Financial reimbursements on inpatient cases are being driven down by the move to outpatient, value-based agreements, and the ever-increasing complexity of coding regulations. Given those conditions, what are sound clinical documentation strategies to receive fair reimbursements for services rendered? The answers to the following five questions can help your organization, and its clinical documentation improvement (CDI) and coding teams, identify improvement opportunities:
- What is the focus of your CDI program? While CDI can be focused on many different things, not all of them have a measurable financial impact. If diagnosis-related group (DRG) assignment isn’t the primary focus of the program, there’s a good chance your organization is missing out on substantial sums each year.
- How are you identifying which cases the CDI team reviews? If limited internal resources means a hospital can’t review each DRG reimbursed case, the cases chosen make a big difference. When it comes to financial impact, high volume does not equal best opportunity. Visit www.ahd.com to compare CC/MCC capture rates.
- Are you leveraging physicians? Most CDI programs employ nurses and coders – a great first step. Bringing on physicians can take a program to the next level as clinical eyes often see more, which leads to the elevation of physician-to-physician communication about documentation of the care delivered at the hospital.
- What are your cases per hour? The biggest drain on CDI program success can be inefficiencies in how cases are reviewed. Activity does not mean productivity, so focus on those activities that provide value.
- Are post discharge, pre-billing clinical reviews being done? Unfortunately, the most valuable cases are those for which the clinical picture doesn’t become clear until the day of discharge, after all test results are in. If a clinician isn’t examining the case post-discharge, it is likely that diagnoses will be missed.
FairCode Associates was founded in 2001 by a team of physicians and clinicians to improve coding documentation and compliance in hospitals. Using board-certified physicians to review every single chart, FairCode validates DRG assignment to match patient acuity and severity of illness to the coding to ensure that their clients receive full compensation for the care they render. In 2017, FairCode client hospitals with at least 150 beds experienced $322,000-$9.5 million in additional billed revenue. FairCode’s hospital clients rely on these resources each year to support their mission. It’s time to test your hospital’s assumptions. Evaluating the efficacy of a CDI approach is imperative to help hospitals properly plan and budget. For more information, contact Denny Henderson at FairCode at 215-510-0832 or visit https://www.faircode.com/.