Objective

HCRS was tasked by the Veterans Health Administration (VHA) with providing coding support and auditing services for VISN 7 facilities, while ensuring cybersecurity and HIPAA compliance.

Background

VHA

VHA currently captures and stores information for all inpatient and outpatient care delivered at VISN 7 facilities, as well as other facilities on VISN 7 expense. This information — including diagnoses, treatments, and providers — is stored by all VA facilities in an integrated computer system known as VistA: the Veterans Health Information Systems and Technology Architecture. 

The value of this coded data for managers and researchers depends on how accurately it portrays the actual clinical events that take place in each medical center. Data validity begins with practitioners providing timely and complete medical record documentation, including an accurate recording of all diagnoses and procedures. 

VISN 7

• $4.5 billion annual operating budget
• 1.2 million veterans served
• Fourth largest healthcare network in the VHA
• 7.6 million outpatient visits and 33,000 hospital admissions per year

Key Strategies

Our team was responsible for dialing into each VISN 7 network to access data, interpret it, and apply the correct medical codes for it to be integrated with VistA. In addition to training required by the VA, we mandated instruction specific to cybersecurity. In six and a half years of performance, we did not encounter any violations for either cybersecurity or HIPAA compliance.

Results

Our annual remote coding production met or exceeded both the 95% accuracy standard and three-day turnaround time requirement, all while averaging:

• 200,000 outpatient encounters/year
• 9,000 inpatient records/year
• 5,000 ambulatory surgery cases/year

Our Methodology

We achieved these results through our risk management planning, which included:

• A dedicated project manager and deputy project manager.
• A dedicated quality assurance team.
• Hiring 30 experienced medical coders who were certified by the American Health Information Management Association (AHIMA) and/or the American Academy of Professional Coders (AAPC).  
• Documenting the operational framework across the enterprise, as well as each of the eight VA facilities.  
• Documenting each facility’s business rules/SLAs.
• Developing “coding cookbooks” based on the coding nuances of each facility.
• Relentless staff instruction.
• Staff flexibility and cross-training to accommodate daily workload changes.