Dynamic Lists: How ‘Googling’ your coded claims data could become a secret weapon

March 9, 2021 Streamline Health

By: Roberta Peters, MS, RHIA
Vice President, Solutions Executive, eValuator™
Streamline Health

In the Internet age, if you need information on anything, your first option is usually to use a search engine.  ‘Googling’ a topic is simply the easiest, and often most effective, form of initial research. But what if that simplicity could be extended to addressing questions and challenges in your work life? For healthcare providers looking to optimize coding accuracy and financial performance, it just became a reality thanks to Dynamic Lists in eValuator.

Dynamic Lists: How ‘Googling’ your coded claims data could become a secret weapon

“Given the tremendous amount of data generated in coding claims, it’s helpful to have
the most powerful options to leverage that data in support of financial improvements.”

Hospitals and health systems compile and leverage vast amounts of data, yet it’s often locked in disparate systems or simply too tough to extract in a timely, meaningful manner. For HIM or Revenue Cycle leaders charged with optimizing coding accuracy and revenue integrity, there’s a wealth of insights stored in that data, which includes medical coding, charge and claims data, not to mention the physician- and payor-specific elements associated with each encounter and supporting claim. All of this data is prepared and packaged as part of the process to submit cases for payment. Each element is uniquely identified and tagged, while still grouped with the associated coded claim, making it potentially searchable using filters much in the same way search engines operate. That’s where the real benefit of Dynamic Lists comes in.

A good use case for Dynamic Lists is leveraging them to proactively address coding issues that impact your financial performance and quality management.  For instance, perhaps you notice a trend of payment delays or denials from a particular payor on claims using a specific DRG. To better understand—and ultimately address — what’s causing the issues, you can run a query on all cases to that payor which include the DRG in question and perform Quality reviews to troubleshoot for potential issues.

Further still, Dynamic Lists empower HIM and RCM leaders with the power of ‘what if’? As in,

  • What if I could identify encounters where the procedure codes aren’t aligned with the charge codes?
  • What if I could isolate cases that meet certain criteria, such as recently announced payor changes, so I can determine if resubmittal or rebuttals are warranted?
  • What if I knew which of my coders had the highest rates of DRG change upon audit?
  • What if I knew which DRGs were most frequently flagged and changed during review?
  • What if we could cross reference coder accuracy with DRG changes to assess which resources are best suited for coding specific types of care?

Going deeper into how this could be leveraged: outpatient coding includes hard-coded data that’s managed outside of the purview of traditional HIM, often by staff or processes at the point of service.  Using Dynamic List functionality on data from your outpatient encounters, you could query which facility or services had significant changes made to hard-coded data. If any major trends/issues are noted, you could use this data to quantify the impact of the issues, then engage relevant stakeholders at the point of service for potential operational changes or training to address the root cause. The ability to drive positive change not only in HIM, but across the enterprise, would be a welcome addition to any organization.

Interestingly, this functionality is a by-product of the industry’s most comprehensive pre-bill coding analysis platform, eValuator™. All coding and charge data is analyzed by eValuator’s rules engine prior to billing, which is how this comprehensive database is continuously updated. It flags potential coding issues (both under- and over-coding) and enables providers to set flexible thresholds for what gets selected and routed for audits.  This enables providers to easily identify and address the highest impact cases prior to billing, for optimized revenue integrity and financial performance.

“The ability to drive positive change not only in HIM, but across the enterprise,
would be a welcome addition to any organization.”

Given the tremendous amount of data generated in coding claims, it’s helpful to have the most powerful options to leverage that data in support of financial improvements. Using it directly to optimize your current cases for coding accuracy and compliant revenue capture is good business; using the same system to proactively seek out additional opportunities for operational and financial improvements is even better business.

See for Yourself

As more providers are discovering, pre-bill technology is the key to optimizing revenue integrity and financial performance across all service lines. As the leader in solutions to optimize coding accuracy prior to billing, Streamline Health is helping providers establish a new normal that improves their bottom line despite these challenging times. To discover how we can improve coding accuracy and financial performance for your organization, contact Streamline Health today.

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