Close the Gaps in Your Coding Audit Workflow
Schedule a demo of hbRecon at the 2025 CHIMA Spring Meeting to learn how a new type of audit can help your health system:
- Identify hidden coding errors that are missed by claims-based audits
- Recover up to 11% of revenue from high-dollar cardiovascular (CV) procedures
- Foster collaboration between providers, coders, and clinical registry abstractors
- Drive proper reimbursement and accurate case mix index (CMI)
Claims Data Isn’t Enough to Verify Coding Quality
Claims-based coding audits have been the standard operating procedure for health systems — but these audits fail to comprehensively assess how accurately your coding team is capturing an episode of CV care. This is due to innate challenges at nearly every hospital and health system, including:
The sheer complexity of CV care and data nomenclature
Multiple sources of information that are not always accessible to coding teams
High volumes of claims to bill and submit in a timely manner
Siloes between providers, coding staff, and clinical registry abstractors
Insufficient Audits Create Discrepancies in Health System Revenue
As a result, many claims are submitted with discrepancies between what was coded and the services rendered. While technically “correct” by standard audit guidelines, countless revenue opportunities are missed or incorrectly coded, leading to:
Over-billing
Under-billing
Revenue loss
How Clinical Registry Data Bridges the Gap
Clinical registry data contains discrete data elements that provide the complete picture of an episode of care — from vital signs and diagnoses to procedures and outcomes — that may not be accessible or easily understandable for coding teams. Supplementing your auditing toolkit with a clinical registry-based coding audit can identify what billing opportunities were missed by the claims-based audit, either due to inadequate provider documentation or inaccuracies when clinical information was translated into coding data.
Discover hbRecon
Clinical Registry Data-Based Audits, Simplified
The hbRecon toolkit compares coding, clinical registry, and financial data side-by-side for the same episode of care, going one step further than claims-based audits to determine whether the codes sufficiently captured the patient’s care. This simple step, made possible by software-driven analytics, rapidly identifies discrepancies between these three datasets, helping CV billing departments understand how to re-bill or update clinical registry data.
How It Works
Three Steps to Revenue Recovery
Phase 1.
INTEGRATION OF CLINICAL REGISTRY, FINANCIAL & CODING DATA SOURCES
The clinical registry, financial & coding data sources must be integrated & aligned in the heartbase hbCOR platform via interfaces and/or extracts from the clinical data registry platform & the financial billing and coding system.
Phase 2.
HBRECON REPORT INVESTIGATION, REVIEW, & SUBMISSION
Once the data is aligned and integrated, the hbRecon toolkit can be immediately run against all complete & coded registry data. Heartbase will provide feedback and insight on a weekly basis during the investigation phase. Data is presented in a wide array of reports from DRG Summary Reports to ICD-10 Procedure & Diagnoses Detail Reports. Users have the flexibility of reviewing all relevant clinical registry and financial & coding data in one location.
Phase 3.
RECONCILIATION & PROCESS REVIEW
Cases are reviewed by the clinical team, and then submitted for secondary review by the hospital coding and compliance teams. This process will vary site to site, network to network. Ultimately there are four primary objectives: 1) Review Documentation & Coding, 2) Recode & Re-bill as Indicated, 3) Identify Outliers with Complex Coding, & 4) Reabstract Clinical Data, as necessary.
The Financial Impact of hbRecon for Health Systems
Case Study Results: Over $100,000 Recovered From 5 CV Rebills
Rebill Scenario #1: The impella was not coded, but was used intraoperatively. $39,133.37 difference between hbRecon Predicted DRG 219 and Hospital Coded DRG 246.
Rebill Scenario #2: The case was missing the CABG. $33,718.89 difference between hbRecon Predicted DRG 234 and Hospital Coded DRG 287.
Rebill Scenario #3: The AVR was not coded, case abstracted as a CAB+AVR. $14,678.66 difference between hbRecon Predicted DRG 216 and Hospital Coded DRG 234.
Rebill Scenario #4: The case did not account for the 4+ stents. $11,611.03 difference between hbRecon Predicted DRG 246 and Hospital Coded DRG 247.
Rebill Scenario #5: The PCI was only coded to a medical DRG. $17,043.43 difference between hbRecon Predicted DRG 246 and Hospital Coded DRG 280.
Why More Health Systems Are Leveraging hbRecon
Minimize Under- and Over-Billing
Correctly and comprehensively capture each episode of care to ensure accurate reimbursement and get paid properly for your services
Increase Your CMI
Accurately represent your patient acuity to increase your health system’s CMI for higher reimbursement rates
Hands-On Learning & Improvement
Hands-on workflows that help your team understand where discrepancies occurred and how they can be prevented moving forward
Foster Collaboration
Help providers, coding staff, and clinical registry abstractors understand how to set the other teams up for success and maximum reimbursement
Start Maximizing Accurate Revenue Capture Today
Schedule a demo of hbRecon to learn how clinical registry data-based audits can increase revenue, eliminate department siloes, and build a more efficient and profitable health system.
