HIM SolutionsProtecting, curating and analyzing health information to ensure Patient-Centric documentation

  • Have you conducted a recent HIM audit?
  • Do you know your team’s coding accuracy rate?
  • Is your CC/MCC capture rate within the CMS established benchmarks?
  • Is your HIM analytics and operational reporting user friendly?
  • Are you challenged with external coding support?

Health Information Management (HIM) is a mission-critical function for every healthcare organization. Evolving with fast-paced technology advancements and increasing regulatory requirements, HIM has broadened its organizational role well beyond its core services of operational coding to coding audit compliance. Today, HIM encompasses privacy, security, legal, regulatory, analytics, financial and a host of Revenue Cycle Management (RCM) responsibilities.

JTS’ Health Information Management solution offers consulting and operational services within planning, auditing, coding, interim management, staff augmentation, outsourcing and co-sourcing solutions for the acute and physician settings. JTS combines business operations with information technology to procure, analyze and secure vital protected PHI.

JTS’ HIM leadership team has extensive knowledge and experience including professionals with RHIAs, RHITs, CHCs, and a host of certified coders delivering a full spectrum of health information management professional services. Additionally, JTS can engage their Physician Advisory Team (active, practicing medical doctors) for peer-to-peer education, clinical documentation improvement and HIM/reimbursement operational sessions.

Auditing | Coding Compliance

HIM professionals today assume a broader organizational role within increasing volumes in inpatient and outpatient settings.  Mitigating risk that accompanies the evolution of HIM to ensure accurate, complete, and compliant coding requires that facilities deploy an independent audit function. These types of audits are usually concurrent and retrospective and often focus on high volume diagnoses, procedures or Diagnosis Related Groups (DRGs).  Audits may also be random in the sampling to demonstrate a true quality of the reported data.

In addition to providing these high-quality audits, JTS designed a different approach to coding audits focusing on analysis, hands-on education, measured improvement, and ongoing risk management which improves sustainability of the improvements.  Our education model is a differentiator because it includes multi-decade HIM professionals as well as practicing physicians.

Health Information Management ServicesAudit Services include:

  • Coding Quality Reviews:  Inpatient and Outpatient
  • Evaluation & Management (E&M) Quality Level Coding Reviews
  • CC/MCC Capture Rate Analysis and Validation
  • Custom Education Programs
  • MS-DRG and APC Validation
  • Telehealth Reimbursement Reviews
  • Peer-to-Peer Education for the following:
    • Physicians
    • Clinicians
    • HIM Professionals

Client Achievements

Quality rating 5-10% above expectation while maintain speed to value of chart completion

Reduced DNFB to $0 while creating a sustainability model to enable client’s team to manage incoming volumes

Developed an operational team within 30 days

Coding

Evaluation and continuous monitoring of your organization’s coding practices should be an established component of your coding compliance program and initiatives.  JTS can provide reviews of your claims coding and practices on a routine basis to:

  • Identify operational problem areas, educational needs, and patterns / trends of risk
  • Promote healthcare compliance to federal and state regulations
  • Determine clinical documentation accuracy to support coding
  • Establish coding guidelines and criteria for compliance of industry standards

Interim ManagementCoding Support

JTS can help you manage staffing gaps that result from medical leave, PTO, turnover or on-boarding new staff.  Our team of trained coders is available to fill that gap in inpatient coding, outpatient coding, as well as other necessary roles.   Allowing us to partner with you on this temporary staffing need will alleviate any spikes in your DNFB and will enable you to focus your time on more pressing issues.

Interim  Management

Have you recently encountered turnover in an HIM leadership position?  Finding the right person to fill that role can take time and patience.  The search and interview process may take weeks, or even months.  JTS Health Partners can provide Interim Management services to ensure daily operations run smoothly while you recruit the right person for that position.

Consulting + Workflow Engineering

Development of standard work & optimization with focus on increased performance

Operational  Review

Spikes in the DNFB can be a symptom of a bigger problem.  That is, a problem in the workstreams and/or standard work.  If you have implemented an EHR or new application and are still experiencing bottlenecks in your daily processes, an Operational Review is the answer.  Through a systematic process of reviewing and evaluating the data flow and/or workflow, opportunities for improvement are revealed.  The final step is a strategy session with the key stakeholders to develop a custom roadmap and plan.

Clinical Documentation Improvement with Physician Advisory

Best practice experience relative to processes, technology and personnel, that advocates the completeness, precision and validity of provider documentation inherent to transaction code sets.

As value-based care models gain traction, so have Clinical Documentation Improvement (CDI) programs in the outpatient arena.  Thorough diagnosis documentation yields to a more detailed view of the patient’s history as well as the patient’s risk factors.  These are the ingredients needed to improve code specificity and accuracy.   An outpatient CDI program can be used to incrementally improve physician documentation, over time.

Client Achievements

Exceeded the required 80% of physician participants meeting clinical documentation standards

Achieved 95% clinical documentation standards in the first 30-day period

90% improvement provider coding accuracy rate

nCREAS Analytics as a Service

nCREAS | Analytics as a Service

Targeted DRG

Analytical engine and processes designed to create revenue improvements

JTS’ patent-pending, nCREAS™ analytics solution pinpoints specific types of coding to assess the extent to which revenue is lost to incomplete or inaccurate coding.

Coding quality reviews are a valuable tool for educating both physicians and coders in an effort to improve coding quality, compliance and reimbursement. JTS’ team of trained coders can ensure optimal coding quality and reduce the potential of lost reimbursement, resulting in improved cash flow.

Analytics as a Service »

Targeted DRG Data Analysis

CC/MCC | Capture Rate

Comparison of data to CMS established benchmarks with analytics

Capturing complications and / or Co-morbidities (CCs) and major complications and / or co-morbidities (MCCs) are critical to the Clinical Documentation Improvement (CDI) and Coding program initiatives.  These conditions can affect Diagnosis Related Grouper (DRG) assignment which in turn, can affect:

  • increased Length of Stay (LOS) volumes
  • financial reimbursement for an organization and /or a physician practice
  • increased hospital admissions volumes

JTS analytics provides insight to ensure the capturing of essential and pertinent information to optimize reimbursement.

Analytics as a Service »

Telehealth Reimbursement Review

Expanded coverage related to Telehealth has been approved by most insurance payors due to the COVID-19 Public Health Emergency.   Because of this expansion, financial reviews of Telehealth claims will be conducted by payors to ensure services were administered and billed in accordance with payor requirements.

Telehealth

The Office of the Inspector General (OIG) has added this review initiative to its current Work Plan, and JTS can provide a thorough review of your organization’s telehealth claims to ensure compliance with payor reimbursement rules and regulations specifically for:

  • Evaluation and Management (E&M)
  • Clinical Documentation Improvement (and Integrity)
  • Coding Accuracy

Analytics as a Service »

Evaluation & Management | Physician Advisory |  Education & Training

For the first time since the 1990’s, The Centers for Medicare and Medicaid Services (CMS) made numerous changes to the Evaluation and Management (E&M) coding guidelines that began on January 1, 2021.  To help ease the transition, JTS Health Partners offers a three-phase process that utilizes a “peer-to-peer” approach, allowing for proficiency and mastery of the changes that enable the “trainers” to be on-sight experts.  The JTS team provides education through hands-on experience that may be conducted face-to-face or virtually.

Recommended phases to consider implementing:

  • Phase I | Conduct ‘Benchmarking Analysis’
  • Phase II | Develop ‘Knowledge Journey’ (peer-to-peer education)
  • Phase III | Develop ‘Sustainability Plan’ (i.e., implement regular audits applicable to E&M)

Client Feedback

See how JTS can optimize your

HIM Solutions