From Registration to Accounts Receivable – The Whole Can of Worms 2007 UBO/UBU Conference 1 Briefing:Implementing EHR is More than Pushing the On Button Date:21 March 2007 Time:

2007 UBO/UBU Conference From Registration to Accounts Receivable 2 Objectives Debrief on AHLTA implementation and sustainment – What went right? – What process(es) could have been improved? – What should we do now? The role of the coder and coder/auditor – What can I do at the start? – What can I do along the way? – How can I help sustain methods?

2007 UBO/UBU Conference From Registration to Accounts Receivable 3 What Is AHLTA? ACRONYM MEANING? This is an actual name, not an acronym!

2007 UBO/UBU Conference From Registration to Accounts Receivable 4 Pre-Deployment Checklist (non-MID!) – Coding and collections on board? – Clinical champions identified? – Ensure the file and table is correct for the clinician type – Meet with implementation team? – Do we know the business plan impact? – Do we know the major procedures and diagnoses in each clinic? – Who is being trained, and when? Who are the other students?

2007 UBO/UBU Conference From Registration to Accounts Receivable 5 Pre-Deployment Receive standard and super-user training Meet with other coders, clinicians, and management already experienced using AHLTA and auditing visits Meet with clinicians and review top 10 ICD-9 codes and top 10 CPT codes Work with clinician to pick best templates for documenting care that maximizes appropriate workload capture

2007 UBO/UBU Conference From Registration to Accounts Receivable 6 During Ensure the providers attend the class – All clinicians – All support staff – All coders – All clinic managers – All medical record and patient administration staff Ensure the over-the-shoulder training occurs in an effective manner – With the appropriate coder – Use real cases – Set up favorites immediately – Find out what each provider needs from the system

2007 UBO/UBU Conference From Registration to Accounts Receivable 7 During Clinic Management – Implement a process for the managers to be the template resource They should be able to set up – Documentation templates – Clinic favorites – Provider favorites Assistance with this process – Templates Electronic documentation templates in AHLTA SF600 overprints, hardcopy – Favorites List of most used diagnoses List of most used procedures

2007 UBO/UBU Conference From Registration to Accounts Receivable 8 Reports ADM and AHLTA Compliance, this will verify what the coders already know – Who is using AHLTA? – Who is still using paper-based documentation? – Shows whether the clinic is receiving credit for their workload M2 and ADM productivity reports – Has there been a change in ICD-9-CM reporting? – Has there been a shift in RVU production? – Coding compliance scorecards can be provided By clinic By provider

2007 UBO/UBU Conference From Registration to Accounts Receivable 9 During Coders and collection staff – Know what is expected in the documentation – Individual clinicians: What does the clinician like about AHLTA? What does the clinician dislike about AHLTA? Work to their strengths – What do the report cards say? Who is over-coding? Who is under-coding? – AUDIT! Discuss results with the command At the directorate, department, and individual provider level

2007 UBO/UBU Conference From Registration to Accounts Receivable 10 During Meet with clinicians four to eight weeks into rollout or after they have begun using AHLTA Review templates that they use to ensure they are accurately capturing coding Review their technique for completing the Disposition Section with ICD-9, CPT, and E&M codes Provide statistical analyses pulled from AHLTA and CHCS to show our success with coding compliance and documentation in AHLTA

2007 UBO/UBU Conference From Registration to Accounts Receivable 11 Post Vigilance – Review reports – Review records – Report results Train with the sustainment trainers (where they have been deployed!) Keep talking with the clinical champions Educate new clinicians and support staff Go back to vigilance!

2007 UBO/UBU Conference From Registration to Accounts Receivable 12 Post Meet at a defined interval (at least quarterly) with business office, clinical leadership and clinicians to review coding accuracy and assess opportunities to improve coding Be part of the sustainment team that meets with new clinicians to: – Learn successes and challenges at previous commands – Determine best practices they may bring with them – Cooperate with classroom training and command indoctrination

2007 UBO/UBU Conference From Registration to Accounts Receivable 13 Policy Review/Development Hybrid Record Environment – Identifying challenges Legal Record (How is it defined in a hybrid environment?) Document/Record Management Workflow Changes Record Completion Compliance Review (EHR and paper) Important Elements of Medical Record Policies – Policies and procedures for: Forms and templates Voice recognition and dictation – Access, privacy, confidentiality, and security policies Mental health notes Sensitive PHI access (i.e. HIV encounters)

2007 UBO/UBU Conference From Registration to Accounts Receivable 14 Policy Review Development Additional Elements of Medical Record Policies – Policies and procedures for corrections (Hybrid records – records scanned into AHLTA) Printing Guidelines (scope and reason for printing) Data Integrity – Reconciliation of electronic processes – Assessing potential data corruption – Downtime policy and procedures