometimes occur when providers continue to use old tools, such as NCR forms that do not track the new codes that are developed each year.

3) Hold on to old habits. Many providers are accustomed to documenting clinical encounters in a specific fashion. For example, many physicians are still using ICD-9 codes, instead of the more specific ICD-10 codes. This could create issues that will cause health plans to be penalized if a problem is not recognized.

4) Miss valuable lessons. Sometimes, physicians are just not in the know when it comes to current documentation practices. For example, in some instances, physicians may be coding for Hierarchical Condition Categories (HCCs) rather than for the treatment they performed for the member – simply because they have not been educated in the new documentation norms.

These human errors and oversights often result in documentation shortcomings. Fixing these foibles, however, requires more than human intervention. Indeed, the analytics of a charting validation service can do what no department of humans can do – review every chart and find the anomalies that indicate problems with diagnostic codes or HCCs so they can be corrected before CMS sees them – and starts assessing penalties. In addition to correcting these issues, a chart validation service can also help remediate problems at the source.

Can you think of any other human errors that could be addressed with an automated chart validation service?

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Tom Peterson
SVP, Risk Adjustment

Tom Peterson brings more than 25 years of experience in healthcare. Prior to joining the SCIO® team, Tom was CEO and co-founder of Clear Vision Information Systems (acquired by SCIO® in 2016), which designed software and services to optimize care and revenue for plans and providers across the country.

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