ACE REACCREDITATION
Q. What are the potential consequences
of poor documentation?
“
ACE reviewers provided guidance and a
framework for standardizing our cath lab reporting system and improving our documentation.
Poor cath lab documentation [can lead to] being misclassified by payers as a
‘high-cost provider.’”
Ms. Reed: From the
business development
perspective, the biggest risks of poor documentation in the cath
lab include being misclassified by payers as
a “high-cost provider”
or being misunderstood as having high
complication rates.
One example of how
this can happen relates to the correct documentation of renal insufficiency versus
renal failure following catheter-based procedures.
The immediate impact of incorrect documentation is financial, as reimbursement
rates for managing the same event in the
same patient may differ substantially depending on whether it is coded as renal
insufficiency or renal failure. The real
difference, however, is how coding the
same event will affect quality metrics.
From a safety perspective, the Centers for
Medicare and Medicaid Services (CMS)
considers renal failure to be a complication of cardiovascular procedures. Each
documented episode of renal failure contributes to the complication rate for the
facility. Therefore, if an event is going to
be documented as renal failure, it is critically important that it meets a welldefined threshold of clinical severity.
In the near future,
cath labs with poor
documentation
habits may run into
trouble as payers
increasingly embrace performance
-based reimbursement models.
We’ve seen a trend
where payers are
quick o adjust their
internal benchmarks to align with
new guideline recommendations
each time the ACC/
AHA/SCAI clinical guidelines are updated.
Right now, the question of whether payers
will adopt AUC standards is an area of controversy and concern for many in the field.
We are not at all worried about how this
will play out, because we are already on
that journey. Personally, I believe public
and commercial payers are going to adopt
AUC and other quality measures that tie
reimbursement to performance. As a result of the ACE review process, we are
already implementing the highest standard for documentation, and we will be
prepared to demonstrate how our procedures meet the AUC for coronary revascularization and diagnostic catheterization.
Q. How would you talk to payers about
the value of ACE accreditation?
Ms. Reed: We are vocal about the fact
that we are ACE accredited, and we invite
payers to look at the accreditation require-
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