hbRecon maximizes accurate revenue capture through the integration of hospital clinical registry & coding data sources. Utilizing this combined dataset, the hbRecon platform algorithmically analyzes and determines a recommended Diagnosis Related Group (DRG) code.

Clinical registry data represents one of the most detailed and accurate records of a hospital procedure or event. Due to the extreme granularity and complexity of this dataset, it is extraordinarily difficult for coders to analyze and consume this information accurately without a process to audit the record and receive assistance from the clinical team. hbRecon facilitates that process by translating the clinical data into the level of specificity a coder would need, automatically flagging potential mismatches, and fostering cross-departmental communication between clinical and coding teams.

Please note: hbRecon is a separate toolkit from the hbAnalytics platform, powered by IBM-Cognos, as these reports and processes are not run into the hbAnalytics engine. However, they work in unison and query/use overlapping data sources.

The hbRecon Phased Approach

  1. Phase 1.

    Integration of Clinical Registry, Financial & Coding Data Sources

    The clinical registry, financial & coding data sources must be integrated & aligned in the heartbase hbCOR platform via interfaces and/or extracts from the clinical data registry platform & the financial billing and coding system.

  2. Phase 2.

    hbRecon Report Investigation, Review, & Submission

    Once the data is aligned and integrated, the hbRecon toolkit can be immediately run against all complete & coded registry data. Heartbase will provide feedback and insight on a weekly basis during the investigation phase. Data is presented in a wide array of reports from DRG Summary Reports to ICD-10 Procedure & Diagnoses Detail Reports. Users have the flexibility of reviewing all relevant clinical registry and financial & coding data in one location.

  3. Phase 3.

    Reconciliation & Process Review

    Cases are reviewed by the clinical team, and then submitted for secondary review by the hospital coding and compliance teams.This process will vary site to site, network to network. Ultimately there are four primary objectives: 1) Review Documentation & Coding, 2) Recode & Re-bill as Indicated, 3) Identify Outliers with Complex Coding, & 4) Reabstract Clinical Data, as necessary.

Key Features

Reduction of both under and overbilling through the automated identification of plausible miscoded DRGs & maximizing procedure coding with higher or lower-weighted DRG codes where appropriate.

Alignment of the clinical registry, coding, and financial datasets in a unified and reconciled platform, which leads to the following improvements: 1) development of an actionable and operationalized model to report, reconcile, and re-bill; 2) increased reimbursement driven from identified factors in clinical registry data; 3) identification of possible overbilling situations; 4) predictable audits from federal, state, and registry bodies; and 5) standardized clinical documentation as hbRecon reports will uncover possible gaps in documentation leading to process evaluation and refinement.

Increased accuracy of clinical data through secondary audit opportunities of clinical registry data during the reconnaissance and reconciliation phases. Heartbase reviews the annual CMS Final Rule and makes necessary adjustments to hbRecon, ensuring scenarios are always in alignment with changes to the DRGs and ICD-10 code exceptions.

Side-by-side review of clinical registry data alongside coding & financial data during data entry with push-button reports.

The hbRecon data model continually evolves as new registry datasets and coding scenarios are added, meaning the algorithm will continually identify new opportunities for increased reimbursement.

Promotion of an ongoing partnership between clinical & coding departments fostering a newfound understanding and appreciation of coding and data registry abstraction processes.

Example hbRecon Scenarios

  • Rebill Scenario#1: The impella was coded as assistance only, but it was inserted.
  • Automated hbRecon Mismatch Findings: The impella was coded as assistance, but an additional code for the insertion was missed. Coding added that procedure code.
  • Recommended hbRecon DRG Assignment: 215 – OTHER HEART ASSIST SYSTEM IMPLANT
  • Was the Case Recoded & Rebilled:  Yes.
  • Monetary Value of Recommended Change: Increased value of case, $77,316.60 versus $19,874.00 – a positive difference of $57,442.60.

  • Rebill Scenario#2: The case was missing the CABG.
  • DRG Assignment as Found in Coding System: 263 – VEIN LIGATION & STRIPPING
  • hbRecon Mismatch Findings:  The case was missing the CABG, and the associated detailed proved that out. The coder added 021109W & 02100Z9.
  • Recommended hbRecon DRG Assignment:   235 – CORONARY BYPASS W/O CARDIAC CATH W MCC
  • Was the Case Recoded & Rebilled:  Yes.
  • Estimated Value of the Rebill:  Increased value of case, $35,494.00 versus $14,154.60 – a positive estimated difference of $21,339.40.

The whole team at Heartbase are great to work with! They all take the time to listen and ask the right questions to make sure we are supported in the best way possible.

Kerry Webb, RN BSN, CV Quality Data Analyst

Solution FAQ

Yes. Heartbase imports coding, cost, and charge data from the hospital’s billing system. The linked data is available from the heartbase hbAnalytics & hbRecon platforms, allowing immediate feedback on the measures and coding mismatches that significantly impact your hospital’s bottom line. View reports by various financial parameters, including Direct Cost, Contribution Margin, Procedure Cost, Case/Mix Index, Severity of Illness, & more.

Heartbase clients obtain a return on investment in the following ways: 1) Coding Reconciliation and Rebilling with hbRecon; 2) Process Improvements through the Merged Clinical + Financial hbAnalytics; 3) Automation of Abstraction Data via Interfaces & Extracts; & 4) IT Savings through heartbase Report Development and Application Support & Maintenance. Contact sales@heartbase.net to see how heartbase can provide your facility with a positive ROI.

Heartbase leverages the fantastic granular clinical registry data to generate a predicted DRG. Heartbase also incorporates custom data elements wherever gaps exist in the standard registry data.

The CV Registry Team has a unique set of skills with a deep understanding of clinical registry data and the ability to communicate the data to various audiences. While hbRecon will flag easily actionable scenarios, there are instances where documentation from a provider is insufficient, or the data abstraction is incorrect. The CV Registry Team is equipped to work with CDI and the providers to improve documentation and ensure those mismatches are corrected.

Heartbase reviews the annual CMS Final Rule and makes necessary adjustments to hbRecon, including hierarchical changes to the DRGs and ICD-10 code exceptions.

Savings vary site-to-site. However, based on recent estimates, the average savings for ACSD cases range from $3K to $14.5 per case, and CathPCI cases range from $350 to $6,500K per case. Outliers include Impella and ECMO/Trach cases, as those cases are weighted and reimbursed at a much higher rate.

Customer Support

heartbase® is relationship-driven and prides itself on its comprehensive and personalized support, as our users can testify. Our solutions are 100% vendor-supported, meaning routine technical support, version upgrades, maintenance, training in database operation, and standard report writing are included with purchase. 

Our US-Based Support staff is accessible by phone, email, or through our online support ticket system, and provides timely and effective solutions to client requests. From assistance during a rapidly approaching data deadline, to educational sessions or customization, our support staff will be at your side every step of the way.

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