Prior to COVID-19, health systems were already operating on generally thin margins, with many finance leaders acknowledging that a significant root cause was leakage from their mid-revenue cycle and that “average performance” was still well below optimal results. Given the unforeseen impact of COVID-19 on hospital revenue, healthcare finance leaders must now be even more protective of margins.
Retrospective reviews are the last opportunity to resolve documentation and coding issues for billing and quality reporting purposes. However, traditional reconciliation is inefficient and often ineffective for a number of reasons, including:
- Chart selection criteria that do not specifically identify all correction opportunities
- Manual processes, which force unnecessary chart reviews
- Complex, frequently changing documentation and coding guidelines
- Over- and under-documentation by physicians
- Understaffed CDI teams
- Strict productivity requirements for coders
Traditional approaches force clinical documentation integrity (CDI) specialists to unnecessarily review a significant number of charts in search of these opportunities, which extends DNFB to no benefit. Additionally, most CDI teams are unable to review every chart, leaving many documentation and coding issues unidentified prior to billing.
The broad scope of factors impacting CDI efficiency and accuracy require creative solutions beyond hiring more CDI specialists. Only technology can automatically review each record during the retrospective review process and direct CDI teams to the charts that are most likely to require their attention, allowing them to eliminate a significant, unproductive portion of their workload and focus on improving documentation integrity.
Iodine Software is redefining reconciliation through its Retrospect module, which eases the burden on CDI and coding teams by automatically reviewing every chart prior to billing. Iodine Retrospect combines the prioritization technology of Iodine’s SmartList™ with an integrated CDI review workflow for post-discharge records. Narrative documentation, clinical evidence, and patient demographics are all taken into consideration, allowing Retrospect to make accurate predictions and automatically identify both cases that do and do not require a review. Discharged patients are therefore prioritized based on their statistical likelihood of containing documentation opportunities.
Retrospect also helps quality-audit CDI staff. Residual documentation concerns are detected in records already reviewed by CDI teams, allowing CDI program leaders to isolate knowledge deficits and identify workflow and process opportunities to support continued CDI program growth and success.
To learn more about the Iodine Retrospect Module, contact: firstname.lastname@example.org.