CDI Moves beyond ICD-10 for Revenue Cycle Management Gains
Jan 22, 2015 | VIA BLOG | Posted 5:21 PM by Dr. Jon Elion

For some savvy organizations, clinical documentation improvement is more than just another onerous piece of the dreaded ICD-10 implementation puzzle. While the countdown to October 1, 2015 is certainly at the forefront of the healthcare industry’s collective mind, the ability to improve reimbursement rates and achieve better revenue cycle management is equally – if not more – important. Clinical documentation improvement can cover both those bases, says Mandy Rogers, RN, of Summit Healthcare Regional Medical Center, and produce significant financial gains along the way.

“About a year and a half ago, we decided that with all the changes coming from Medicare and the RACs, we needed to be a little bit more defensive about our money that was going in and out,” Rogers told HealthITAnalytics. “So we decided to start a CDI program from the ground up about a year ago.”

“One of the things that we hit pretty hard at first was what changes to the documentation were going to change our DRGs,” she added. “What was going to get us a major complicating condition (MCC)? We focused on those things and really just did the rudimentary queries about things like pneumonia. What kind is it? That changes your DRG this way or that way. So, we really just focused on that.”

After only four months of working with physicians and coders to improve the detail and quality of their clinical documentation, Summit achieved significant revenue gains. By increasing the case mix by 20 percent, raising MCC and complicating condition (CC) capture by 37 percent and 22.8 percent respectively, the hospital has seen more than $550,000 in positive financial impact.

While Rogers acknowledges that ICD-10 certainly had an influence on the decision to invest in clinical documentation improvement, approaching the project from a revenue cycle management standpoint has allowed the CDI team to collaborate with physicians in a positive way.

“I think physicians right now, as a whole, are being inundated with so much,” said Rogers when asked how Summit’s physicians have viewed the CDI program when it’s put through the ICD-10 lens. “No matter where you go, you’re going have a few of those doctors that go, ‘Oh, no more. Please.’ It is helpful that this is a small hospital, and that I see these doctors all the time in the hall or in the cafeteria. I worked here for seven years before this. They know me—that is helpful when I’m asking them to change the way they’re doing things. Our doctors have been pretty open to the whole clinical documentation improvement process. When we’ve explained to them what we’re doing and why we’re doing it – if we’re querying them, it’s because it’s going to change something.”

To learn more about Summit’s clinical documentation improvement program and its associated financial gains, read the rest of the interview

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