heartbase News & Events | Cardiovascular Data Collection

Posted on July 29, 2025

hbRecon: The Clinician-First Solution for CV Reimbursement

A medical team converses in a hospital hallway, providing guidance and support in a healthcare environment.

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.

Demo hbRecon

Posted on July 10, 2025

Strengthening CV Outcomes with Merged Clinical & Coding Data – from Registry Submission to Revenue Capture

A doctor typing on a laptop, focused on their work in a clinical setting.

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.

Download Case Study

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.

Posted on June 16, 2025

Heartbase, Inc. Certified in ACC-NCDR LAAO v1.4

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.

Posted on February 20, 2025

It’s All About Collaboration: The Transformative Power of Clinical Registry Data-Based Audits

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/

Posted on January 22, 2025

Coding Audits in Cardiovascular Care: Why Claims Data Isn’t Enough

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.²Managing 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.³hbRecon 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.

Schedule a discovery call today: https://www.heartbase.net/social-discovery-call

Sources

1. Conifer Health Solutions. (2023, August 7). Common coding challenges hospitals face and how to fix them. Healthcare Financial Management Association. https://www.hfma.org/revenue-cycle/coding/common-coding-challenges-hospitals-face-and-how-to-fix-them/

2. MGMA. (2023, March 23). Bottom line impacts from revenue cycle staffing challenges. MGMA. https://www.mgma.com/mgma-stats/bottom-line-impacts-from-revenue-cycle-staffing-challenges

3. Physicians Revenue Group. (2024, August 26). What is Unbundling in Medical Billing? | PRGMD. Physicians Revenue Group. https://prgmd.com/what-is-unbundling-in-medical-billing/

4. Enhancing CC and MCC Code Capture: Three Real-World Scenarios for Maximizing Reimbursement Revenue. (2024, November 25). heartbase. https://www.heartbase.net/news/2024/11/25/enhancing-cc-and-mcc-code-capture-three-real-world-scenarios-for-maximizing-reimbursement-revenue/

Posted on January 9, 2025

Heartbase, Inc. Certified in ACC-NCDR EP-DI v3.0

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.

Posted on November 25, 2024

Enhancing CC and MCC Code Capture: Three Real-World Scenarios for Maximizing Reimbursement Revenue

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.

Sources:

1. Gluckman, T. (2020). Trends in Diagnosis Related Groups for Inpatient Admissions and Associated Changes in Payment From 2012 to 2016. JAMA. https://doi.org/10.1001/jamanetworkopen.2020.28470

2. CDIP, MCC, CC, HCC: The Road to Better Revenue. AAPC. https://www.aapc.com/blog/25741-cdip-mcc-cc-hcc-the-road-to-better-revenue/

Posted on October 10, 2024

Heartbase Certified in ACC-NCDR AFib Ablation v2.0

CHICAGO, IL—As of September 30th, 2024, we are excited to announce that heartbase™ is officially certified by the ACC-NCDR for Version 2.0 of the AFib Ablation Registry Database. This registry begins with October 2024 discharges, and for the first time offers the ability to track follow-up visits. Heartbase Users, please contact Support@heartbase.net to schedule your upgrade today!

From the ACC-NCDR website:

“The AFib Ablation Registry™ assesses the prevalence, demographics, acute management and outcomes of patients undergoing atrial fibrillation (AFib) catheter ablation procedures. Its data supports the development of evidence-based guidelines for AFib treatments that will improve patient outcomes.”

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 standard reports to follow.
Pending integration with the hbRecon Module to ensure AFib Ablation cases are correctly coded and billed, maximizing reimbursement.

About heartbase, Inc.

Since 1992, heartbase™ has provided health care centers with the most technologically innovative and clinically intuitive data management and analytic solution in the industry. Working collegially with its immense network of users, heartbase™ has created a vast library of reporting tools that provides its clients with complete control of their hospital-owned clinical data. Heartbase’s revolutionary hbCOR platform propels clinical performance, aligns clinical data with registry requirements, and unites health care systems from across our network to the most comprehensive reporting repository in the industry.

Posted on August 1, 2024

Real User Insights: Evaluating the Impact of hbRecon at Three Hospitals

Discrepancies between coding data and clinical registry data can significantly impact reimbursements in a cardiac services department — yet many health systems are unable to recognize these missed revenue opportunities without a comprehensive coding audit.

The hbRecon solution was selected by the following three hospitals to help identify and resolve these discrepancies in their cardiac services billing departments. Here, we share their experiences and explore how hbRecon’s clinical registry data-based audits helped build a more profitable and efficient cardiac services department in each organization.

Evaluating the hbRecon Impact: Explore Three User Experiences

1. How does your hospital use clinical registry data?

Jerod Weimer, Bakersfield Memorial Hospital: We use the registries to measure, monitor, and improve our patient care and outcomes.

Kerry Webb, Chandler Regional Medical Center and Mercy Gilbert Medical Center: We use our data for measuring performance, quality goals and performance improvement.

Beth Kennalley: To measure and monitor clinical performance, quality goal performance, and performance improvement activities.

2. What do you find most valuable about collecting registry data?

Jerod Weimer, Bakersfield Memorial Hospital: The ability to keep our “finger on the pulse” of the systems involved in our patient care and program performance.

Kerry Webb, Chandler Regional Medical Center and Mercy Gilbert Medical Center: The data helps to identify any processes that may need to be improved and usually end up uncovering other things that can use improvement.

Beth Kennalley: Identifying performance opportunities and excellence.

3. How has hbRecon fit into your current processes and workflows?

Jerod Weimer, Bakersfield Memorial Hospital: hbRecon has allowed us to expand the awareness and performance of our documentation and interdepartmental working relationship by closely tying the clinical data to the administrative data.

Kerry Webb, Chandler Regional Medical Center and Mercy Gilbert Medical Center: It fits in looking at and reviewing the data when I have a chance. Sometimes, it is right after it is uploaded, and other times, it takes a week or two.

Beth Kennalley: hbRecon is a monthly review of any abstraction and coding differences on both our Open Heart and CathPCI cases, and has taken less and less time as we have improved performance in both areas. It allows me to quickly and accurately review both data sets to ensure they accurately reflect the case that was performed.

4. What do you find most valuable about using hbRecon?

Jerod Weimer, Bakersfield Memorial Hospital: hbRecon’s most valuable impact has come from increased accuracy in both clinical and administrative documentation.

Kerry Webb, Chandler Regional Medical Center and Mercy Gilbert Medical Center: hbRecon has helped identify documentation issues on the physician’s end. It has also helped our coding team to improve their system when it or the people are combing through the charts.

Beth Kennalley: The ability to compare two independent chart abstractions is invaluable but would take too much time to do manually to be useful. This tool allows us to do this and find multiple errors in a short amount of time, and to submit this information for correction in a timely manner. The tool has allowed us to be reassured that our billing is accurate in these areas.

Realize These Financial and Operational Benefits in Your Organization

Each of these hospitals’ experiences highlights the critical importance of accurate coding for cardiac services, as well as the challenges of comprehensively capturing the services provided during each episode of care. The hbRecon toolkit equips health systems with a more granular audit based on clinical registry data to reduce under and over-billing, accurately reflect patient acuity and case mix index (CMI), and drive proper reimbursements. Through step-by-step improvements in coding quality, with a core focus on enhancing interdepartmental collaboration, hbRecon is helping health systems maximize accurate revenue capture for their cardiac services.

Want to learn more? Schedule a demo to discover how hbRecon can improve cardiac services profitability in your health system.

Posted on June 10, 2024

The Case for hbRecon: Comparing Clinical Registry Data and Claims-Based Auditing Tools

Learn how integrating claims-based audits with clinical registry data-based audits like hbRecon provides more actionable insights to optimize financial and clinical performance.

Conducting coding audits is crucial for healthcare organizations in maintaining accurate billing, compliance with regulations, revenue integrity, and quality improvement. In turn, audits provide insight into optimizing coding practices, ensuring the delivery of the highest-quality care, and identifying missed opportunities for appropriate reimbursement. When performed more granularly, audits allow for optimizing the coding processes, accurately capturing all eligible services and procedures while minimizing financial and legal risks.

Historically, claims-based audits have been the standard practice; however, registry data-based audits provide an alternative, nuanced insight into each episode of care and associated event. While claims-based solutions utilize billing data to investigate the revenue cycle journey, hbRecon uses clinical registry data, which provides unique insights into uncovering coding errors that lead to missed revenue opportunities.

The Difference Between Clinical Registry Data and Claims Data

So, how do clinical registry data and claims data differ? Clinical registry data and claims data are valuable information sources in the healthcare industry, but they serve different purposes and have distinct characteristics.

Clinical registry data from sources such as the American College of Cardiology (ACC), the Society of Thoracic Surgeons (STS), Extracorporeal Life Support Organization (ELSO), the American Heart Association (AHA), and State Organizations (COAP & CCORP), includes discrete data elements that contain detailed clinical information about patients, diagnoses, procedures, and outcomes. It is particularly useful in auditing the clinical processes and outcomes of specific medical procedures or conditions.

On the other hand, claims data refers to information collected from insurance claims submitted by healthcare providers for reimbursement purposes. This coded data source includes details about the services provided, such as procedures performed, diagnoses, medications prescribed, and associated costs. However, information for each claim is limited, and it doesn’t capture all aspects of a person’s treatment or health – many things must be inferred.¹

Expanding Your Toolkit for Effective Auditing

Both clinical registry data and claims data are instrumental in medical data auditing. Claims data is typically used for financial audits and to assess the appropriateness and accuracy of billing and reimbursement practices, aiming to ensure coding accuracy, compliance with payer requirements and regulatory standards, and integrity of the submitted claims data. On the other hand, clinical registry data provides deeper clinical insight to determine if the claims’ codes appropriately represent the services provided and diagnoses assigned, revealing any missed opportunities for revenue capture due to miscoding. This increased specificity allows auditors to assess adherence to clinical guidelines, identify variations in care, and evaluate patient outcomes.

When segregated, the audits’ data sets lose efficacy. For example, a claims-based audit may determine the claim’s coding to be accurate, but this audit alone cannot determine if additional, necessary coding was omitted due to insufficient provider documentation or missteps in translating clinical language into coding language, especially around MCC and CC conditions. However, clinical registry data-based audits, analogous to the hbRecon-based audit, can reveal potentially missed diagnoses and/or treatment codes, reducing the risk of undercoding or missing revenue opportunities.

The integration of both audit types provides a more comprehensive and accurate assessment of healthcare quality, outcomes, and financial performance. With this synergistic approach to healthcare delivery, it’s possible to ensure that both clinical and financial aspects are aligned and optimized. This is where hbRecon’s use of clinical registry data in conjunction with claims data in the audit process demonstrates its distinctive superiority when uncovering errors in revenue capture.

Harness the Power of Clinical Registry Data With hbRecon

When it comes to revenue capture, the following factors demonstrate why clinical registry data offers superior results:

Clinical Specificity and Coding Accuracy. hbRecon analyzes clinical registry data with detailed discrete & structured clinical information about a patient encounter, including diagnoses, procedures, treatments, and outcomes. This level of specificity allows for an accurate and comprehensive comparison of the services provided and the services billed, leading to improved revenue capture.
Comprehensive Data. Clinical registry data often includes information beyond what is captured in claims data. It may include additional clinical measures, patient-reported outcomes, and quality indicators that provide a more comprehensive view of the patient’s condition and treatment. One clinical registry module alone can warehouse over 2,000 data elements in a single visit. With the hbRecon toolkit, this additional information can support accurate documentation and coding, leading to improved revenue capture.
Quality Improvement. Clinical registry data is often used for quality improvement initiatives, clinical research, and benchmarking. These activities focus on optimizing patient outcomes and care processes, which can indirectly impact revenue capture by enhancing the quality and efficiency of care delivery. hbRecon allows users to review all relevant clinical registry, financial, and coding data in one location.
Patient Acuity. This is where hbRecon’s use of clinical registry data shines again, capturing a better picture of the patient’s acuity – because if the coding is wrong, patients may appear healthier or sicker – lending to a more accurate CMI. From there, hbRecon translates that into the associated diagnosis-related group (DRG) code, adding a CC or MCC when applicable. This benefits the cardiovascular population by better reflecting their actual patient acuity, CMI, and severity of illness, which makes way for appropriate quality improvement initiatives and medically indicated clinical research, ultimately enhancing patient outcomes and care processes.
Beth Kennalley, a quality professional with one of hbRecon’s major hospital clients, shared what she found most valuable about implementing hbRecon in terms of efficient and accurate billing: “The ability to be able to compare two independent chart abstractions is invaluable but would take too much time to do manually to be useful. This tool allows us to do this, find multiple errors quickly, and promptly submit this information for correction. The tool has reassured us that our billing is accurate in these areas.”

Beth shared that hbRecon’s monthly review of abstraction and coding differences has taken less and less time, and her organization has improved performance in both areas. Efficiency is critical to her ability to quickly and accurately review both data sets to ensure they accurately reflect the case performed.

hbRecon: Translating Clinical Data for Coding Specificity

hbRecon’s phased approach for clinical registry data auditing is a valuable tool for increasing revenue capture with its unique clinical registry and coding data dataset, providing detailed and specific clinical information about patient encounters, allowing for accurate and complete coding based on the documentation of services provided.

Schedule a discovery call today: https://www.heartbase.net/social-discovery-call

Sources

MIT OpenCourseWare (Dec 13, 2018) 4.3.3 Healthcare Costs – Video 2: Claims Data https://www.youtube.com/watch?v=WYrDTn37m-I