Across the country, most of healthcare is dragging its feet when it comes to keeping up with privilege delineation or automation. In fact, there are still facilities using three-ring binders in an attempt to keep pace with advances and requirements in healthcare. If you’ve moved from the trusty three ring binder to an excel spreadsheet, congratulations, you’ve left the 1980’s behind but your facility is still a marathon or two away from harnessing the ability to educate providers or improve quality of care in a meaningful way. Moreover, every patient crossing the threshold of your facility risks receiving care from a potentially unprepared or unqualified provider.
Information available from another department, within your organization, that’s readily available and has the ability to deliver an enormous impact on quality metrics and performance across your entire organization are the ICD & CPT codes utilized for the services you render. If there’s any type of data readily available within a healthcare organization, it’s billing codes, for without them no revenue would be realized. This information is available today and waiting to be utilized to help healthcare organizations get well and recover from what it’s been missing, knowledge.
The ability to monitor and compare procedures performed against the billing codes submitted for care. What does that mean? You’re missing the ability to understand why the readmission rates of one provider are higher than those of another. You’re missing knowing whether a provider is qualified to perform procedures you’re allowing them to administer in your facility. Challenges caused by the never ending race to be first in an area of healthcare is not uncommon. However there is a great deal we can learn about ourselves and what we’re doing “for” or “to” our patients if we would simply utilize information we already have. Automating a process to map ICD/CPT codes to privilege criteria within your facility could accelerate improvement in your quality of care, reduce risk, increase reimbursements, exceed CMS requirements and reduce readmissions.
Jim serves symplr as the business development leader of Provider Management and Payor Enrollment. He brings more than 20 years of highly successful sales, marketing and consulting leadership to symplr. His team’s focus is to aid clients with the identification and resolution of gaps in current credentialing, privileging, peer review, quality, and event reporting programs. Jim’s insight into utilizing technology to create transparency and improve operational efficiency promotes overall improvement in provider and hospital performance; further aiding clients in meeting or exceeding compliance with governing body requirements such as CMS, JC, DNV, and CIHQ.