Each stage of the CDI documentation integrity process represents an opportunity for additional leakage of accurate and appropriate documentation, resulting in inaccurate coding of conditions being monitored and treated during the patient’s encounter. This results in inappropriate reimbursement for care provided as well as potentially imperfect quality reporting. And despite massive investments in documentation and coding solutions, earned revenue loss continues to persist — Medicare and Medicaid underpayments reached $75.8 billion in 2019*.
Retrospective reviews are the last opportunity to resolve documentation and coding issues for billing and quality reporting purposes. Traditional reconciliation is inefficient and often ineffective for a number of reasons, including: inefficient process, understaffed CDI teams and lack of technology that supports accurate identification of opportunity.
Listen to this webinar as Fran Jurcak, Iodine Software, and Dee Banet, Advent Health, discuss strategies for implementing a more robust retrospective review process, including:
- Why current approaches for retrospective reviews aren’t working
- Strategies for prioritizing what to review
- Solutions for automating the Retrospective review process
*AHA Fact Sheet: Underpayment by Medicare and Medicaid January 2021
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Prior to COVID-19, many hospital finance leaders knew that a major reason for thin margins was leakage from mid-revenue cycle, specifically documentation integrity. Today, health systems face even more unknowns — from the unexpected 30% reimbursement decline due to COVID-19 medical admissions (according to an Iodine Software analysis) to the rise in telehealth vs. inpatient visits. As health systems prepare for “the new normal,” finance leaders are looking for ways to ensure their system is ahead of the curve and built to ensure financial resiliency.
Be part of the discussion with other health system revenue cycle leaders that will cover:
- The projected financial impact of COVID-19 and current financial recovery trends, based on a real-world analysis of 600+ U.S. hospitals
- Mid-cycle leakage and the role clinical documentation plays in driving revenue
- Revenue cycle strategies you can employ today that are short-term revenue accretive and build financial resiliency for the long term
- Kyle McElroy, VP, Health Information Management
- Fran Jurcak, MSN, RN, CCDS, Chief Clinical Strategist, Iodine Software
- Ravi Chopra, MD, Clinical and Product Specialist, Iodine Software
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Last week, The Association of Clinical Documentation Integrity Specialists (ACDIS) hosted a webinar to assess the impact of COVID-19 on CDI operations. Panelist Fran Jurcak, Chief Clinical Strategist at Iodine Software, was joined by CDI leaders from Yale New Haven Health System, LifePoint Health, and Catholic Health Services.
All panelists noted overall volume declines, mainly due to fewer inpatient elective surgeries. Lower patient volumes provide a unique opportunity for healthcare leaders to explore opportunities to re-assess workflow and processes in their CDI programs. Angie Comfort, Senior Director of CDI and Coding Operations at LifePoint Health, noted that she discussed with CFOs across the system the possibility of expanding review to all payers given the decline in inpatient admissions. Reviewing only select payers leaves gaps between clinical evidence, documentation uncorrected and reimbursement uncaptured on cases of payers not reviewed. Many Iodine clients were able to go to all payer coverage prior to COVID-19, leveraging Iodine’s prioritization technology to identify appropriate records for review. According to Jurcak, “most of our programs are all-payer, trying to look at every appropriate record to ensure documentation integrity.”
The panel also discussed the potential to maintain remote CDI work after the pandemic. According to the in-webinar survey, only 15.6% of respondents were already remote prior to COVID-19, but an additional 74.0% who were previously either onsite or hybrid onsite/remote are now fully remote. Adelaide La Rosa, VP of HIM, CDI, EMPI, and DRG Appeals at Catholic Health Services, believes healthcare leaders will consider fully remote CDI teams as a strategy for limiting resource usage, particularly onsite workspace. In addition, removing the geographic barrier to staffing could help mitigate the impact of challenges such as staffing shortages and differences in cost of living.
If you are interested in a recording of the webinar, register here and the recording will be shared. To learn how accurate documentation can help your health system navigate these unexpected challenges, contact Iodine at email@example.com.