Clinical Documentation and Coding Improvement Program
Why conduct a CDI Review?
Your hospital is being put under the microscope. Government, insurance and now consumers/patients are looking at your "quality". The government and insurers are using your quality ratings to adjust your payments. Consumers/patients are looking for the best "quality" care.
The "quality" ratings/rankings are based on the codes submitted on bills. Your hospital's quality and revenue can be understated because you are not given credit for the actual severity of illness of your patients. There are three areas responsible for low quality ratings:
1. Lack of specificity in clinical documentation (60%)
2. Coding Issues ( 30%)
3. Other areas ( 10%)
The YPRO CDI Review and coding improvement program helps you accurately define your "quality" definition.
The YPRO CDI Review program is unique in terms of :
· Ease of Implementation - usable by all size hospitals, and scalable to meet the size of your hospital
· Designed to Improve Physician Relationships - Case Managers/ Nurse works concurrently with the physician; protects the physician from liability; maximizes physician productivity; eliminates coder queries, assists the physician with his own practice and reimbursement.
· Focus Is Correct and Complete Clinical Documentation - Case Manager/Nurse focuses on medical necessity, NOT DRG's; prevents 'gaming' the system; avoids unintentional consequences of pushing DRG's to the next level
· Improve Case Manager/Nurse coder Communications - coders are the DRG experts; Case Managers/Nurse interact with coders to understand regulatory requirements.
· Eliminates Complexity-Easy to maintain; quarterly benchmarking
The YPRO CDIP Program is unique in terms of:
Tailoring of Program- Tailored to the specific needs and requirements of the client
Hospital Assessment- Assessment of current hospital operational climate and landscape with specific recommendations offered as to best approach and strategy to clinical documentation improvement
Designed to Improve Physician Relationships- Case Manager/Nurse works in collaboration with the physicians to improve clinical documentation in support of their business of the practice of medicine. Improved clinical documentation is achieved through a focus upon clear synergies of clinical documentation between Evaluation and Management and MS-DRG reimbursement methodologies. Reduces the hassle factor of retrospective clinical queries by the coder, thereby reducing DNFB and improving cash flow
Focus is Correct and Complete Clinical Documentation- Case Manager/Nurse focus on establishment of medical necessity for both the hospital and the physician, beginning with documentation in the Emergency Room, extending through the History and Physical, progress notes and discharge summary. YPRO’s philosophy of CDI focuses upon and recognizes that reasonable and medically necessary and supporting documentation are key elements of medical record documentation, incorporating the interdisciplinary approach to clinical documentation improvement.
Enhances Communication between Case Manager/Nurse and Coders- Improved collaboration between coding staff and clinical documentation improvement specialists through focus upon building and expanding upon each other’s skill sets and core competencies in clinical medicine and coding guidelines, policies and procedures.
Focus Upon Physician Education- Case Manager/Nurse focus upon providing clinical documentation education for physicians in best practice techniques and strategies that can be effectively utilized in the office and hospital setting
Affect Positive Change in Physician Patterns of Clinical Documentation- Focus of program is upon affecting positive change in behavior modification of physician clinical documentation patterns as opposed to episodic, individual impact on individual chart review and optimal reimbursement.
Eliminates Complexity- Case Manager/Nurse efforts are devoted to providing real physician clinical documentation education with less time spent on administrative data entry tasks
How YPRO's CDI Review Works-
Educate - YPRO will educate your case managers and physicians on the level of specificity necessary to assign the correct severity of illness. Case managers will receive an YPRO CDI Review manual that prompts them on what to look for.
Mirror - YPRO consultants work with case managers one-on-one to convert the education to practical application.
Experience - The case managers and HIM staff have an opportunity to gain experience on their own using YPRO consultants as a resource to answer questions.
Review- After the case managers and HIM staff have had a chance to work on their own for a period of time, YPRO will perform a follow-up review. A review cycle will be established in order to keep the system working correctly.
Gauge - YPRO will gauge your case mix index movement as a result of the YPRO CDI Review process. Case mix movement of a tenth of a point for an average size hospital can mean the difference of $1.5-2.0 million to your bottom line.
Evaluate - YPRO will evaluate the CDI Review progress and produce a written executive management report identifying the findings and recommendations of the program.
Quality Issues driven by clinical documentation- the benefits of a YPRO CDI Review:
1. Reimbursement Impact - decrease denials, improve correct DRG assignment, improve quality ratings/rankings, improve charge capturing and your bottom line
2. Competitive Position - Improve consumer choice, improving your position against your competitors.
3. Patient Care - improved clinical documentation leads to improve care, increase patient confidence, decrease risk liability issues.
4. Compliance - eliminate the number one compliance issue- lack of documentation.