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:

  1. 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.
  2. 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.
  3. 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:
    1. Reviewing documentation and coding
    2. Re-coding and re-billing as indicated
    3. Identifying outliers with complex coding
    4. 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 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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.

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

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

Request a Demo Want to see how we can help you with collection and reporting?