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Case Studies   |   11.23.16

How a Veteran Coder Used Apixio’s HCC Profiler to Eliminate Data Entry Error and Double Productivity

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Fun Stats

  • Increased productivity from 3 charts per hour to 10 charts per hour
  • Decreased data entry errors

About the Plan

Gloria currently codes charts for Kelsey-Seybold, a health plan in Houston, Texas which operates 19 multi-speciality care centers and services more than 400,000 patients.

Chasing and Reviewing Paper Charts an Exhausting Process

At the beginning of her career, Gloria coded HCCs for a large provider group. Gloria was given a list of patients whose charts required auditing at each physician office. She drove to each office, collected the patients’ charts, and reviewed them onsite, working out of a file room or employee common room.

A big pain point was that many physician offices did not use an EHR, so Gloria had to read many handwritten charts. If a provider had bad handwriting, she needed to reach out to an office manager for assistance, which slowed review.

Additionally, Gloria tracked her work in Excel and later transferred it to the documentation program that the provider preferred. With this system, it was easy to err and transpose the numbers in an ICD-9 code or misspell a name.

Most significantly, though, the process of traveling to secure charts and work around a physician office’s schedule was exhausting. The provider group required that 150 charts be reviewed per week, in 40 hours, which was hard given all the hurdles involved.

PDFs Often a Disorganized Jumble and Difficult to Work With

Next, Gloria worked with a third-party contractor to audit for a provider group with widespread EHR adoption. Through the contractor’s system, all the relevant charts for a patient were printed and scanned into one PDF file.

These charts were easier to read, because they weren’t handwritten, but they were still very difficult to work with. The patient files could be anywhere from 1 to 1000 pages and would contain a lot of irrelevant information. The pages came in no particular order, were sometimes upside down, and some pages were missing altogether.

HCC Profiler Enables Increased Personal Productivity and Fulfillment

Gloria began to use Apixio’s HCC Profiler during her work with Kelsey-Seybold. With HCC Profiler, she doesn’t have to chase charts from physician offices, or read charts by hand. HCC Profiler reads the patient charts, identifies potential HCCs, along with supporting evidence, and presents them to Gloria for quick confirmation or rejection. It doesn’t show HCCs that have been identified by Kelsey-Seybold already, so Gloria doesn’t duplicate previous work. With HCC Profiler’s dynamic search functionality for ICD-10 codes and providers, and pre-fill of the member name, she is at lower risk for data errors and much more productive.

This all means Gloria is able to review charts quickly and accurately. With HCC Profiler, she completes 8 to 10 charts per hour, equalling up to 80 charts per day. She has time for advanced projects such as physician documentation audits and professional education. It’s a far cry from the days of driving from office to office searching for charts, and it’s a process that respects Gloria’s value as an expert resource.

Goals

  • Increase HCC coding accuracy and completeness
  • Put expert coding skills to best use and eliminate administrative “grunt” work
  • Create a simple, easy coding workflow that facilitates an enjoyable work experience
  • Enable better insights and quality assurance of work
  • Increase speed of chart review
  • Develop accurate clinical profile for patient

Approach

Gloria used Apixio’s HCC Profiler, a HIPAA-compliant cloud application that transforms the complex chart review and HCC coding process into a simple, intuitive workflow. Through HCC Profiler, coders are presented with evidence for one HCC at a time, and asked to confirm or reject the findings.

Results

Gloria went from reviewing around 3 charts per hour, to reviewing around 10 charts per hour, with fewer data entry errors. She is happier with the type of work she is doing and has more time for provider documentation education and professional enrichment.

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Author
Andrew Raymore