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Clinical Coding

Clinical Coding and Health Information Management Services
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Our Services

Our Clinical Coding services include:

  • Clinical Coders/Health Information Managers
  • Analytical auditing.
  • Clinical information transformation
  • Training and education.
  • Data errors correction of Clinical Coding from VAED/VEMD extracts/returns for Victorian Hospitals that are ABS funded.

Clinical Coding

AusHealth can provide certified, experienced and knowledgeable Coders, Health Information Managers, Auditors and Learning and Development specialists to support hospitals on a permanent or long term and short-term basis, to level out seasonal challenges, planned or unplanned staff shortages and/or simply to clear backlogs.

Our services are flexible, cost-effective, align with your requirements and volumes, and are focused on securing maximum reimbursement, mitigating denials while minimising compliance risks.

Analytical Auditing Service

AusHealth uses innovative analytical software to gather clinical data from across client health services. Sources may include:

  • Notes extracted from the Electronic Medical Record;
  • Pathology/Medical Imaging results;
  • Medication data;
  • Clinical observations. including blood pressure.

The software, which understands the IHPA NWAU model and DCCL values, runs hundreds of algorithms across all episodes of care to identify gaps and missing diagnosis codes – as opposed to the accepted audit practice of searching for key words in a single patient episode.  This comprehensive approach provides operators with:

  • Fulsome data analysis to identify coding gaps;
  • A mechanism to identify possible missing codes for coding/query;
  • Identification and audit of records – frequently including Coder/Auditor education;
  • An analysis driven approach – identifying knowledge gaps and targeted education opportunities for clinical staff.

Clinical Information Transformation

To many health service providers, Clinical Information is an unknown quantity – to the potential detriment of their patients and organisational performance.

AusHealth’s Clinical Information Transformation Services change that by:

  • Capturing and analysing the wealth of detailed clinical information held within health services;
  • Allowing better understanding of financial opportunities and risk;
  • Identifying the source and size of potential compliance issues;
  • Enhancing reporting accuracy.
  • Improving and reducing data entry errors that impact reimbursement.

When coupled with our billing, resolutions and revenue recovery solutions, AusHealth’s Clinical Information Transformation Services present health care providers with an opportunity to exponentially enhance operations and bottom-line performance.

The pillars supporting AusHealth’s integrated package of transformational services combine:

  • Industry leading expertise (headed by Dr Paul Tridgell);
  • Benchmarking against Hospital / State / Local Health District results and current acute and sub-acute inpatient coding; and
  • Utilisation of innovative analytical software.

Our clinical information transformation services include:

  • Documentation Gap Analysis.

The quality of clinical coding of acute inpatients can have a major impact on the Diagnosis Related Group (DRG) allocated to a patient. Too often, complexities including additional medications or diagnostic tests are not documented in a way that can be coded – with a negative impact on funding and the benchmarking of a hospital’s efficiency.

AusHealth allows users to analyse both administrative coded data and clinical data (such as clinical notes, discharge summaries, medications, and diagnostic test results) to identify missing diagnosis codes that may change the DRG.

  • Coding classification changes.
  • Sequencing of ICD-10 diagnosis and procedure codes to clinical appropriateness of the case-mixed episodes.

AusHealth assists analysis of the impact of coding classification system changes on back casting calculations used by the Independent Hospital Pricing Authority (IHPA).

This can be particularly important when analysing the National Weighted Activity Unit (NWAU) output across significant accounting changes.

  • Coding processes and outputs.

Aushealth can assist with the analysis of potential variations in coding processes and outputs in a State or Local Health District (LHD).  This analysis is useful in assessing consistency, under-reported codes, and clinical areas with the greatest opportunity.

A key to this analysis is linking differences in rates of codes to NWAU impact.

  • Medicare and billing.

Under the terms of the National Health Reform Agreement (NHRA) the Commonwealth conducts data linkage to assess compliance with the funding agreement and Medical Benefits Schedule billing.

The AusHealth team has extensive experience in undertaking data linkages to assess compliance with current Activity Based Funding (ABF) under the NHRA. Such analysis may be of particular benefit to a health service seeking to identify risks and gaps or ahead of a scheduled audit.

  • HAC and monitoring.

AusHealth can assist with analysis of Hospital Acquired Complications (HAC).  By linking clinical and administrative data, we can also assess the likelihood of a pre-existing condition.

Training and Education

AusHealth can provide targeted education in:

  • Documentation;
  • Overcoming coding gaps;
  • Data extraction;
  • Data errors correction;
  • Health Information Services Operation;
  • Freedom of Information Requests;
  • Clinical coding rules, conventions and standards;
  • Coding classification system changes.

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