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How Provider Documentation Impacts Coding and Reimbursement
Wednesday, January 29, 2020, 12:00 PM - 1:00 PM EDT
Category: Events

How Provider Documentation Impacts Coding and Reimbursement

Summary:  Medical billing and coding are integral for health care revenue cycle processes.  They are the cornerstone of the health care revenue cycle as reimbursement is primarily based on accurate coding.   The new era of health care requires renewed focus on ensuring that patient records are as accurate as possible. Clinical Documentation Improvement (CDI) in hospitals is key to achieving this goal. Quality measure initiatives, health care reform-related financial penalties, and missed revenue optimization are issues that warrant a coordinated effort to improve clinical documentation. Understanding and addressing the root causes of poor clinical documentation is critical to patient record accuracy and revenue cycle success.
Clinical documentation improvement is a fundamental cornerstone for data quality, accurate reporting, streamlined claims reimbursement and robust public health information tracking. More than an essential component of the health care system, CDI quantifiably affects revenue. According to Black Book Market Research, 90% of hospitals with 150 beds or more that outsourced clinical documentation functions realized at least $1.5 million increase in revenue and claims reimbursement. 
Most hospitals are not well-equipped hospitals to solve the most prevalent CDI problems, which may result in in not collecting the appropriate reimbursement to which they are entitled. Several common challenges affect clinical documentation improvement:

  1. Incomplete or inaccurate documentation. DRG assignments and codes affect billing and, if assigned erroneously, can lead to denied claims or inaccurate reimbursements. Truth time – how thorough is your physicians’ documentation? The latest health care technology can recommend potentially missed clinical indicators or documents lacking required specificity that, if caught early, can lead to higher quality care, exact coding and accurate reimbursement.
  2. Physician query fatigue. The extraordinary time demands placed upon physicians is no secret. They are frequently pulled in multiple directions and workflows, whether it’s a request from the patient care team, a required signature, or patient order clarification suffice to say physicians are spread thin. An EMR workflow provides physicians the ability to answer all requests in a single platform. 
  3. Communication gaps between CDI specialists (CDIS), coders and auditors. Physically and organizationally, CDIS and coders may work in two different areas, making collaboration difficult. Implementing a single technology platform that encompasses workflows for all stakeholders and provides visibility into the same work queues eases the burden of rework and redundancies.
  4. Prioritization of work. Hospitals can improve productivity by implementing a workflow that surfaces the most valuable cases first with automated case prioritization. The user can quickly parse out different review types – by DRG, patient status, length of stay or query status. Cases flagged by an auditor or coder are visually identified so they can be addressed first.

By eliminating CDI challenges that impede quality and reimbursement success will improve cash flow and quality scores

Learning Objectives:

  • Review common opportunities for poor documentation
  • Identify coding struggles based on poor documentation
  • Understand benefits of routine audits

$59 for members
$25 for students
$99 for non-members
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Jason Siedman
Jason Siedman is Vice President of Sales for the Northeast at nThrive. With experience driving innovation to improve the delivery and efficiency of healthcare, Jason leads the Northeastern market to transform the Patient-to-Payment revenue cycle for health care providers.   Prior to joining nThrive, Jason served as Vice President of Revenue Cycle for a four-hospital health system in Pennsylvania.  Previously, Jason held numerous leadership positions in business offices and clinical service lines for academic medical centers through the Northeast.  Jason is a husband and father to three girls and lives in Mullica Hill, NJ.