EMERGE- YPRO Corporation's Clinical Documentation and Coding Improvement Program
Why EMERGE?
Your hospital is being put under the microscope. Government, insurance and now consumers/patients are looking at our "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 EMERGE clinical documentation and coding improvement program helps you accurately define your "quality" definition.
The EMERGE clinical documentation 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
How EMERGE 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 EMERGE 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 EMERGE 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 EMERGE 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 EMERGE:
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.
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