After any successful Clinical Documentation Improvement (CDI) program implementation, project sponsors know that despite their successes, the real work is often just beginning. After building a CDI program, organizations must strive to ensure that it fully reflects the complexity of cases, severity of illnesses (SOI), and resources consumed, while improving physician documentation. Improved documentation, particularly now under ICD-10, better reflects the quality of care given and facilitates greater coding specificity,which translates into more accurate reimbursement and an improved case mix index (CMI).
Clinical Documentation Improvement Reinvigoration Services Overview
Ensure appropriate reimbursement and revive CMI with Provident’s CDI Reinvigoration services.
Taking into account that all Clinical Documentation Improvement programs are unique, Provident works with clients to determine the level of work required to advance the goals of the CDI program.
Our strategic, cooperative approach includes:
- Assessment (all assessment activities are included in the Full Reinvigoration option)
- Reviewing all aspects of the program (forms, policies, audits, etc.)
- Identifying efficiencies and opportunities
- Conducting a focused review of one-hundred (100) claims to assess accuracy of working DRG assignment against final billed DRG, missed clinical documentation specificity query opportunities, and query compliance
- Evaluating current state metrics and adjusting individual productivity goals to ensure program optimization
- Provision of education to CDIS and/or lead physicians;
- Delivery of advisory services;
- Creation of a continuous education improvement loop through medical record reviews which analyze the following:
- Chart review volume
- Queries volume/rates
- Query response/agreement/disagreement rates
- SOI/ROM scoring
- RAC denial /target areas
- Effectiveness of training received;
- Identification of opportunities for improved documentation; and
- Identification of opportunities for reimbursement;
- Monitoring high risk DRGs.
- Application of Provident’s relevant tools and technology
Our consulting and technology-based solutions provide synergies not available through other companies. Furthermore, we tailor our approach to address many of the problems faced by fully implemented, maturing and mature Clinical Documentation Improvement programs including:
- Staff turnover;
- The need for an enhanced physician champion role by utilizing lead physicians; and
- Outdated policies and procedures
and include key concepts in our training such as:
- Key coding concepts for CDI specialists
- Strategies for communicating with physicians and obtaining buy-in
- Drafting compliant and impactful provider queries to improve the accuracy of reported financials
- Guidance on identifying query opportunities and supporting clinical data and documentation
- Review of complex DRG scenarios
- Strategies for continuous development and performance improvement
- Development of skills that facilitate continued identification and prioritization of improvement goals and more impactful self-monitoring
- Complication documentation and coding tips
- SOI/ROM- Documenting the Dying Process
- Value Based Purchasing Initiatives
- Department Reporting and Metrics
Provident’s clients have benefitted from a standardized query process that includes electronic querying and reporting capabilities. The DocEdge™ Communicator is a HIPAA compliant cloud based application that enables documentation of the communication among Clinical Documentation Improvement Specialists and attending physicians in an efficient and effective manner. Additional information regarding DocEdge™ Communicator is available here.
WHAT SETS US APART
Provident has an experienced team of dedicated, highly integrated professionals, who have consistently provided CDI reinvigoration services. We have extensive experience working with healthcare organizations on a variety of needs including clinical coding and documentation audits and assessments, coding and documentation improvement initiatives, and coding and document training efforts. Provident’s team of clinical reviewers has helped clients increase DRG accuracy rates, optimized DRG assignments and provided continuing education based on findings to coding, clinical documentation improvement staff and providers. Our professionals maintain nationally recognized coding and compliance certifications and credentials including RHIT, CCS, AHIMA approved ICD-10-CM/PCS trainer, JD, CFE and others.