The hospital revenue cycle has grown in scale over the years as administrative tasks have increased and a new coding set, ICD-10, is primed to become the new standard. Hospitals and other healthcare organizations received some buffer time earlier this year when HHS announced plans to delay ICD-10 by another year to Oct. 1, 2014.
However, an extra year of preparation should be seen as an extra year to shore up coding processes, from the moment diagnoses are recorded to the instant claims are sent to payors.
One technique that has gained traction within the revenue cycle is clinical documentation improvement. CDI programs are those in which clinicians and health information management professionals work together to increase coding accuracy and appropriately depict the quality of care delivered.
"CDI is communication and education for physicians but also for hospital staff," says Patricia Woods, director of case management at Community Hospital Anderson (Ind.)-CHN. "There's also identification of improvement opportunities and getting a greater specificity to the medical record."
Ms. Woods has overseen the implementation of different CDI initiatives in her organization's revenue cycle, and there have been both procedural and financial benefits — but not without some challenges along the way.
Benefits and challenges of CDI
Ms. Woods and CHA have focused on several specific aspects of CDI with the help of healthcare revenue cycle firm MedAssets. These include greater specificity in physician documentation and notes and the utilization of queries. Queries are questions from coders and clinical documentation specialists directed to physicians who made documentation changes in a patient's chart.
For example, if a clinical documentation specialist sees a patient had elevated white blood counts — which indicates a patient could be septic — but the physician did not notate any documentation, that CD specialist can place a query identifying clinical indicators in the chart. The query would ask the physician of his or her medical judgment, and the physician then responds to the query in the medical record.
The benefits are twofold, Ms. Woods says. First, and foremost, this CDI process could improve documentation and help out with patient quality measures. Second, the increased documentation could enhance profitability because physicians and coders are capturing DRG data that would have gone without reimbursement. "Since we began this program in November 2011 through April 1, we have identified $647,000 in financial benefits," Ms. Woods says. "This represents the untouched resources that we wouldn't have realized."
Improved quality scores, faster coding, higher case mix indices, newly captured revenue and helping to expose potential DRG problem areas are some of those immediate benefits a CDI program can produce. It could also enhance a hospital's compliance efforts, as better revenue cycle documentation reduces future exposure to Recovery Auditor recoupments (i.e., RAC audits).
CDI programs can lead to both improved profitability and compliance, but there are some challenges. Ms. Woods says one of the biggest challenges has been obtaining buy-in from physicians, but that problem can be confronted with any hospital department's best friend: communication. "What we are doing is a lot of one-on-one conversation with physicians to explain what we're doing and why," Ms. Woods says. "We share data with physicians and take it to monthly steering committee meetings. We keep communicating and collaborating."
With ICD-10 looming and revenue cycle processes taking more precedence, Ms. Woods adds CDI programs can also help build stronger overall revenue cycle departments through a constant free flow of communication, ideas and inquiries. "This is definitely a time to build bridges with the coders," Ms. Woods says. "We tend to work in silos, and we're all going to have to be on the same page with ICD-10."
However, an extra year of preparation should be seen as an extra year to shore up coding processes, from the moment diagnoses are recorded to the instant claims are sent to payors.
One technique that has gained traction within the revenue cycle is clinical documentation improvement. CDI programs are those in which clinicians and health information management professionals work together to increase coding accuracy and appropriately depict the quality of care delivered.
"CDI is communication and education for physicians but also for hospital staff," says Patricia Woods, director of case management at Community Hospital Anderson (Ind.)-CHN. "There's also identification of improvement opportunities and getting a greater specificity to the medical record."
Ms. Woods has overseen the implementation of different CDI initiatives in her organization's revenue cycle, and there have been both procedural and financial benefits — but not without some challenges along the way.
Benefits and challenges of CDI
Ms. Woods and CHA have focused on several specific aspects of CDI with the help of healthcare revenue cycle firm MedAssets. These include greater specificity in physician documentation and notes and the utilization of queries. Queries are questions from coders and clinical documentation specialists directed to physicians who made documentation changes in a patient's chart.
For example, if a clinical documentation specialist sees a patient had elevated white blood counts — which indicates a patient could be septic — but the physician did not notate any documentation, that CD specialist can place a query identifying clinical indicators in the chart. The query would ask the physician of his or her medical judgment, and the physician then responds to the query in the medical record.
The benefits are twofold, Ms. Woods says. First, and foremost, this CDI process could improve documentation and help out with patient quality measures. Second, the increased documentation could enhance profitability because physicians and coders are capturing DRG data that would have gone without reimbursement. "Since we began this program in November 2011 through April 1, we have identified $647,000 in financial benefits," Ms. Woods says. "This represents the untouched resources that we wouldn't have realized."
Improved quality scores, faster coding, higher case mix indices, newly captured revenue and helping to expose potential DRG problem areas are some of those immediate benefits a CDI program can produce. It could also enhance a hospital's compliance efforts, as better revenue cycle documentation reduces future exposure to Recovery Auditor recoupments (i.e., RAC audits).
CDI programs can lead to both improved profitability and compliance, but there are some challenges. Ms. Woods says one of the biggest challenges has been obtaining buy-in from physicians, but that problem can be confronted with any hospital department's best friend: communication. "What we are doing is a lot of one-on-one conversation with physicians to explain what we're doing and why," Ms. Woods says. "We share data with physicians and take it to monthly steering committee meetings. We keep communicating and collaborating."
With ICD-10 looming and revenue cycle processes taking more precedence, Ms. Woods adds CDI programs can also help build stronger overall revenue cycle departments through a constant free flow of communication, ideas and inquiries. "This is definitely a time to build bridges with the coders," Ms. Woods says. "We tend to work in silos, and we're all going to have to be on the same page with ICD-10."
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