Protecting, 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.
HIM Expertise and Services
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.
Audit 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:
- HIM Professionals
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
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
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.
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
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.
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
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.
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.
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.
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
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)
JTS Health Partners was instrumental with providing the support and back up we needed to eliminate our back log, allowing our staff to take a breather and focus on current cases. They have operated as a highly professional organization with openness and honesty. Their project management and expertise within our clinical system were excellent.
Mr. Ron Evans
Director of Revenue Integrity and Reimbursement
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JTS Health Partners has provided us with high quality service and outcomes related to our Siemens Soarian Financials Implementation and optimization efforts. JTS has been a consistent and dedicated parter/group of revenue cycle and health information management professionals through our journey so that we can maximize our technology investment.
Ms. Joanna C. Weiss
Vice President of Revenue Cycle
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JTS Health Partners came highly recommended and after a site visit, we were convinced their client-focused approach, their deep revenue cycle expertise and experience working with Soarian supported with some proprietary tools would be a great fit for Shepherd Center. JTS’s interaction with my team was professional and very organized from the very start. They were able to integrate themselves and adapt to our processes with ease. Their performance from start to finish was first-rate.
Ms. Pat Alford
Director, Revenue Cycle
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University of Utah Health Care recently underwent a change to the patient billing system, an implementation that encompassed both facility and professional billing. We partnered with Tom Stewart and JTS Health Partners to perform a risk mitigation analysis and create an action plan. JTS Health Partners was instrumental in helping us project the impact this implementation would have on our key performance indicators and create an action plan which would allow the organization to be proactive in dealing with billing/AR relate issues.
Mr. Clint Reid
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JTS Health Partners was instrumental with providing directin on our CPOE strategy. They have operated as a highly professional organization with openness and honesty. Their project management and physician adoption leadership and expertise within our Cerner clinical system were excellent.
Mr. Thomas M. Fisher
SVP / Chief Financial Officer
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JTS Health Partners is a highly professional organization with honesty and integrity. Their change management and informatino technology leadership and expertise within our Siemens Soarian Clinicals, POE, and Physician Adoptions projects were excellent. They truly operate as a ‘Trusted Advisor’ to our organization.