This week, health IT consultant Alex Tate breaks down the challenging topic of Revenue Cycle Management (RCM) and explains techniques to improve your clinical documentation.
Revenue cycle management has grown to be increasingly tricky to handle, largely due to the ever growing healthcare reforms and policies. With the implementation of ICD-10, practices as well as hospitals have started to arm themselves with as many supplies and tools as they can to help them manage their revenue cycles efficiently.
One technique that has shown tremendous promise is clinical documentation improvement (CDI). CDI helps physicians and coders increase coding accuracy and properly depict the quality of care delivered. CDI aids in communication as well as identifies those areas of the documentation process that could use some improvement and greater specificity. With proper implementation, CDI offers both procedural and financial benefits.
If your practice has been struggling to improve patient outcomes, smooth clinical workflows and streamline your revenue cycle, here are more ways better clinical documentation can help:
With increased demands on quality care, patient safety and regulatory compliance, it has become more important than ever that communication between clinicians and staff be easy and effective. CDI solutions offer a common platform for data sharing and real-time reporting which leads to better communication between clinical teams. As providers begin to have greater access to appropriate data to make diagnoses and remediate problems, they are even more likely to interact with CDI solutions and each other.
Advanced CDI programs break down the operational and information silos by integrating workflows and data. This allows physicians to get the most value out of their initial investment while avoiding additional costs of incorporating more clinical documentation specialists.
Better Patient Outcomes
Improving patient outcomeshinges on a provider’s ability to access detailed information in real-time that is 100% accurate. Since today’s CDI solutions have been developed to drive adoption through workflow-sensitive technologies and processes, providers can identify patients that are at risk for certain complications and take preventative measures sooner. CDI also aids in improving discharge planning, and reduces hospital readmissions that escalate costs and diminish patient satisfaction.
It Ensures Compliance
Ask any provider what are some of the biggest hits to their revenue cycle and they will tell you the significant fines and financial investments that are a result of ever-evolving compliance mandates. Most of the time these mandates act like a moving target, and a lack of accurate, real-time clinical documentation will quickly send providers to an audit. CDI allows physicians to create and report patient information that is hyper-accurate, thus helping them avoid compliance penalties.
Perhaps the greatest benefit of CDI is the enhanced profitability. Since coders now have the ability to capture DRG data that would have gone without reimbursement, practices are now uncovering untouched financial resources, some to the tune of hundreds of thousands of dollars. Besides capturing untapped DRG data, CDI solutions can improve quality scores, lead to faster coding and higher case mix indices, all leading to newly-captured revenue.
CDI and ICD-10
Let’s face it, the looming ICD-10 transition has made revenue cycle management processes take center stage. CDI shatters silos and builds bridges between coders and clinicians to help build an overall stronger revenue cycle management company, which is critical to stay afloat after ICD-10. CDI is one of the most effective means to long-term financial stability that health systems and private practices have.
Now that you know how CDI can lead to better revenue cycles, here are some tips to get your CDI program to boost your bottom line:
Perform an Objective Assessment
Those physicians interested in implementing a clinical documentation improvement program should perform an objective assessment on the quality of their current documentation and coding processes, and they should continue to do so on a regular basis. You can’t possibly improve upon something until you first know what isn’t working. Practices should focus on finding ambiguous documentation and any other deficiencies so the issues can be resolved.
Focus on Patient Care
Yes, CDI is about assisting your revenue cycle, but in the end all change should lead to one conclusion: enhancing patient care. Also, when healthy systems and private practices use CDI as a tool to better patient outcomes, they naturally see an increase in revenue. It’s a bit like dieting – when people exercise to lose weight, they generally see small results. However when they exercise to increase mobility and be healthier, they see bigger weight loss. When providers use CDI purely as a revenue cycle tool, they typically see only a small revenue impact. But when they use it as a means to help physicians engage with patients, they tend to see a bigger revenue impact.
Break Down Silo Barriers
As we’ve mentioned, no one in the healthcare system can work in a vacuum AND be successful in the new value-based payment model. The walls that have been built over decades between coders, physicians and CDI management teams must come tumbling down for any real improvements to be seen in documentation or revenue cycles.
They don’t really teach you about measuring operational processes in medical school, but you’ll need to do just that in order to gauge just how successful your CDI program is to your bottom line. Take heart, if you measure, you’ll also be able to identify numerous revenue opportunities.
If you are someone that still insists technology is more trouble than it’s worth, you are in for a rude awakening as you struggle to keep up with the never-ending reforms coming down the ol’ healthcare pike. While technology definitely comes with a learning curve, it should be embraced and leveraged to assist with documentation. Things like templates and voice recognition programs can greatly help a physician document clinical impressions. Don’t think of clinical documentation improvement as a choice, think of it as a survival tactic in constantly-shifting and competitive marketplace.
Alex Tate is a health IT Consultant at CureMD who provides perceptive, engaging and informative content on industry wide topics including EHR, EMR, practice management and compliance.