Introduction
Annually, over five billion dollars in medical bills are submitted to be processed and paid according to Litchman (2015). Due to the need for processing these large quantities of payment each year, it is essential that the entire process of handling the transaction is optimized to minimize the amount lost through the various errors that characterize the process. For this reason, effective and consistent coding is required in order to ensure that all the medical charges that are handled by the system are processed in a smooth, effective and reliable manner. Failure to observe the importance of coding in the optimization of the process of charging inpatient procedures, the health sectors risks losing a significant amount of money through the use improper or faulty coding.
Over the recent past, the rapid evolution of the Health Information Management (HIM) system has been largely credited to coding. The increased use of HIM in the industry has led to a subsequent increase in the complexity of the system and ultimately an evolution in coding. That is, the larger and more complex the system gets, the more increased its coding needs become. For instance, the growth and evolution of the HIM over the past few years has seen the change of its coding requirements from the use of the traditional Ambulatory Data Record (SADR) to the current Comprehensive Ambulatory/Professional Encounter Record (CAPERS) and the Standard Inpatient Record (SIDR). Despite the success of the latter coding systems, their successful use in the healthcare industry has proved challenging as its proper implementation and use requires the coders to possess some degree of knowledge in the medical field, especially for the commonly used terms such as pathophysiology, pharmacology and anatomy. This system utilizes clinical data alongside the guidelines and procedures for coding in order to assign correctly the proper codes.
Therefore, for the industry to reduce the quantity of money lost from the errors arising from the use of improper and inappropriate coding, the healthcare system should adopt the ACAPER coding method as it ensures accurate inpatient scheduling through the proper and comprehensive communication of the status of the patient, guaranteeing the correct billing codes for every patient.
Problem Statement
In order to correctly bill patients, their respective details must be captured and recorded in a proper and accurate manner. The need to capture and record every detail of the patient in an effective way is essential as the smallest mistakes in the capturing, recording and retrieving of such information may lead the provision of inaccurate information and the wrong bill for the wrong patient in the long run. As a result, the wrong patient bill generated due to the mistake made in any one of the above processes may lead to heavy losses for the healthcare provider, in the form of the money reimbursed from Medicare.
This, therefore, creates the need for accuracy in coding the detailed patient information. However, accurate coding alone cannot solve the problem as the accurate codes must additionally be correctly allocated after they are created. Therefore, identifying the most appropriate codes for different operations is equally important as creating these proper and accurate codes. In addition to creating and allocating the accurate and appropriate codes for the various functions, the codes must also represent the detailed and comprehensive information documented by the respective physicians. This has been an area of concern for some time as the medics in the different facilities have been urged to record the full and accurate scope of the condition of the patient (Scot, 2015). In fact, leading hospitals have in the past dedicated a significant share of their resources to multiple programs aimed at improving the record keeping of physicians as far as the details of the condition of their patients are concerned. Due to the importance of these details, such programs have seen the collaborations of doctors and coding experts to maneuver around the challenges presented by the technicality of some of the medical terminologies used in the documentation of the patients’ conditions. Understanding such terms is important for coders as it will enable them to accurately represent when coding, and subsequently assign the codes appropriately.
However, the collaborations have not been much successful as physicians continue to fail to take their time to record accurate and comprehensive conditions of their patients, as well as the recommended course of treatment for the different conditions. This, in turn, further complicates the work of the coding experts as they lack the specific information to be represented in their coding. Moreover, despite the ability of the coder to understand the intended communications by the physicians and medics, their attempt to represent the information based on their deductive abilities will be futile as the codes will fail to pass the tests required especially for codes associated with payment processing due to their poor documentation. The need for some insurance companies to merely focus on the compensations has further contributed to the poor record keeping that is the case throughout the industry. According to Wyman (2015), the medical service providers continue to emphasize the importance of adhering to the current guidelines governing the procedure of payment processing irrespective of the effectiveness and success of the procedures. As a result, the procedures in place continue to affect their cash flow as it lacks in accuracy.
Research Questions
This research will, therefore, mainly, seek to determine the effectiveness of CAPERS as the preferred coding method of choice for charging the medical bills of military personnel.