Ahead of the marcus evans National Healthcare CFO Summit 2020, read here an interview with Tracey Goessel on why physicians are needed alongside hospital coders to cover the gaps in inpatient documentation

1. Interview with: Tracey Goessel,
Co-Founder, FairCode Associates
LLC
“Hospitals need to bridge the gap
between physicians and hospital
coders,” advises Tracey Goessel, Co-
Founder, FairCode Associates LLC.
CDI programs alone only recover 25
percent of revenue lost to missed
documentation, but with a physician on
board, hospitals can get the full 100
percent, she explains.
FairCode Associates LLC is a service
provider at the marcus evans
National Healthcare CFO Summit
2020.
What are some of the hidden truths
in inpatient documentation that
physicians can uncover?
Physicians can see subtleties and
nuances that hospital coders are not
trained to capture. Was it a simple
appendectomy? Or did the physician
dissect and resect further into the
cecum, which changes the surgery to a
subtotal colectomy? Was it a biventricu-
lar pacemaker, or univentricular? That
matters. On the other hand, attending
physicians do not know – nor should
they have to know – the arcane coding
rules. A patient with endocarditis is
septic. Which comes first, which is the
principal diagnosis? Sepsis or endocardi-
tis? It depends whether it is a native or
a prosthetic heart valve. It is all very
complicated.
Vis-à-vis COVID-19, most physicians do
not know that they can establish the
diagnosis in the absence of testing.
Testing remains unreliable, unfortu-
nately, and is not always available.
Why do hospitals need to bridge the
gap between physicians and
hospital coders? How does it impact
reimbursement and bottom line
results?
It makes a huge difference to train a
cadre of physicians in coding rules, and
add them to the HIM team as a
resource. CDI programs alone only
recover 25 percent of the dollar lost to
missed documentation. Add a physician
and you get the full 100 percent -- a
4:1 gross ROI.
What assistance are you providing
to hospitals during the COVID-19
crisis?
The most important thing we did was
ignore our contracts. If hospital volume
had plummeted, we did not bill them for
contracted hours; we only worked as we
were needed. For a few months there,
we had a 41 percent dive in our
revenue. But we were not going to hold
hospitals to their contracts; they had
more than enough worries. Then, when
they were swamped with volume, we
dialed up in our review work. Our ROI
never decreased.
How can hospitals be more proac-
tive and prepare for the next
pandemic?
They have to bulk up their cash
reserves. They operate on such thin
margins. If they put in an aggressive
MD-based DRG audit program, they can
increase their cash flow and be ready
for the next rainy day. That, and have a
cache of PPE and a pandemic crisis plan.
Our company has been planning for a
pandemic since 2006, with annual
updates.
We had cash reserves, so no staffers
were furloughed, and we were in a
position to not force our hospital clients
to honor their contracts. Every person is
cross-trained to step in for someone
else.
We estimated that with over 100
people, we were statistically likely to
have at least one of our team out of
commission. Sure enough, one of our
top executives was on a ventilator in the
ICU, but happily he survived.
Physicians
can see
subtleties
and nuances
that hospital
coders are
not trained
to capture
The Hidden Truths in Inpatient Documentation
that Physicians Can Uncover

2. The marcus evans - Healthcare
Summits group delivers peer-to-
peer information on strategic
matters, professional trends and
breakthrough innovations.
Please note that the Summit is a
closed business event and the
number of participants strictly
limited.
About the National Healthcare CFO Summit 2020
The National Healthcare CFO Summit is the premium forum bringing senior level
finance executives and solution providers together. The Summit includes
presentations on navigating the legality and ramifications of new requirements,
enhancing your healthcare brand, proactively securing reimbursement, and
delivering a better and empathetic experience for the new consumer.
www.nhcfosummit.com
About FairCode Associates LLC
FairCode combines the domain expertise of experienced physicians with modern data science and analytics technologies. We bridge
the gap between your attending physicians and hospital coders. As a result, patient acuity and Case Mix Index is more accurately
captured; hospital reimbursement adjusts accordingly.
Physician-conducted medical chart reviews happen in real time, significantly impacting quality and bottom line results. From clinical
chart reviews to payor denial defense, our physicians and data scientists are a part the hospital team.
www.faircode.com
About marcus evans Summits
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To view the web version of this interview, please click here:
http://events.marcusevans-events.com/healthcarecfo2020-tracey-goessel
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