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Cardiology, MACRA and structured reporting

March 31, 2017
From the March 2017 issue of HealthCare Business News magazine

Overall, coding was correct in approximately half of both PCI and PV cases, with 47.5 percent of facility cases and 50.5 percent of physician cases identified as accurate. In analyzing the data, MedAxiom determined that:

• The most common problems with physician coding were extra codes (13 percent), incorrect codes (10 percent) and missed codes (10 percent), while facilities recorded incorrect codes in 17 percent of cases, followed by extra codes at 16 percent.
• In PCI cases, physicians coded 73 percent correctly while facilities coded 53 percent correctly.
• In PV cases, facilities coded 42 percent correctly while physicians were correct just 28 percent of the time.
• Common facility PCI errors include incorrect codes (20 percent) and extra codes; for PV coding they were extra codes (20 percent) and incorrect code (14 percent).
• Common physician PV errors include incorrect code (16 percent), incorrect code plus extra code (16 percent), extra code (14 percent) and missed code (14 percent).

Further analysis by Wolters Kluwer suggested these errors put revenues in both settings at substantial risk. For studied facilities, over-billing of 6 percent for five sites put $795,000 at risk and could catch the eye of RAC and other regulatory auditors. Potential facility under-billing for those same five sites adds to lost revenue of $1.2 million.

For physicians, accurate procedure documentation remains the primary source of information in determining ongoing care for patients while also driving payments and allowing for effective cost-reporting. Researchers found that the potential cost of over-billing was $365,000 while under billing adds $881,000 to lost revenues. When the MACRA/MIPS performance-based penalties and bonuses, along with the cost of noncompliance with numerous other mandates, are added to the already high cost of inaccurate or ineffective procedure documentation used to support coding, the critical need to encourage adoption of structured reporting as a foundational best practice becomes clear.

Closing the gap
A primary reason why cardiology service lines and practices have yet to fully adopt structured reporting, despite issuance of a health policy statement defining the clinical standards for structured reporting in the cardiac catheterization suite, is a gap in technical capabilities that prevents automation of data capture, analysis and reporting. The cardiovascular information systems that are popular in these settings often lack the functionality, or are too labor intensive to keep current, to drive structured reporting by standardizing documentation based on industry best practices.

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