The Challenge
Manage Increasing Insurance Carrier Requirements to Submit Timely and Accurate BP/BMI CPTII Code Attestations
Several years ago, Gessler Clinic was confronted with increasing attestation requirements from regional insurance carriers and CMS related to Adult BMI Assessment – Ages 20-74, and Comprehensive Diabetes Care: BP < 140/90 metrics. A major change to measure weighting tripled the impact of BP metrics on Gessler Clinic’s overall quality scores.
The time involved in looking through patient records and pulling data up on thousands of BP codes manually took ½ to 1-full day, every day, for their billing department to manage. In addition, manual methods were prone to errors and/or omissions in required attestations.
The situation resulted in reporting gaps for payors and CMS, and inaccurate negative scores for Gessler Clinic. Gessler knew that maintaining current manual methods and processes was going to be unattainable for the organization, so they began an initiative to find an automated alternative to improve efficiency and increase their quality scores.
The Solution
Collaborated with a Trusted Vendor to Create an Automated Solution
Keena was a trusted vendor having worked successfully with Gessler Clinic on several workflow efficiency applications, interfaces and EHR upgrade projects. All with a focus on improving efficiency and care delivery.
When Keena and Gessler Clinic discussed their CPTII coding automation initiative, it was an easy decision to move forward with their solution.
Because of previous work together that included excellent communication and collaboration, the implementation of the Keena solution went very well and was live within several weeks.
The Result
The impact of Keena’s CPTII coding automation solution was felt almost immediately. The billing staff BP/BMI coding labor went down to nearly zero, allowing them to refocus their time on more productive activities. They also saw a time-savings and convenience factor for the provider team.
“Keena’s CPTII Coding Automation solution has saved Gessler Clinic scores of labor hours every month. The reduction in supplemental coding demands on our billing staff also trickles down to provide a positive labor savings for our providers. We were able to manage a 125% increase in required supplemental coding submissions over the past two years with very little impact on our billing team!
The automated program immediately resulted in BP/BMI metric gap closure, bringing our scores up with plans and increasing quality incentive reimbursement – all by avoiding mistakes and missed opportunities through automation.
Bringing a combination of unparalleled expertise, responsive communication, and excellent collaboration, Keena had us up and running with CPTII Coding Automation in a matter of weeks.”
Dan Rakes
Director of Informatics and Optimization, Gessler Clinic
Benefit to Organization
Gessler Clinic saw a dramatic decrease in the time required to accurately submit CPTII BP/BMI coding metrics through the Altera TouchWorks EHR system. Keena’s automated solution also led to the following organization-wide benefits:
- Gessler managed a significant increase in BP/BMI metrics, from 126,000 in 2019, to 283,000 in 2022 (a 125% increase) – without any impact on existing staff.
- Insurers/CMS scores and reimbursement levels improved and were maintained at consistently high levels.
- Gaps in attestation requirements were closed and coding and omission errors greatly reduced.
Benefit to Billing/Coding Staff
The coding staff recognized significant time savings, eliminating previously required chart pulls, record look-ups and error tracking/corrections from 1⁄2 to 1 full FTE per day, down to minutes.
These changes resulted in:
- Increased productivity freed up staff to be redeployed to other departmental priorities previously put on hold. The result was improved departmental operational performance.
- Errant and omitted CPTII coding metrics were significantly decreased resulting in organizational and departmental benefits.
Benefit to Providers & Staff
Keena’s CPTII coding automation relieved the tedious tasks of tracking down BP/BMI metrics when the billing team hit a dead end and allowed providers more time to focus on patients.
These changes resulted in:
- Consistent incremental improvements in patient care and quality scores.
- Compliance reports were generated for use by clinical department stakeholders to maintain quality performance over time.