Modus ONe
ModusOne “empowers physicians to solve the fundamental issues facing hospitals and clinics: inaccurate diagnoses, lower quality of care scores, and reduced reimbursement”. It is a way to ensure that we are coding at the highest level and best representing what is going on with our patients in our documentation.
Billing and coding is frustrating, but a necessary evil. Our business is low margin and many hospitals and systems are under financial strain. Piedmont is making a concerted effort to do a better job of capturing the complexity of the patients we serve to ensure the hospitals receive the optimal reimbursement.
We have sick patients, but our coding/billing doesn’t always reflect that. Although we should continue to put the patient first and focus on healthcare delivery above all else, the environment we are in with all the complexities and healthcare legislation necessitate we also focus on our documentation and how we code and bill. If Piedmont Healthcare does well it makes it easier for us to get things approved like office renovation, salary increases, new equipment, etc.
For coding and billing, the most important thing is what is in your progress note. If it is on the problem list but you did not import the problem list into your note or type that problem into your note then it cannot be used to support your level of billing
The Modus One team has shown that if we include problems that we often don’t add to our assessment that it can increase the DRG payment for the hospital. A couple of examples are hyponatremia and morbid obesity
The problem list is impactful because when you add certain problems it will generate care pathways
What does This mean?
You will attend a formal training to get the entirety of what it means, but in short there are certain diagnoses that if identified will yield higher reimbursement. These diagnoses can be seen on the pocket card below. What needs to be included is also on this card.
POA (Present on Arrival) - needs to be placed next to any problem listed on the problem card if it is present on arrival. For example, if someones sodium was 132 on arrival, you would but “Hyponatremia (POA)” on the problem list
See the pocket card below to study in detail what conditions are considered high yield and what must be included in order to properly document these conditions.
How do I know I’m doing it right
Periodically, the ModusOne team will go through and audit our charts and send a Diagnosis Accuracy Report. This lets us know the condition capture rate as well as individual provider accuracy rates at each hospital. They will also calculte a CMI gap; ModusOne Health calculates the CMI Gap by reviewing randomly selected charts for errors. Errors consist of omitted diagnoses and overdiagnoses. Omitted diagnoses can result in a higher CMI when captured. Overdiagnoses can result in a lower CMI when removed.
If you have any questions, please let the ModusOne physician leadership team know. You may contact them directly with questions at Feedback@ModusOneHealth.com.