The analogy of a punctured hose that springs a new leak each time one hole is plugged is an apt depiction of the challenges currently facing healthcare executives and, in particular, CFOs. Massive changes, including a switch to pay for performance and increased specificity in documentation and related coding standards, are causing healthcare organizations to seek ways to safeguard revenue integrity while simultaneously improving efficiencies. These changes, which are looming on the all-too-near horizon, threaten to leave organizations – and the CFOs and revenue cycle teams who look after their financial viability – in a major lurch.

In an effort to ensure their organizations are being appropriately reimbursed for the healthcare their physicians provide, many CFOs are taking a closer look at physicians’ approach to clinical documentation. Moreover, many are devoting resources to clinical documentation improvement (CDI) programs that help ensure that the documentation the physician captures accurately reflects the severity of illness for each patient. Incomplete or inaccurate information in medical charts can severely impact revenue that would be reimbursable and put providers at risk for audits.

CDI programs, like the one implemented at Baptist Health South Florida (more on their successful CDI program below), are allowing healthcare organizations to ‘bullet proof’ their documentation against potential audits, while also capturing the severity of illness for their patient population.

A solid CDI program accurately reflects case mix index (CMI) and also reduces risk for RAC audits which is why more CFOs are paying close attention to how patient care is being documented by their physicians. The following is a roundup of CDI advice and best practices from leading health systems and industry leaders:

  • After investing in strengthening their CDI program, Hackensack has increased their ROI and their CMI from 1.72 to 1.92. Anne Goodwill Pritchett, vice president of Patient Financial Services, outlines three key areas that helped drive these improvements – including building solid relationships between clinical documentation specialists and clinicians, physician education and securing leadership buy-in from the start.
  • The University of Washington Medical Center faced many challenges as it has geared up for the ICD-10 transition. Sally Beahan, director of Health Information Management, spoke candidly with EHRIntelligence about the challenges of implementing a new documentation program and how her teams are using comprehensive training and testing to prepare for October 2014.
  • When Baptist Health South Florida decided to introduce a comprehensive CDI program, they hired clinical documentation specialists (CDS) who were also physicians to work alongside their medical staff. Having a CDS team who “spoke the same language” as treating physicians helped secure buy-in for the program. A year later, Baptist’s CMI has increased from 1.56 to 1.74.

When it comes to healthcare providers’ bottom-line, CFOs are feeling the pressure to plug the “leaky holes” in the system. Clinical documentation improvement is one proven way to do just that and ensure your organization gets paid for the type of care provided to your patient population. What types of strategies and technologies is your organization using to improve clinical documentation and safeguard revenue integrity amidst industry change?

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Mel Tully

About Mel Tully

Melinda (Mel) Tully is the vice president of clinical services and education for Nuance Healthcare, overseeing the development and expansion of clinical documentation programs and clinical education best practices. Mel joined Nuance in 1998 and has more than 25 years of experience in multiple healthcare arenas as a provider, clinical manager in a large academic facility, and as an expert in clinical documentation improvement (CDI). Mel attended Emory University, where she earned her Master’s degree in Nursing. She has been certified through the Association of Clinical Documentation Specialists (ACDIS) as a clinical documentation specialist, as well as by the American Health Information and Management Association (AHIMA) as a documentation improvement practitioner.