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The road to a streamlined code audit and review process

University of Utah Health’s journey implementing a prospective prebill review process and a retrospective audit process

The challenge

University of Utah Health started the audit process in a spreadsheet-based world. The spreadsheet changed and adapted over multiple years, and grew when new information was added. Although the organization made it work, it was far from the most efficient or unified approach to manage audits. In addition to a manual process, each auditor had a slight variation in their approach.


The ultimate outcome? A time consuming and inefficient way to understand and manage the data. As the team’s responsibilities continued to increase, they needed a better process and more supportive technology to make their audits more efficient.

The solution

University of Utah Health is a long time partner of Solventum. The organization partnered with Solventum to deploy two new prospective prebill and retrospective audit solutions: 3M™ 360 Encompass™ Audit Expert System — Inpatient Prebill Review and 3M™ 360 Encompass™ Audit Expert System — Code Audit. The goal was to use technology to streamline, automate and standardize the review and audit processes, integrating a more efficient practice across the different functions. University of Utah Health pioneered these two solutions and provided valuable feedback and user experience data that the Solventum product team used to enhance the solution.

Prospective prebill review process

The new edit, review and audit solutions within the 3M Inpatient Prebill Review module enable actionable custom edits to identify errors at the point of coding, as part of the coder’s workflow. These custom edits were developed to specifically address the coding errors identified by the University of Utah Health coding and auditing management team. Coding errors are resolved within the coding workflow rather than placed on an additional hold, or worked on further downstream in the revenue cycle, which facilitates better coding accuracy.

In addition to the actionable custom edits, 3M Inpatient Prebill Review prompts specific criteria to a second level review for additional analysis. According to Nancy Blattberg-Smith, MPH, RHIA, CDIP, CCS, manager of data integrity at University of Utah Health, “ultimately the additional review could eliminate rebills and enable coders and auditors to work together and provide quicker and more timely feedback.”

The second level review process allows the auditors to take a deeper look at their mortality review gains and losses, identifying net dollar changes that could affect the facility’s revenue stream.
 

Retrospective audit process

In addition to using actionable custom edits and second level reviews as part of the prospective coding accuracy process, University of Utah Health also integrated 3M Code Audit for retrospective reviews. Retrospective audits are completed within the 3M™ 360 Encompass™ System, referencing the codes and the documentation used to create the patient record and removing the manual methods required to create randomized audits previously managed via email.

3M Code Audit provides a more efficient way to initiate retrospective audits, review the code set, provide two way communication and agreement between the coder and the auditor, and operationalize the overall process. The retrospective audit process also provides insight into coding errors and challenges. This helps direct targeted education and potential new custom edits and review opportunities that can be added to the prebill process– all within a single platform.

Results, outcomes and/or financial improvements should not be interpreted as a guarantee or warranty of similar results. Individual results vary depending on circumstances.


Tags
Revenue Cycle Teams
Coding
Case Studies

Organizational profile

University of Utah Health


Academic and trauma medical center with a tertiary referral base. Serves the intermountain West region.

An integrated auditing and coding team made up of nurses, coders, auditors, educators and quality liaisons.

Ultimately the additional review could eliminate rebills and enable coders and auditors to work together and provide quicker and more timely feedback.

Nancy Blattberg-Smith

MPH, RHIA, CDIP, CCS, manager of data integrity, University of Utah Health

Results from the study

Reduced rebill time from 30+ days to 3 days post-patient discharge with the prebill process

DRG mortality review identified $210k potential undercoding

Issues resolved at the front end of the coding process

Audit output doubled from 5% to 10% per coder per month

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