What is Denial Management? On an average, around 20% of the entire revenue of healthcare providers falls prey to denials. 1 in every 5 claims
Importance of Clinical Documentation Improvement Programs
Clinical Documentation Improvement (CDI) is a complex, comprehensive, multi-disciplinary process that requires not only an accurate understanding of clinical processes but also the ability to work with clinicians to improve quality of documentation and accurate capture of all services rendered.
With advancement in technology, the expertise of certified professionals (health information management professional and clinical professionals) is increasingly being augmented with new age technology tools i.e. Artificial Intelligence, Machine Learning, and Natural language Processing, to accurately convert the patient’s medical records (treatment, history, etc. and other clinical documentation into precise codes with appropriate terminology in line with the requirements of international regulation, accreditation and coding standards.
CDI is critical for both quality patient care and experiences as well as hospital revenue cycle management. Accurately coded data is equally important for preparing quality medical reporting, maintaining a sound public health database, enable disease tracking and forecasting trends through advanced analytics.
What drives the need for Clinical Documentation Improvement Services?
Clinical documentation has always been an important and indispensable part of hospitals, however, the way in which regulatory standards, revenue cycle management in medical billing and the entire healthcare sector have evolved over the past few years have made the CDI service indispensable to hospitals for effectiveness and efficiency.
Let us take a closer look at some of the factors driving the need for the CDI service.
High-quality patient care: The need for high-quality and proper care fuels the need for CDI programs. Successful CDI services ensure that the patient’s encounter with hospitals and clinical service providers is accurately captured, reflecting the services provided and the course of action taken. This is critical for the healthcare service providers in the present and future to provide proper care to the patient taking into cognizance their previous clinical history. Improper and inaccurate clinical documentation place the patient’s life and health at great risk.
Hospital Revenue Cycle Management (RCM): Successful CDI programs hold the key for hospitals to effectively and efficiently manage their revenue cycle, avoiding the problems of overpayments and underpayments, reducing claim denials, ensure correct billing and reimbursements for services provided and avoid fraud accusations. Overall, successful CDI ensures that hospitals maintain positive revenue cycles. Often, CDI programs help uncover opportunities for billing for procedures that were not billed or DNFB (Discharges Not Fully Billed), as it is popularly referred to. DNFB results in underpayment as many of the minor procedures are not recorded by the clinicians due to lack of understanding of the reimbursement rules.
Involving the clinicians. The success of CDI programs is anchored on several parameters – ability to understand clinical procedures and reimbursement, quality of medical coding team, the effectiveness of the CDI expert leading the CDI program, and most importantly, the involvement of the clinicians in understanding the findings and implementing them. A CDI program must include education of physicians as a critical component to sensitize physicians on their documentation responsibilities and the impact it has on reimbursement. This would go a long way in improving
Smoother transitioning into value-based care models: Successful CDI programs enable healthcare service providers to successfully transition from fee-for-service models to pay for performance / quality or other value-based care models. This, in turn, will help improve the quality of services, improve hospital reputation and make care delivery more predictive in nature.
Better compliance: Successful CDI programs ensure that the clinical documentation is accurately converted into ICD-10 CM, ICD-10-PCS, or CPT® codes which, in turn, are used to accord the risk adjustment scores, and evaluate the quality of care delivered by the service provider. It also ensures that the service provider is consistently compliant with the regulations and standards of care.
Deliver Seamless patient experiences: Successful CDI programs enable healthcare services providers to provide the right kind of care and ensure overall seamless patient experiences whether in care or billing. With the emergence of the experience economy, improper care leads to quick negative reviews online and brings disrepute to the service provider’s facility.
With Atom Healthcare’ experience in risk adjustment coding, medical chart abstraction, and medical coding- all critical components of Clinical Documentation Improvement services, healthcare providers can focus on delivering great patient care, while we help you improve the accuracy and quality of clinical documentation and enable you to be compliant.
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