Retrospective Reviews: The Last Line of Defense for Documentation Integrity?

By Fran Jurcak, MSN, RN, CCDS, CCDS-0, Chief Clinical Strategist

Executive summary:

Even before the COVID-19 pandemic, hospitals struggled with mid-revenue cycle leakage. In 2019 (pre-COVID), Medicare and Medicaid underpayments had reached $75.8 billion¹ and 84% of healthcare leaders cited inaccurate clinical documentation and coding as the root cause of lost or decreased revenue.² The pandemic has only exacerbated the problem.

There isn’t a single root cause for mid-cycle leakage—it remains difficult for healthcare leaders to manage due to competing priorities, a lack of clinical knowledge, and a scarcity of appropriate software solutions. But healthcare leaders have options for mitigating mid-cycle leakage, and one of the most compelling strategies is to implement a thorough retrospective review process.

Download this whitepaper to learn:

  • Why retrospective reviews are necessary
  • Strategies for prioritizing what to review and how to implement a retrospective review process at your organization
  • The impact of machine learning on retrospective reviews

 

¹ 2019 AHA Fact Sheet: Underpayment by Medicare and Medicaid January 2021

² HIMSS and Besler Revenue Cycle Management Research Report – Insights into Revenue Cycle Management October 2016

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