Case Study: Center for Specialty Surgery Gets Documentation, Coding Right From Day One with ProVation® MD Software

Business Profile: Center for Specialty Surgery

In 1933, just as orthopedic surgery was emerging as a medical specialty, Dr. Harry Blair founded the Orthopedic and Fracture Clinic in downtown Portland, Oregon, and quickly built a national reputation for their pioneering work in the new field. Ever since then, the clinic has been at the forefront of orthopedic medicine, committed to providing its patients with exceptional care and comfort, as well as the latest in technical innovations. As the demand for orthopedic services grew, it was a natural progression for the clinic to open its own Ambulatory Surgery Center (ASC) to accommodate the high volume of outpatient surgeries, and in Fall 2003, the Center for Specialty Surgery (CSS) opened its doors.

Dedicated to outpatient orthopedic and pain management procedures, CSS was designed to offer immediate patient access, a more efficient facility and increased patient satisfaction. The CSS management team was determined to get things right from the get-go - from the facility design to top-of-the line instruments to replacing outdated dictation and transcription processes with ProVation® MD clinical documentation and coding compliance software.

A Grand Opening

CSS Administrator Tina Caster knows all too well the costs of medical transcription. As Clinical Coordinator for the Orthopedic and Fracture Clinic, she had overseen all the facility's business office functions, including documentation, coding and billing, and she was determined to find a more cost-effective system for the surgery center. "If you're going to start a new facility, you should start right," she says. "We'd run some numbers on projected transcription costs for the surgery center and were looking at about $50,000 - $75,000 annually."

Her search for an alternative eventually led to ProVation MD Software for Orthopedics and Pain Management. The software enables the center's surgeons to create highly detailed, multimedia operative notes with associated coding. As the physicians use the software to quickly create the procedure note, the software's powerful coding engine generates the associated codes. By linking clinical terminology with the right CPT/ICD codes and CCI Edits, the software produces coder-ready procedure notes, and delivers coding compliance, correct reimbursement, and shortened days in accounts receivable.

Eliminating Costs and Delays

The Center for Specialty Surgery opened its doors in November 2003, and almost immediately started documenting procedures with the ProVation MD software in workstations located outside the two ORs and one pain procedure room. Caster attended Power User training at ProVation® Medical headquarters in Minneapolis, and acts as an onsite resource for the physicians who have questions or concerns while using the software. And although the learning curve is a significant one, she states that the center's physicians have become quite adept at using ProVation MD.

Aside from the elimination of transcription costs, one of the biggest benefits CSS has seen from the software is the immediacy of the finished documentation. "The referring doctors appreciate having instant access to reports," Caster attests. "In a sense, we see the ProVation system as a marketing tool - being ahead of the technological curve and offering quick, complete procedure notes with images is a plus for us. It's another service we can provide to patients and referring physicians."

Compliant Coding, Complete Documentation and Faster Billing

Lisa Smith, the Billing Specialist who handles coding and billing for both the surgery center and Orthopedic and Fracture Clinic, where transcription is still used, sees a quantifiable difference in the coding and billing time between the two facilities. "Overall, the surgery center's coding process is faster and more efficient," she says. "In general, we receive same-day procedure notes that are already finalized and signed. With transcription, that process can take up to a week depending on

The software's coding engine generates the associated CPT and ICD codes, as well as CCI edits, which also means that professional and technical codes match. This is a tremendous benefit to hospitals and surgery centers like CSS, since discrepancies between what the physician bills for services and those submitted by the facility can raise a red flag with payers. According to the Office of Inspector General (OIG), 23 percent of all claims do not match between the facility and the professional components.

Because the software prompts physicians to capture all the details required for compliant coding and accurate reimbursement, Smith says the ProVation-generated documentation is also more complete than many transcribed reports. She also spends less time tracking down the physicians for clarification or additional procedure details. Because preliminary codes have already been included with the procedure documentation, Smith is able to quickly review and validate rather than coding from scratch. If she wishes to make changes to the coding report, she accesses and updates the report via ProVation Online, a secure connection that makes documentation available to coders and billing specialists. "Depending on how busy we are, we're often able to bill for a procedure the same day it is performed," she says. "In the worst case scenario, we're sending the bill out the following day."

A Good Beginning... A Great Future

Admitting there's a learning curve involved with use of the new software, the physicians at CSS are doing quite well. Although he had reservations at first, Dr. Brad Butler, an orthopedic surgeon operating at CSS and two other Portland area facilities, believes that ProVation MD has been beneficial overall. "ProVation is very efficient once you take the time to construct your Preferences, although it does take some time to initially construct them," he says. "It works very well for cases that you do over and over again, and it provides great patient take-home info. The inclusion of diagrams and images is a very valuable feature."

Moving forward, CSS is working toward accreditation, constantly benchmarking against FASA, AAAHC and MGMA standards. The center also aims to grow its current monthly volume of 130 cases to 250. To gauge progress on both fronts, Tina Caster relies on the software's data reporting feature, which allows her to instantly compile data on utilization, and procedures by day, week and month.

It has been a year since the Center for Specialty Surgery opened its doors, and Caster sees ProVation MD as a beneficial and powerful tool that better positions the center for the future. "The cost savings, the coding efficiency and the ability to bill sooner and better manage revenue have made the biggest difference," she says. "We have gone through the struggles that occur when you introduce any new technology, and we still tweak and refine the way we use it. But ultimately, the ProVation software has enabled us to open our facility on the right foot."