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● Revenue Cycle Management Untangling healthcare’s

Gordian knot T e integrity of clinical documentation is vital to protecting an organization’s bottom line. By Mel Tully


he “threads” of clinical documentation, ICD- 10 codes, quality measures, and meaningful use have become so tangled that it seems that healthcare revenue cycles have become a veri-

table Gordian knot. But carefully following the strands of education, coding, and clinical documentation may reveal that this massive knot that has been tying up reimbursement may be all one piece of the same string. When attempting to untangle any knot, it is important to be cognizant of how, when pulled, each individual strand can tighten, increase the tension, and impact the dynamic of the whole. T ere is still almost a year until ICD-10 goes into eff ect, and with proper clinical documentation strategies, organiza- tions can take the right actions to protect their revenue cycles and safeguard their bottom lines. Here are some guidelines that will help keep revenue cycles undisrupted throughout the coming changes: Educate. Policies and deadlines can change, so keeping all

employees informed and providing them with training will help your organization anticipate and overcome hurdles as they arise. As providers look to establish accurate and effi cient processes across the board, many are taking a physician-fi rst approach to capturing the correct clinical documentation information the fi rst time around. Trinity Health recently adopted this physician educational model and, according to Don Bignotti, M.D., senior vice president and CMO, “We’ve had great success collaborating and educating our physicians on the importance of improved accuracy of documentation within the new world of ICD-10.” Using a physician-fi rst approach not only prepares clinical staff , but more impor- tantly ensures that the patient’s story is accurately captured at the point of care. Implement a clinical documentation improvement

program. Clinical documentation improvement (CDI) programs enable organizations to identify and target gaps in documentation and more accurately capture a patient’s story. After implementing a CDI program, St. Luke’s University Health Network, which comprises six hospitals, saw an aver- age of 21 percent improvement in their case mix index (CMI)

12 December 2013

and a marked improvement in both quality and severity of ill- ness scores. Cheryl Davidson, clinical documentation manager at St. Luke’s, asserts, “T ere is so much at stake, and accurate clinical documentation is critical to safeguarding the quality of our patient care, addressing compliance regulations, and ensuring appropriate reimbursement.” Dual code. With ICD-10 threatening to severely im-

Mel Tully, MSN, CCDS, CDIP, is VP of clinical services and education, Nuance Communications. For more on Nuance Communications: www.rsleads. com/312ht-201

pact productivity levels, experts suggest that, in addition to educational training, employing a dual-coding strategy that focuses on diagnosis-related groups (DRG) relevant to each individual hospital’s population is important to preparing coders for the ICD-10 transition. Dual coding will help expose any points of confusion coders are having and allow organizations to protect against the risks of improper cod- ing, denied claims, lost revenue, and/or raising red fl ags for external audits. Prepare clinical documentation specialists. Coders are not the only group being directly impacted by the October 2014 transition – clinical documentation specialists (CDS) also need to be supported through this process. Implementing a dual-CDI program means specialists work both in ICD-9 and ICD-10, which better prepares them for any potential procedural changes and allows health information manage- ment teams to identify any challenges, schedule additional training, and work through problem areas. Additionally, these programs help both HIM teams and physicians acclimate to the new procedures and indexing process. Use technology to drive workfl ow improvements. T e impact technology can have on streamlining workfl ows is incredible, if used properly. But frustrations can quickly mount when a system doesn’t produce the desired results. If an organization doesn’t have a CDI program in place, installing a computer-assisted coding (CAC) program isn’t going to yield optimal results. T e codes will only be as good as the information being entered into the system, so implementing a CDI program that integrates with established physician workfl ows is essential.


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