If you’ve ever wondered how hospitals generate income from the work you do – the answer is clinical coding. In this article, you can learn how the NHS is structured and how it reclaims its income. With this information, you can learn how as doctors we can maximise the income through documenting appropriately.
How is the NHS Structured?
The NHS is actually part of a multitude of entities that are governed by the Department of Health and Social Care. The Department draws down money from HM Treasury on an annual basis and distributes this amongst these organisations based on the costs and activities they reportedly incur. A group of hospitals can form a Trust, which then with other Trusts report to a Clinical Commissioning Group (CCG).
How is income reclaimed by the hospital?
Income is reclaimed by hospitals in two ways. Either by reporting all their activities as codes, which the CCG then interprets and pays based on the tariff attached to those codes. Or by block payments- where the hospital department is paid a fixed amount of money regardless of its level of activity. Most hospitals still use clinical coding extensively. The following flow chart uses the example of a surgical procedure to explain how income is reclaimed:
A simpler way of looking at this is imaging a machine (grouper) where all activity is entered and the grouper interprets these into codes. The resulting codes then tell the CCG how much the hospital needs to be paid. If the codes are not correct, the hospital will lose out on money that it could have been entitled to through its activities.
What is clinical coding?
There is a whole department dedicated to clinical coding in each hospital. Clinical coders follow a handbook that interprets particular medical terms from the patients’ notes, TTOs and discharge summaries. They cannot make any assumptions, interpret results or use diagnoses that are not in the nomenclature of the coding handbook. The current problem is that the language we communicate in as healthcare professionals does not translate easily into codes. We need to keep in mind that not only are the patient and their GP reading our letters, but the coders are too!
What can you do?
The following examples may help you identify what small changes you can make to your written communication to increase income.
Always include all co-morbidities for the patient where you can. More complex patients attract greater tariffs as they require increased clinical input and care.
Always write out results of scans, blood tests and any other tests without using abbreviations or arrows.
Always use the terms “working diagnosis” or “treated as”. We are accustomed to using “?” or “query” which cannot be coded for. Many coders have highlighted this issue as a significant reason we lose out on income. If an entire diagnosis is left out, we cannot justify all of our activity. Use the following terms:
I hope this article has been useful. Please do comment if you have any questions. If you are interested in finding out more about how the NHS is run and how it financially functions, the following links may be of interest.
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