Clinical coding, data quality and financial assurance

Transcription

1 Clinical coding, data quality and financial assurance

2 THE LARGEST PRIVATE PROVIDER OF HEALTHCARE CLINICAL CODING, DATA QUALITY AND COST IMPROVEMENT SERVICES IN THE UK. Accurate clinical data and cost information is vital for holding healthcare providers to account for the care they deliver, funding that care in a fair and appropriate manner, and ultimately ensuring value for money for the tax payer. We form ongoing relationships with the people and groups we partner with, built on trust, and the effectiveness of the services we provide. Through integrated programmes of analysis, audit, and advisory services we help healthcare providers and commissioners ensure that clinical data and cost information accurately reflect patient care. We also provide clinical coding services and support to help providers get their data right first time. We have unrivalled experience of working with national and local healthcare bodies to improve the quality of healthcare information, having delivered over 2,000 audits, assessing over 350m of payments. Our services include: Clinical coding Data audit and payment assurance Costing services Contracting services Benchmarking and analytics 3

3 CLINICAL CODING We are the main private provider of clinical coding services for the NHS and independent sector, offering a range of services to support NHS and private healthcare providers to deliver high quality clinical coding. We provide scalable clinical coding services to produce accurate coded data in a timely, efficient, and effective manner. Our services range from short-term coding support to outsourced service delivery, through to innovative approaches for remote and automated coding. This flexible approach allows you to make the best use of budgets and resource. Our experienced staff are fully qualified expert coders proficient in coding all areas of healthcare, who work within rigorous quality controls to ensure all our outputs meet the highest IGT requirements. Working with CHKS has improved our coding which in turn means our data quality is much higher. Our coding error rate is less than 4%, which compares favourably with the NHS average of between 7 and 9%.This is very important when it comes to assuring our commissioners that we are invoicing for the right activity. As a result we are being paid more promptly. Six years ago we had a 60 day debt figure of in excess of 28 million and that figure now sits at around 8 million for a business twice the size. Martin Rennson, Director NHS Business - Spire Healthcare. We also work in partnership with providers to help improve coded data: Clinical coding audit to support IGT requirements and to ensure payment accuracy Query resolution providing access to a national organisation with expert, in-depth and up-to-date knowledge of coding practice Process reviews ensuring the processes in place support efficient and accurate coding, and providing innovative ideas on coding delivery Documentation reviews and clinical engagement ensuring source information is complete and enables accurate coding Clinical coding training our TAP approved HSCIC trainers provide a wide range of training, mentoring and coder assessment services to help develop coding team capability 5

4 DATA AUDIT AND PAYMENT ASSURANCE We are the main provider of data quality audits and reviews to the NHS and private healthcare sector, working with both providers and commissioners in health economies to improve the quality of data. We provide an independent and authoritative view to assure senior managers, commissioners and regulators that health care data is accurate for payment and all its other uses. Our audit and assurance programmes ensure that patient information is coded, recorded, classified and reported in line with national guidance and local expectations so that contracts and payments accurately reflect the care delivered. The quality of the team s work and the robustness of the judgments was exactly what we were looking for, but the most important aspect of the review for us as commissioners was that the Trust s senior clinicians agreed with the findings. Matt England, Head of Contracting and Commercial Strategy, NHS Wakefield Clinical Commissioning Group Our experienced auditors and data quality consultants have experience of over 2,000 audits at every acute trust in the country. We engage directly with clinicians and service leads to ensure clinical buy-in to our findings. Our reviews cover all aspects of care delivery, and recent work includes: Clinical coding audits Zero length of stay (0LoS) emergency admissions Mental health clustering Maternity pathways Day case vs. outpatient classifications Outpatient procedures District nurse data A&E Critical care 7

5 COSTING SERVICES We support the NHS in producing and making the best use of accurate cost information, enabling trusts to make informed decisions about the effectiveness and efficiency of the services they deliver. Costing data provides business intelligence on the activity a hospital delivers, how much income is generated by each service, how much those services costs and, most importantly, why they cost what they do. The CHKS team helped us review our costing and clustering data. The provided assurance around the work that we are doing and gave us opportunities to learn. The final report was both useful and positive. It reinforced our understanding around areas of good practice but also confirmed areas where we needed to focus our efforts to improve. James Duncan, Director of Finance and Deputy Chief Executive, Northumberland and Tyne and Wear NHS Foundation Trust We worked with NHS Improvement during the development of their new costing standards and also in delivering national audit programmes, where we tested the governance, and the accuracy of cost information at NHS trusts. We bring that insight to support trusts deliver world-class costing in an ongoing and sustainable manner. Our services include: Engagement and efficiency programmes we are experienced in engaging with clinical teams around cost information, supporting organisations to unlock the knowledge within detailed cost data to increase efficiency and reduce unwarranted clinical variation Costing support our knowledgeable and experienced staff use learning from across the NHS to help trusts implementation patient level costing systems and increase the accuracy of their cost information Audit and assurance we provide independent and trusted assurance on the accuracy of costing data and processes so trusts can be confident they are making informed decisions about your services 9

6 CONTRACTING SERVICES We have worked with health economies for over ten years to support the effective implementation of the payment system. Overall system sustainability is dependent on ensuring that organisations are appropriately reimbursed for services they provide within the current national financial framework and the proposed future frameworks of capitation budgets. We support health economies to resolve system issues relating to the cost of care within tightening financial constraints. Our services include: Contract negotiation and mediation independent third party support to contract negotiations between the trust and commissioner to ensure contracts are set at a realistic level that takes into account improvement plans, and facilitate shared ownership of financial cost of care across the health economy Service sustainability reviews detailed reviews of whole services, within trusts and across whole health economies, comparing the true cost of care against the income received to establish whether services are viable within current configurations and contract arrangements, and identifying alternative approaches to commissioning, delivering and funding care Tariff setting working with healthcare organisations to set accurate and appropriate local tariffs, covering all activity at mental health providers, or discrete services such as clinical decision and assessment units at acute trusts. We make sure tariffs reflect the care being delivered, and are transparent and justifiable to ensure buy-in from internal and external stakeholders 11

7 BENCHMARKING AND ANALYTICS An excellent robust piece of work that stood the test of arbitration. Lynn Matthews, Head of Contracting, NHS Luton Clinical Commissioning Group We have a proven track record of analysing payment and healthcare data. The intelligent use of analytics under-pins all our services. Our analytics and data quality teams developed the PbR National Benchmarker, and continue to use this knowledge to support local organisations to assess the quality of activity and cost data to identify where improvements are necessary. We provide tailored analytical support packages from a comprehensive review of all coded data that provides assurance to senior managers on the depth of coding at a trust to supporting an integrated audit programme identifying areas for improvement for local NHS staff to investigate and address. Some of our recent work includes: Benchmarking of coded data sophisticated casemix and depth of coding reviews will identify where coding can be improved, or where poor source documentation is resulting in under-coding and under-payment Payment data reviews covering all areas, including A&E, outpatient and non-tariff areas, focusing on data quality, payment accuracy and the impact of service delivery on income Contracting analysis such as the application of the non-elective thresholds, reviews of local tariffs and specialised commissioning activity Linking costs and quality we also support hospitals to improve the value of their services by linking quality and outcome measures with cost data through our value triangle 13

8 OUR CLIENTS We partner with commissioners, acute trusts, mental health and community providers, as well as independent healthcare providers to guarantee that data and payments exactly reflect the care delivered. We form ongoing relationships with the people and groups we partner with, built on trust and the effectiveness of the services we provide. Come from all sectors of the health service in all four UK NHS health economies. Commissioners we support clinical commissioning groups and commissioning support units to make sure the contracts and payments made to providers accurately reflect patient care, and to provide transparency and assurance of the contracting process. Many organisations include our independent reviews as part of the contract setting process, taking the heat out of contract negotiations through a credible and independent view on data quality and payment accuracy Acute trusts - we have a proven track record of working in partnerships with acute trusts to ensure payment is accurate and appropriate for the care delivered. We provide invaluable support to clinical engagement to help improve the efficiency and quality of services and our integrated audit programmes provide assurance to boards, commissioners and regulators that services are sustainable and funded appropriately Mental health and community providers - we support trusts as they move away from block contracts and seek to improve the data underpinning their services. We help develop currencies and set local tariffs that are credible and robust, ensuring trusts are paid appropriately for the care they deliver Independent sector we have a long history of working with the independent and private sector, not only supporting the accuracy of coding for the care they deliver on behalf of the NHS but also supporting data recording and payment accuracy for private healthcare. We also maintain the CCSD schedule of procedures on behalf of the four main insurers 15

9 For more information please get in touch CHKS Unit 6190 Knights Court, Solihull Parkway, Birmingham Business Park, Birmingham B37 7YB