Simple Visit Coding (SVC) in Epic is designed to make life easier for HIM leaders and medical coders. So, if it’s instead bringing medical coders grief, it’s a sure sign that something needs to change.
SVC’s value lies in the way it can reduce the number of simple outpatient visits that require a human coder’s intervention. Some healthcare organizations say they code close to 90% of all outpatient visits using SVC. Others are only achieving 15% effectiveness.
Why does SVC effectiveness matter? Quite simply, the more efficiently SVC runs, the faster the revenue cycle will be. A well-optimized SVC build helps healthcare organizations reduce their current cashflow pressures. It also provides invaluable support to HIM leaders and medical coding teams during a time of a nationwide shortage of coders.
SVC optimization often comes down to the way SVC is built. Let’s look at 5 telltale signs your organization’s SVC build needs tweaking.
1. A high number of SVC errors is hitting your error work queue.
When considering what an ideal SVC build should look like, think about the filter on your home’s air-conditioning unit. That filter blocks out bad particles and lets only clean air through. But the filter must be just right for your A/C unit and your house. If the filter is too thick, it may completely block air flow. If it’s too thin, it may let both good and bad air through.
Similarly, an effective SVC build will handle a majority of simple outpatient coding cases on its own, and will only allow errors “pass through” to a human coder. So, if you’re seeing high levels of SVC errors hit your error work queue, it’s a good bet that the coding validation error safety net within your SVC build needs some tweaking. You need to make sure it’s not creating such a “thick” filter that nothing can pass through. HIM leaders and IT should carefully weigh coding validation errors, however, it’s important to have the basics built to prevent downstream issues.
Three basic coding validation errors built and that are common:
- Registration errors that occur when certain admission/discharge transfer (ADT) information isn’t filled in completely.
- Provider name errors. These happen most often when a coder or provider enters the name of a nurse or lab tech instead of the name of a valid physician or mid-level provider on individual diagnostic lab orders.
- Missing orders or diagnoses. There are instant red flags.
2. An increase in claim edits of accounts flowing through SVC.
Some SVC encounters involve claim edits for medical necessity. For example, let’s say you had an MRI that was coded using Epic SVC. However, that MRI was not covered as a medical necessity based on national or local coverage determinations (NCDs/LCDs). That case would then hit your work claim edit queue. Ideally, it should have triggered an Advance Beneficiary Notice (ABN) flag at the point of registration or scheduling.
3. An increase in claim denials.
What’s even more troubling than seeing an increase in claim denials is not knowing how many denials you’re getting in the first place. A recent survey from HCPro showed that about two-thirds of HIM directors don’t know their average denial rate.
Fixing the problem starts with knowing your denial rate and identifying the root cause of your denials. It’s possible some or many may be flowing through your Epic SVC build. Some may be related to medical necessity. Others may be for different reasons. If you want to know more about how to find your denial rate and reduce your denials for good, check out this blog post from Nicki Bucceri, an expert medical coder and my colleague here at DeliverHealth.
4. Accounts in SVC workflow contain full provider reports.
SVC is most effective for simple cases without provider reports. So, if cases with provider reports hit your SVC workflow, it’s another red flag. When it happens, it can limit a coding department’s ability to capture hierarchical condition category (HCC) opportunities for chronic illnesses, something that’s becoming more important on the hospital outpatient side as organizations continue to move toward value-based purchasing.
5. Unclear on current SVC build.
Epic SVC has been a part of some healthcare organization’s medical coding infrastructure for more than a decade. So, if you’re a newer HIMleader or medical coder—or you’re relatively new to your organization—you may not have been there when SVC was first built. You didn’t have any say into how it was developed or why it was implemented. If that’s the case, it’s time to get a more thorough understanding of your particular SVC instance so you can identify potential opportunities sooner than later.
What to do if you see the 5 signs your SVC needs tweaking
If you notice any of these 5 signs, it’s time to strengthen the oversight and governance around your SVC build. A few best practices include:
- Form a governance committee and structure so you know when SVC can—and cannot—be used.
- Establish a submission process for any build changes so HIM leadership can have a say in approving or denying proposed changes.
- Analyze your SVC trends and patterns with robust analytics that go beyond what Epic offers.
- Audit your SVC accounts so you know the facts.
You can get more details on effective governance in our SVC Benefits and Pitfalls webinar.
If you’re ready to tweak your SVC instance, DeliverHealth is uniquely positioned to help you. When you choose our SVC consulting services, our deep bench of SVC experts will help you audit your current SVC instance, identify gaps and opportunities, and give you a detailed go-forward plan. In addition, our robust analytics platform will give you metrics like denial rates, % of outpatient Epic cases simple visit coded and not simple visit coded, and give you all the information you need to track your way toward an Epic Gold Star.