Inpatient Coding: What Every Clinician and Hospital Administrator Should Know

1.0 CME Credit

1.0 CE Credit

ABQAURP sub-specialty credits: Managed Care 1.0, Physician Advisor 1.0

The Recovery Audit Contractor demonstration program found significant errors in Medicare beneficiary payments; most were overpayments from inpatient hospital providers and almost half of the improper payments were improperly coded. While these statistics have changed over the years since then, improper coding of inpatient claims remains an important area for improvement in today’s health care facilities.

While providers worked on improving documentation, along came CMS' ICD-10 implementation for claims after October 2015. Updated coding will deliver greater detail and have the potential to provide better data for evaluating and improving the quality of patient care. Increasing the detail and better depicting severity may clarify the connection between a provider’s performance and the patient’s condition. Complete, accurate, and up-to-date procedure codes will improve data on the outcomes, effectiveness, and costs of new medical technology and ensure fair reimbursement policies.

However, it is not easy. The process of properly preparing a claim for inpatient services brings together the work of a wide spectrum of professionals. Clinicians, including physicians, nurses, respiratory therapists, wound care specialists, nutritionists, etc., have the vital responsibility of accurately and completely documenting the patient’s clinical condition as well as the care provided. The role of clinical documentation specialists is to aid clinicians in their documentation. The duty of translating this documentation to ICD-10 codes falls to coders. In order to make the process as error-free as possible, it is important for each participant to understand the role of the other participants. In addition, administrators must have a grasp on the entire process since it is their responsibility to create an atmosphere in which the process can work efficiently.

At the conclusion of the activity, attendees will be able to:
  • Utilize knowledge of coding principals to improve documentation in the medical record.
  • Improve communication between clinicians and HIM personnel related to documentation and coding.
  • Discuss the history of the DRG system and the important part that proper coding plays in correct reimbursement.
This course is intended for Physicians of all specialties, Nurses, and Other Health Care Professionals with appropriate CME credit and nursing contact hours offered for each profession.

The American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

ABQAURP designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABQAURP is an approved provider of continuing education for nurses. This activity is designated for 1.0 contact hour through the Florida Board of Nursing, Provider # 50-94.

This program is approved for Category 2 credit by the American Osteopathic Association.

All participants must achieve a final assessment score of at least seventy percent (70%) for recertification and continuing education credits. You have 60 days to complete the course after ordering. Please note: Exam candidates taking the Core Body of Knowledge and Diplomates renewing their certification may have less time to complete, as determined by deadlines imposed.

This activity is valid from March 15, 2016 through March 15, 2019.

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COURSE FEES: Diplomate $29.00      Member $34.00      Non-Member $42.00

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About The Authors
Members of the CME Committee, Planners, and Faculty have disclosed to ABQAURP any relevant financial relationships. No relevant financial relationships or conflicts of interest exist in regard to the content of this activity.

Timothy J. Garrett, MD, MBA, CHCQM, CIC

Timothy J. Garrett, MD, MBA, CHCQM, CIC is an emergency physician who serves as Medical Director of Clinical Claim Validation Solutions at Cotiviti Healthcare. He received his medical degree from the Medical College of Georgia and his MBA from Auburn University. Dr. Garrett is an ABQAURP Diplomate, HCQM certified in 2012, and was one of the first physicians in the nation to earn the Certified Inpatient Coder credential from the American Academy of Professional Coders.

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