CHICAGO, IL – We are excited to announce that heartbase™ is officially certified by the STS for the General Thoracic Surgery Database v5.26.1. On January 8th, 2026, at 2:30 pm CT, heartbase clinical specialist Carmen Ernst, RN, BSN, will hold a special training class covering the ins and outs of this version. Heartbase customers can click here to register.
From the STS website:
The STS General Thoracic Surgery Database (GTSD) is the largest and most robust clinical thoracic surgical database in North America. The GTSD contains nearly 800,000 general thoracic surgery procedure records and currently has more than 900 participating surgeons.”
Participation offers:
Integration & Interoperability with other heartbase hbCOR registry events.
Interoperability options from other hospital systems, such as Epic Clarity, to allow for the pre-population of discrete fields.
A comprehensively streamlined & customizable electronic DCF, improving upon the flow and functionality of the STS Online Tool, with options such as role-based access.
Simplified reporting with the hbQuery Tool, with measure reporting and other standard reports to follow.
Integration with the hbRecon Module to ensure GTSD cases are correctly coded and billed, maximizing reimbursement.
Planned hbAnalytics updates to include new dashboards and associated breakout reports.
If you’re an STS data manager or abstractor and would like to take a look at our new forms, please contact heartbase Director of Client Accounts Alex Potanos to schedule a review session.
About heartbase, Inc.
Heartbase™ is a privately-held company founded in 1992 and designed to be intuitive & centered on the needs of the clinician. Since our inception, we have known that the most effective way to develop a robust and reflexive software platform is through collegial partnerships with our clinical & financial users. Working directly with our customers – listening to their concerns and honoring their suggestions for improvement – allows us to build a tool that is fast, efficient, and tailored specifically to the individual needs of each healthcare institution.
For leading cardiovascular programs across the U.S., their custom heartbase workflow is a driver of success across the board. heartbase solutions like hbCOR, hbNote, and hbAnalytics streamline workflows, unearth actionable data, and unlock greater insights into the financial and clinical performance of their program.
Each heartbase solution was designed to have a powerful impact in a key area of cardiovascular (CV) data capture, reporting, and analytics. They work seamlessly together with hbRecon as the connective tissue that helps programs like yours do more with their data.
Follow along throughout this blog series, where we’ll explore how hbRecon works together with other heartbase solutions to unlock greater outcomes for your CV program. In Part 1, we’re covering how hbRecon is a perfect partner for hbCOR, heartbase’s solution for streamlined CV data collection.
hbCOR: Data Capture Made Simple
Every year, clinical data sets become increasingly complex. CV programs find themselves juggling more registry requirements than ever across various systems, and capturing it all can feel like a Herculean task—not to mention ensuring that the data is accurate and reliable.
hbCOR is the easier way to capture CV data. With support for submission and collection from every major CV registry, hbCOR arms your team with standardized, validated data they can trust at every step. Check out the features that are included with hbCOR below:
hbAudit: Data validation & pre-harvest checks. hbCOR’s hbAudit feature validates CV data as it is entered in real time, automatically flagging any entries that look incomplete or out of the ordinary. When it’s time for submission, hbCOR runs a pre-harvest check to ensure 100% accuracy before the data is passed downstream.
hbReporting & hbQuery: Pre-generated report templates & ad hoc reporting. hbCOR’s hbReporting feature houses an extensive library of clinically meaningful reports that the average user can run without any special knowledge. With hbQuery, clinical staff can easily generate reports on demand and access all clinical data points for a patient population over a specified time period.
hbInteroperability: Integrate clinical data from various IT sources. Between EMR, hemodynamics systems, billing software, and other sources, it can be tricky for CV programs to manage all of the data at their fingertips. hbCOR’s hbInteroperability feature automatically pre-populates data from these disparate sources, cutting down on the burden of data abstraction.
When CV clinical and coding datasets are not aligned, there’s six-figure revenue at stake—and it happens in CV programs across the country more often than you might realize. Clinical documentation often lacks the required specificity that coders need to appropriately code CV procedures, especially complications and comorbidities, leaving major reimbursement opportunities on the table.
hbRecon breaks down this costly barrier and helps clinicians and coders find alignment. Extrapolating your CV data allows hbRecon to recommend an appropriate MS-DRG code for the procedure, leading to more accurate revenue capture.
Clinical registry, coding, and financial datasets in one place. hbRecon consolidates all of the data needed for accurate billing, uncovering potential gaps in documentation. This thorough process reduces underbilling and overbilling by flagging discrepancies between clinical data and coding.
Cross-departmental collaboration. Clinicians and coders are often siloed, with neither having visibility into the other. heartbase facilitates communication between these two departments through monthly workbooks, emails, and meetings, to ensure both sides understand what the other needs to do their job efficiently.
Institutional enhancements. More accurate revenue often leads to a fortified bottom line, which many leaders reinvest in their CV programs. hbRecon is the first step toward hiring new staff, giving raises and bonuses, investing in new equipment, and other ways to move your program forward.
hbCOR + hbRecon: More Accurate Data, More Actionable Outcomes for Your Bottom Line
When data is reliable and accurate, your CV program’s bottom line flourishes. That’s the reality for the leading CV programs that lean on hbCOR paired with hbRecon.
On its own, hbCOR’s extensive data cleanup tools ensure that your CV registry is as accurate as possible from the earliest stages. When hbRecon is brought into the picture, it serves as a final audit, then uses that accurate registry data to correct and improve coding—and thus, your program’s ability to capture more accurate revenue.
Many heartbase customers use that improved revenue to justify improvements to their CV program. Take it from Kerry Webb, MBA, BSN, RN, an RN CV Quality Data Analyst at a healthcare network with more than 40 hospitals and care centers across the U.S.
“hbRecon has given us a different language to speak to our physicians and our stakeholders,” she shares. “We can talk in dollars and cents, so we can show the impact our program has on patient care. Getting new equipment, hiring the top talent, taking care of our people—it’s all on the table when we’re armed with data hbRecon gives us.”
hbCOR paired with hbRecon ensures that your registry and coding data are always in alignment—a critical factor in the event of a CMS audit. From boosting your bottom line to safeguarding your compliance, the combined hbCOR + hbRecon workflow is a winning combination for CV programs.
Unlock a Stronger heartbase Workflow
With hbCOR and hbRecon working together as part of a unified heartbase workflow, CV programs can rely on trustworthy, actionable data to impact their bottom line. Schedule your personalized demo to see how a heartbase workflow based on hbCOR and hbRecon can help your CV program flourish.
Cardiovascular (CV) physicians have a lot on their plates, but what they accidentally let slip through the cracks could be costing your CV program five- to six-figure revenue.
Clear, complete physician procedure/operative notes (Notes) that fully detail the services rendered for a cardiovascular procedure are the key to accurate reimbursement. Sometimes those Notes fall to the wayside during a particularly busy day. At other times, the physician simply isn’t aware that cataloging their experience has a direct correlation to the amount billed for the procedure.
Whatever the reason, hbRecon helps keep those critical details in focus for complete and accurate billing. Let’s follow along to see where a physician’s experience can get lost in the mix, from the procedure all the way through to coding and reimbursement.
The CV Procedure
A patient visits the hospital for a planned elective inpatient electrophysiology procedure – an Automatic Implantable Cardioverter-Defibrillator (AICD). During the procedure, the electrophysiologist implants the AICD, which functions as both a defibrillator and a pacemaker.
The procedure is a success, and the patient is discharged with no complications.
Unclear Procedure Note: The First Misstep
In the middle of their particularly busy day, the electrophysiologist hastily dictates their Notes on the procedure. Along with a brief overview of the services rendered, the electrophysiologist notes that the patient received a “pacer” or a “defibrillator pacer.”
The electrophysiologist submits their procedure note to the EHR and gets back to their busy day. Unfortunately, the lack of specificity in Notes means that accurate billing for the procedure has already gone off the rails.
Coding: Another Layer of Abstraction
Put simply, the coder’s job is to interpret the data they receive from the clinical team and assign a proper code that is used to bill the procedure. What physicians might not know is just how much room for interpretation their Notes can leave for coders.
Without explicit, crystal-clear Notes about every aspect of the procedure, coders are left to make reasonable assumptions about the services rendered, the intention behind those services, and other critical details that directly affect reimbursement.
In the case we’ve described here, there is one glaring point of ambiguity: the noted “pacer” or “defibrillator pacer.” While there is certainly room for CDI or Coding to issue a query to the provider in this instance, this is not always done.
There are several factors that contribute to an accurate code for pacers, including whether the device was newly introduced or a replacement, as well as the presence of complications or comorbidities.
Since those details weren’t clarified by the “pacer” or “defibrillator pacer” note, the coder in the case we’ve described reviews the clinical data available to them and settles on MS-DRG Code 262: Cardiac Pacer Revision Except Device Replacement without CC/MCC.
It’s a reasonable abstraction to make, but it unfortunately doesn’t represent that the device was actually an AICD.
Billing: The Financial Implications
Compared to coding, the biller’s job here is more straightforward. Billing considers the code recommended by coding and seeks reimbursement based on that code.
Unfortunately, the code that categorizes the device as a simple “pacer” rather than an AICD leaves a significant amount of money on the table — $15,000–25,000 per miscoded device, in fact. That money really adds up, like it did for Karen G. McNickle, RN, MSN:
“A few years back, we noticed that we weren’t getting our defibrillator cases coded correctly. We had 15 cases in one month that ended up being coded incorrectly. That got some real attention once we realized the lack of clarity in the physician’s notes.”
With that revenue, the hospital’s CV program could have saved toward new equipment or hiring a new staff member. However, due to the lack of clear communication between electrophysiologists and coders, that revenue is left on the table. That’s where hbRecon comes into play.
hbRecon: More Complete Clinical Data, More Accurate Billing
hbRecon helps clinicians and coders see eye-to-eye and provide an accurate, more detailed account of the services rendered. It integrates seamlessly into your existing heartbase workflows to present all the information about a CV procedure (clinical, coding, and financial) in one place, ensuring nothing slips through the cracks.
With hbRecon, clinicians can easily see how the Notes they provide have a direct impact on their CV program’s bottom line. It automatically identifies areas where greater specificity is needed, empowering clinicians to obtain the necessary clarification to assign the most appropriate DRG code and maximize reimbursement.
“We can’t take care of patients if we aren’t reimbursed appropriately,” says Karen G. McNickle, RN, MSN. “hbRecon gives us tangible evidence of the revenue we’re losing or could be capturing.”
The cost of ambiguous Notes is a tough pill to swallow, but hbRecon puts CV programs on a clearer, more profitable path. Schedule a brief demo of hbRecon to see how it can transform your own program’s bottom line.
When clinician documentation isn’t accurately captured in coding for cardiovascular procedures, it can spell a massive amount of lost revenue that could be funneled back into your CV program. hbRecon’s clinician-first approach ensures that reimbursement is based on the complete, accurate scope of the CV services rendered.
Without hbRecon: The Case of the Missing Impella
To see the impact of hbRecon’s clinician-first approach, consider the following scenario that occurred within a leading CV unit in the U.S.
A patient was admitted for a PCI with an aortic dissection, during which the PCI operator inserted an Impella device to stabilize the patient. The procedure was a success, and the patient was discharged with the Impella device in place.
The PCI operator noted the use of the Impella device in their procedure note, and passed it on to coding for reconciliation. Just one problem: the coder missed the Impella in the documentation — and that mistake shortchanged the bill by tens of thousands of dollars.
Therefore, the procedure was assigned a MS-DRG Code of 321, Percutaneous Cardiovascular Procedures with Intraluminal Device with MCC or 4+ Arteries/Intraluminal Devices. The account value added up to $24,362.30.
It’s important to note that coding an Impella can be difficult, as various use cases can involve an MS-DRG assignment of 1, 2, 215, or 216-221, depending on the approach, intended use, and device type. Typical coding challenges include:
Selecting the correct qualifier if the intent was intraoperative only
Understanding when to code the removal of the device, especially if the device is not removed prior to exiting the operating room
Coding the Impella CP 5.5 when inserted with a cut-and-sew with a graft
Let’s see how the situation changes with hbRecon in the mix.
With hbRecon: Accounting for the Complete Clinician Experience
One of the biggest benefits of hbRecon is that it empowers clinicians and the CV registry team to take an active role in how CV data is used for coding and billing purposes. It works by automatically reviewing the clinical registry data, which is abstracted from documentation found in the EHR, and identifying areas where information may be misinterpreted or missing entirely.
In the situation described above, the miscoding error was due to a failure of the coder to identify the Impella in the documentation. Education was provided to the coder to ensure the error wouldn’t occur in the future.
However, due to the complexity of Impella coding, it is not uncommon for the coders to miss key pieces of information in the documentation, such as the approach, due to the clinical jargon used in the procedure note. Large opportunities for revenue can come down to the clarity of the documentation and knowledge of the coder.
In this case, hbRecon automatically analyzed the provided CV data to flag that the Impella was missed. From there, the CV registry team provided the context of the Impella’s usage to ensure it was mapped to the correct MS-DRG.
Adding those critical details allowed the coding team to confirm and reassign the MS-DRG Code from 321 to 215 (Other Heart Assist System Implant) to the account, representing that the PCI operator implanted a heart assist system. Together with the original MS-DRG Code, the account value was accurately reassessed to $85,394.30 — a $61,032.00 boost in reimbursement.
Without hbRecon
With hbRecon
DRG Code
321 – Percutaneous Cardiovascular Procedures with Intraluminal Device with MCC or 4+ Arteries/Intraluminal Devices
215 – Other Heart Assist System Implant
Account Value
$24,362.30
$85,394.30
Results: hbRecon uncovered an additional $61,032.00 in reimbursement
Keeping Patients in Focus
hbRecon raises awareness so that CV clinicians can better understand how their documentation is interpreted and used toward reimbursement, facilitating the conversation between clinicians and the coding team.
It’s not just dollars and cents on the line. hbRecon’s clinician-first approach captures accurate revenue commensurate with the CV services rendered. CV programs, like yours, are using that extra revenue for the greater good.
“The simple fact is that nurses aren’t trained to be coders,” shares Karen McNickle, RN, MSN. “CV data can feel like just numbers on a spreadsheet if you don’t understand how it fits into the bigger picture.”
“hbRecon reminds us that the data we pass to coding can improve outcomes for the patients in our community. It helps us accurately document the severity of our patients’ illnesses and receive appropriate financial compensation to pour back into improving our CV program.”
Put Clinicians First With hbRecon
When clinicians ensure that their full experience is accounted for in reimbursement, patients and CV programs alike prosper. Schedule a brief demo to see how hbRecon can put your CV clinicians in the driver’s seat for more accurate revenue capture.
Reliable clinical registry data management is at the heart of any cardiovascular program. While collecting data through abstraction and reports and integrating it with coding can feel like a well-oiled machine, many leading cardiovascular programs are unaware of a gap that could be costing them six-figure revenue.
The gap? Clinical registry data and coding teams often speak different languages.
hbRecon: Opening the Door for More Accurate CV Coding
hbRecon, a complement to hbCOR, bridges that gap. It translates clinical data into a specific and actionable coding format to identify a DRG code that more accurately captures the nature of the care provided.
Here’s how hbRecon integrates into your existing heartbase workflow:
Data integration. hbRecon integrates data in its custom platform to create a unified dataset. This includes integrating clinical data with hospital coding and financial information to accurately reflect the care provided.
Report generation and review. heartbase provides feedback and insight on a weekly basis and presents a wide array of reports, from DRG Summary Reports to ICD-10 Procedure & Diagnoses Detail Reports.
Reconciliation and process review. This step gives the clinical team a chance to review the cases and submit them for secondary review by the hospital coding and compliance teams, if needed. This process varies site-by-site, but its four primary objectives are:
Reviewing documentation and coding
Re-coding and re-billing as indicated
Identifying outliers with complex coding
Reabstracting clinical data, as necessary
Following this integration, your clinical data will “speak the same language” as your coding team to capture revenue more accurately than ever before. The implications for your CV program’s bottom line can’t be understated.
hbCOR: A Solid Foundation for CV Data Collection
Of course, a strong clinical registry data management system starts with a solid foundation. hbRecon is most effective when paired with hbCOR’s ability to unify clinical data from every major CV registry. Using a single comprehensive repository, clinical teams can easily access a complete picture of a patient’s cardiovascular history.
With hbCOR, the following CV Registries are all in one convenient location:
The American College of Cardiology NCDR (ACC-NCDR)
The Society of Thoracic Surgeons Database (STS)
The American Heart Association Get With The Guidelines (AHA GWTG)
Extracorporeal Life Support Organization (ELSO-ECMO)
State Registries (CCORP, COAP, IHA, and more)
Custom Registries
Additional benefits include:
Simplified data collection: Reduce the burden of manual data collection with hbCOR’s advanced interoperability.
Real-time data validation: Leverage immediate pre-harvest data validation for completeness, accuracy, and compliance.
On-Demand Reports & Scorecards: Access the following reports and scorecards.
Ad Hoc Queries
MD Scorecards
Complications & Outcomes Reporting
Equipment Analysis
AUC & Risk Scoring
and more!
With the partnership between hbRecon and hbCOR in place, many leading CV programs turn data into actionable insights that boost financial performance, including improvements in the Case Mix Index (CMI).
Improved Financial Outcomes from CV Data Collection
While hbCOR and hbRecon can be employed independently, this iterative work between the two platforms – available in one seamless heartbase workflow – can have a profound impact on your cardiovascular program’s bottom line. By facilitating more accurate data transfer between clinical registry and coding, the addition of hbRecon helps CV programs with:
Reduction in overbilling and underbilling: hbRecon runs real-time data analysis to identify and rectify coding discrepancies. That leads to more precise DRG assignments that reduce over- and under-billing. Improved reimbursement rates: Integrating clinical registry data and coding with hbRecon results in more accurately reflected episodes of care. The result is reimbursements that are commensurate with the care provided, which isn’t always a given. Consistent performance improvement: Clinical registry data-based audits deliver actionable insights that build momentum for cross-departmental initiatives focused on addressing specific challenges, ultimately leading to efficiencies that save costs.
See hbRecon in action and discover how it captures six-figure revenue.
You’ve already built the foundation for better CV data management with hbCOR. Schedule a demo to discover how integrating hbRecon can make your data more accurate and actionable to transform your CV program’s revenue capture.
CHICAGO, IL – As of June 10th, 2025, we are excited to announce that heartbase™ is officially certified by the ACC-NCDR for Version 1.4 of the LAAO Registry Database.
On July 23rd, 2025, at 12:00 pm CT, heartbase clinical specialist Carmen Ernst, RN, BSN, will hold a special training class covering the ins and outs of this registry module. Heartbase customers can click here to register. Heartbase staff highly recommends that hbCOR users attend this session or view the recording.
For customers wanting to learn more about this module, Alex Potanos will host a general information session on June 27th at 3 pm CT as part of the heartbase Virtual User Conference. Please click here to register.
From the ACC-NCDR website:
“Get the support you need to ensure quality patient care for your atrial fibrillation patients with the American College of Cardiology’s LAAO Registry™.
Join the first national registry capturing data on left atrial appendage occlusion procedures to assess real-world procedural outcomes, short and long-term safety, comparative effectiveness and cost effectiveness. LAAO provides a treatment option to manage stroke risk for non-valvular atrial fibrillation patients who are unable to maintain adequate anticoagulation through medication therapy.”
Participation offers:
The LAAO Registry is approved by the Centers for Medicare and Medicaid Services (CMS) to meet the registry requirements outlined in the national coverage decisions for Percutaneous Left Atrial Appendage Closure.
Integration & Interoperability with other heartbase hbCOR registry events.
Interoperability options from other hospital systems, such as Epic Clarity, allow for the pre-population of discrete fields.
A comprehensively streamlined & customizable electronic DCF, improving upon the flow and functionality of the ACC Online Tool, with options such as role-based access.
Simplified reporting with the hbQuery Tool, with measure reporting and other standard reports to follow.
Integration with the hbRecon Module to ensure LAAO procedures and associated MCCs are correctly coded and billed, maximizing reimbursement to MS-DRG 273, 274, & 317.
Planned hbAnalytics updates to include new measure reporting and associated breakout reports.
About heartbase, Inc.
Heartbase™ is a privately-held company founded in 1992 and designed to be intuitive & centered on the needs of the clinician. Since our inception, we have known that the most effective way to develop a robust and reflexive software platform is through collegial partnerships with our clinical & financial users. Working directly with our customers – listening to their concerns and honoring their suggestions for improvement – allows us to build a tool that is fast, efficient, and tailored specifically to the individual needs of each healthcare institution.
Our primary major business lines are the following: hbCOR, Data Capture & Reporting; hbAnalytics, Realtime Clinical & Financial Dashboards; hbRecon, Coding Reconciliation & Revenue Generation; & hbNote, Data First Structured Reporting.
In cardiovascular (CV) services, and today’s healthcare landscape as a whole, achieving seamless collaboration across departments is a necessity. Unfortunately, many healthcare organizations struggle with structural & data silos, inconsistent communication, and disjointed processes – this heavily impacts their ability to streamline coding data. Outsourcing coding audits to a trusted partner not only provides a powerful solution to these challenges, but it facilitates compliance, higher quality healthcare, and invaluable interdepartmental collaboration.
Before an Audit: The Challenges
Inconsistencies Impede Ability to Hit Quality Benchmarks
Quality clinical registry benchmarks provide CV services with a method to compare performance to other similar providers and identify areas of improvement. By obtaining consistent & accurate coding data, healthcare organizations can ensure alignment between these two datasets and reduce reporting errors from systems that rely on coding data. This, in turn, leads to more informed changes rooted in evidence-based care. Unfortunately, without a clinical registry data-based audit performed in partnership with a trusted CV data partner, many organizations face significant roadblocks that stand in the way of collaboration and quality improvement efforts, such as:
Data Silos: Tracking data in silos across teams leads to inconsistencies in data reporting and makes it challenging to gain a unified view of patient outcomes and system-wide performance.
Inconsistent Quality Metrics: Inconsistent metric tracking across various departments can lead to confusion and misaligned priorities, hampering the ability to identify and address system-wide CV trends that need intervention.
Fragmented Communication: While a coder who has worked with the same provider for many years may understand shorthand or abbreviations, confusing notes and ineligible provider handwriting can still make it difficult for coders to decipher a provider’s EMR notes. Because many coders likely find it uncomfortable to approach a busy provider to ask for clarification on a specific note, coders may try to guess what the provider meant. Unfortunately, that usually results in more work long term. A clinical documentation improvement (CDI) process, or program, may help minimize these errors by checking coding data for an accurate reflection of the patient’s condition. By engaging in this exercise, practices proactively address any mistakes that may stand in the way of proper reimbursement.
Missed Opportunities for Improvement: Healthcare organizations rely on coding data to inform performance improvement and maintain quality benchmarks. In the absence of robust clinical registry-driven data analysis and reporting, it’s more challenging to make informed decisions about improving care processes, which can negatively impact patient outcomes and financial performance.
Coder Turnover: Coders not only experience a steep learning curve, but they must keep up with constantly evolving payer requirements. High turnover in the field only makes it more difficult for departments to keep up with these changes and avoid denials. Furthermore, there are 11,000 CPT codes for coders to learn, 225 new codes added in 2023, 75 deleted, and 93 revised. In fact, anesthesia represented the only section of the coding guidelines the American Medical Association didn’t change that year.1
After an Audit: The Benefits
Data-Driven Decision-Making Leads to Actionable Insights
Organizations that introduce clinical registry data-based audits with hbRecon experience more clarity, structure, and accountability – primarily driven by our tool’s intense focus on interdepartmental collaboration. In fact, after an audit using hbRecon’s three-phased approach rooted in integration, investigation, and reconciliation, many CV practices experience the following advantages:
Reliable, Centralized Data: One of the most valuable outputs of an audit with hbRecon is the consolidation of data from disparate systems into one single platform. This allows all departments to access consistent information, eliminates discrepancies, and enables unified decision-making.
Crystal Clear Accountability and Transparency: The hbRecon audit involves developing standardized metrics that support comprehensive reporting. This enables departments to clearly see how their contributions impact overall outcomes and builds a sense of shared responsibility.
Matching Goals and Priorities: Rather than making sense of disparate goals and priorities, the audit process brings departments together to establish common quality benchmarks and objectives that set everyone on the same path toward the same goals.
Uplevel Communication Channels: hbRecon fosters cross-departmental communication between clinical and coding teams, fostering a more collaborative environment built in proactive and effective dialogue that is open and constructive so issues can be addressed before they escalate.
Consistent Quality Improvement: Clinical registry data-based audits deliver actionable insights that build momentum for cross-departmental initiatives focused on addressing specific challenges.
Seamless Collaboration: By weaving clinical registry data-based audits into the fabric of organizations, departments learn to trust one another and work together seamlessly, creating lasting partnerships that extend beyond the scope of the audit.
While clinical registry data-based audits provide outsized benefits in terms of compliance, they are also catalysts for cross-departmental collaboration and long-term improvement. In today’s complex healthcare environment, a trusted CV data partner can be the difference between hitting quality benchmarks or falling short.
Given the collaborative nature of our clinical registry data-based audits, we inherently help CV teams build transparency, alignment, and communication around coding data. But the results of these types of audits don’t stop at hitting quality benchmarks – they produce a culture that benefits patients and your bottom line.
It’s all about collaboration.
References:
HFMA. Common coding challenges hospitals face and how to fix them. HFMA. Published August 7, 2023. https://www.hfma.org/revenue-cycle/coding/common-coding-challenges-hospitals-face-and-how-to-fix-them/
Accurate revenue capture is crucial to protecting your bottom line, improving financial performance, and reducing the risks of audits and penalties. Most importantly, it informs strategic decision-making around pricing, investments, and resource allocation that drives future profitability of cardiology services and revenue cycle optimization. While claims data has traditionally been the method of choice for coding audits, relying solely on claims data for comprehensive coding audits brings several limitations.
Limitations of Claims Data in Healthcare Audits Claims data comes from the information healthcare providers submit to insurance companies for reimbursement. Each data source includes details about procedures performed, diagnoses, medical prescriptions, and associated costs.
However, there are limitations to relying solely on claims data for revenue capture, primarily rooted in the following coding quality issues that many cardiovascular providers face today1:
Difficulties Keeping Pace with Changing Payer Requirements: Health insurers continually update and change coding requirements. For example, a new guideline for implanting a pacemaker may suddenly become available, and if the coding team isn’t up-to-date on the latest requirements, the claim could be denied.
Challenges Managing Coding Complexity: The range of CPT codes for cardiovascular procedures ranges from minimally invasive to complex surgical, and The American Medical Association changes CPT codes every year.1 It’s important to consistently revisit codes to ensure accurate coding and limit denials.
Unclear Communication with Providers: Illegible handwriting or hard-to-decipher notes in EMRs make it difficult for coders.1 Coding can be further muddied by inputs from multiple providers, as well as physician notes lacking in clinical detail.
Poor Provider Coding Education: Providers may not fully understand the importance of accurate coding to the organization’s financial bottom line, making it crucial to educate providers on the necessity of using accurate codes and communicating with coders.1
Privacy: Patient privacy protections may limit the amount of information that can be included in claims data and – as a result – difficult to rely on claims data for revenue insights.
High Turnover for Medical Coders: In 2023, coders took the lead as the most difficult group to hire in the billing office.2 Managing high staff turnover and the associated learning curves only exacerbate coders’ already challenging jobs of tracking changing payer requirements, coding complexity, and learning provider communication styles.
Revenue and Compliance Issues as a Result of Coding Gaps
Coding gaps can produce several revenue and compliance issues, including:
Overbilling: Overbilling, a revenue and compliance issue, may happen when a coder accidentally uses multiple codes instead of a single code for a procedure, potentially putting themselves at risk for insurance fraud.3 hbRecon reduces overbilling through its ability to identify plausible miscoded DRGs and maximize procedure coding with higher or lower-weighted DRG codes where appropriate.
Missed Reimbursement Opportunities: A service, procedure, or condition (a CC or MCC) during a patient encounter being left out of a claim due to a missing code or skewed data can lead to a loss in revenue. hbRecon’s phased approach to integrating clinical registry and claims data results in increased reimbursement driven by identified factors in clinical registry data.
Faulty Re-Bill Processes: Faulty rebilling occurs when a claim is rebilled due to a medical or coding error. In Phase 3 of the hbRecon integration – reconciliation and 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 from site to site and network to network, but one of the primary objectives of this is to recode and re-bill as indicated by the findings.
The Importance of Comprehensive Medical Coding Audits for Heart Care
These challenges with claims data collection due to coding gaps, and subsequent pitfalls in revenue and compliance, point to the necessity of undergoing comprehensive coding audits that can successfully identify coding gaps in cardiovascular care and address them to support revenue cycle optimization.
However, claims audits focused on financial data inherently miss the other side of the coin – clinical registry data.
hbRecon maximizes accurate revenue capture through the integration of hospital clinical registry & coding data sources. Through this integration, hbRecon can identify cases where coding may be incorrect and identify thousands of dollars in services per case that would have otherwise gone unbilled. With claims data, if conditions are not coded, such as Acute Heart Failure, it is not possible to identify them. With clinical registry data and hbRecon, we can extrapolate those values, maximizing the revenue capture.4
Because clinical registry data uses discrete data elements that contain detailed clinical information about patients, diagnoses, procedures, and outcomes, and claims data uses a coded data source that includes details about procedures performed, diagnoses, medications prescribed, and associated costs, hbRecon provides a more comprehensive and accurate assessment of healthcare quality, outcomes, and financial performance. The hbRecon platform then employs an algorithm to determine a recommended DRG code using this combined dataset.
The higher levels of specificity produced by hbRecon lead to improved revenue capture through more accurate documentation and coding through education and process-improvements; enhanced quality and efficiency of care delivery; and a better reflection of patient acuity, all of which benefit the cardiovascular population.
hbRecon: The Combined Impact of Combining Clinical Registry Data with Claims Data
hbRecon’s integrated approach to coding audits is a valuable tool for increasing revenue capture as it relies on both the discrete data elements found in clinical registry data as well as the coded data sources found in claims data.
Is your healthcare organization ready to discover alternate revenue streams through the hbRecon toolkit? Our platform can integrate clinical registry and coding data sources to algorithmically analyze and determine recommended billing codes and identify probable coding mismatches and rebilling opportunities.
CHICAGO, IL – We are excited to announce that heartbase™ is officially certified by the ACC-NCDR for Version 3.0 of the EP Device Implant Registry (EP-DI) Database.
On January 29th at 12:30 PM CT, heartbase clinical specialist Carmen Ernst, RN, BSN, will hold a special training class covering the ins and outs of this version. Heartbase customers can click here to register. Heartbase staff highly recommends that users attend this session or view the recording.
From the ACC-NCDR website:
“EP Device Implant Registry™ establishes a national standard for understanding patient characteristics, treatments, outcomes, device safety and the overall quality of care for ICD/ CRT-D and select novel pacemaker procedures, while also delivering benchmarking data. Participating facilities can submit data for pacemaker procedures or submit data for ICD/ CRT-D procedures or submit data for both. The registry plays an important role in providing data-driven knowledge for optimizing patient care.”
Participation offers:
Integration & Interoperability with other heartbase hbCOR registry events.
Interoperability options from other hospital systems, such as Epic Clarity, to allow for the pre-population of discrete fields.
A comprehensively streamlined & customizable electronic DCF, improving upon the flow and functionality of the ACC Online Tool, with options such as role-based access.
Simplified reporting with the hbQuery Tool, with measure reporting and other standard reports to follow.
Integration with the hbRecon Module to ensure EP-DI cases are correctly coded and billed, maximizing reimbursement.
Planned hbAnalytics updates to include new measure reporting and associated breakout reports.
If you’re an EP-DI data manager or abstractor and would like to take a look at our new forms, please contact heartbase Client Account Manager Alex Potanos to schedule a review session.
About heartbase, Inc.
Heartbase™ is a privately-held company founded in 1992 and designed to be intuitive & centered on the needs of the clinician. Since our inception, we have known that the most effective way to develop a robust and reflexive software platform is through collegial partnerships with our clinical & financial users. Working directly with our customers – listening to their concerns and honoring their suggestions for improvement – allows us to build a tool that is fast, efficient, and tailored specifically to the individual needs of each healthcare institution.
Our primary major business lines are the following: hbCOR, Data Capture & Reporting; hbAnalytics, Realtime Clinical & Financial Dashboards; hbRecon, Coding Reconciliation & Revenue Generation; & hbNote, Data First Structured Reporting.
Accurate documentation and coding are crucial for patient care and financial sustainability in the ever-evolving healthcare landscape. For conditions like heart failure, precise capture of complications and comorbidities (CC) and major complications and comorbidities (MCC) play a significant role in payer reimbursement.
In recent years, changes in inpatient coding, including ICD-10 and Diagnosis Related Grouper (DRG), have had an increasing impact on hospitals’ bottom lines. Reimbursement payments for patient care with complications or comorbidities are substantially higher. For example, reimbursement for heart failure and shock with MCC is approximately twice that for heart failure and shock without CC or MCC.1 Physician documentation plays a key role in ensuring accurate diagnosis coding, which in turn is crucial for billing, reimbursement, and quality reporting across all healthcare providers.2
With heartbase’s hbRecon, a multitude of cases were uncovered in which the patient’s acute heart failure coding was incorrect, identifying thousands of dollars in services per case that would have otherwise gone unbilled.
Enhancing Heart Failure Detail Capture for Optimal Revenue Generation
Clinical registry data represents one of the most detailed and accurate hospital procedures or event records. Due to this dataset’s extreme granularity and complexity, it is challenging for coders to analyze and consume this information accurately without a process to audit the record and receive assistance from the clinical team.
hbRecon Client Success Stories
Discrepancies in coding led to incorrect classifications and subsequent billing errors for the three example patients below. hbRecon leveraged standard (STS Adult Cardiac Registry and ACC-NCDR CathPCI) and custom clinical registry data elements to collect and capture Acute and Acute on Chronic HF conditions and, after detailed reviews and corrections by the registry & coding teams, the accounts were properly classified, resulting in significant differences in reimbursement for each patient.
The importance of improved reimbursement through accurate coding cannot be overstated. Here are three examples of a coordinated audit uncovering incomplete coding and associated potential revenue loss. hbRecon plays a crucial role in identifying potential billing errors by isolating commonalities between clinical registry and coding data – automatically flagging potential mismatches and fostering cross-departmental communication.
Three Examples of Improved Reimbursement with Complete Capture and Coding
Patient #1
In the STS Adult Cardiac Registry dataset, a patient undergoing coronary artery bypass graft (CABG) with mitral valve replacement was documented as having Acute on Chronic HF, which should have grouped the account to MS DRG 219. However, the coding data did not include any specified HF code. After a detailed review by the registry site manager, they flagged the documentation in a physician consult note stating “acute on chronic congestive heart failure.” The coding was then updated to properly classify the account, resulting in a positive reimbursement difference of $19,471.00 at that facility.
Patient #2
Within the ACC-NCDR CathPCI Registry dataset, a patient was clinically abstracted as having CV Instability Type – Acute HF Symptoms, which would likely group the account to MS DRG 246. However, the coding data indicated HF as chronic only. A query was opened, which confirmed the patient’s condition as “acute on chronic systolic + diastolic CHF,” a discrepancy from the discharge summary. The coding team promptly rectified the error, regrouping the account from MS DRG 247 to MS DRG 246. This correction resulted in a significant difference in reimbursement, amounting to $7,058.00 at that facility.
Patient #3
Within the STS Adult Cardiac Registry dataset, a patient was marked as having acute HF for CABG (without cardiac catheterization or open ablation), which should group the account to MS DRG 235. However, the coding data does not specify any HF. Upon further review by the registry site manager, they located the specific documentation on a physician-scanned document wherein “acute HF” is documented. After reviewing this documentation that was placed into the EMR post-discharge, coding made the necessary changes to regroup the account from MS DRG 236 to MS DRG 235. As a result, there was a difference in reimbursement of $24,776.65 at that facility.
Each of these claims uncovered by hbRecon underscores the pivotal role of accurate coding for cardiac services and the difficulties in fully capturing the services provided during each episode of care. hbRecon, with its ability to provide a more detailed audit based on clinical registry data, can significantly reduce under- and over-billing, accurately reflect patient acuity and case mix index (CMI), and ensure all available reimbursements are collected. By steadily improving coding quality and fostering interdepartmental collaboration, hbRecon empowers health systems to optimize revenue capture for their cardiac services.
Complete Capture and Coding with hbRecon
Accurate capture of CC and MCC in patients with Acute or Acute on Chronic Heart Failure is not just a matter of compliance but a critical component of effective healthcare delivery. By focusing on thorough documentation and continuous education, healthcare systems can optimize revenue, improve patient outcomes, and contribute to the overall quality of care. As the healthcare landscape continues to change, staying informed and adaptable will be key to success in managing these complex patient populations.
Want to learn more? Schedule a demo to discover how hbRecon can improve the profitability of cardiac services in your health system.
