Mazars healthcare: clinical documentation integrity program retooling
Challenge:
A general medical and surgical hospital located in Vermont with 100 beds providing for approximately 25,000 Emergency Room visits and 3,200 inpatient admissions had a legacy CDI program reviewing only 29% of total cases with about 2% had a positive adjustment after review. The facility looked to an outside firm to identify the root cause of poor performance and provide a framework for improvement.
Mazars in the US was engaged to assist the facility in the evaluation of current CDI workflows, policy and procedures and systems impacting output, and the identification of steps to improve performance as well as reflect accurate patient acuity and need for resource use.
In today’s challenging payment environment, it is essential for healthcare organizations to develop an efficient and effective CDI process with the understanding that while not every CDI intervention may lead to increased reimbursement, highly accurate documentation can help the facility to attain higher Quality and Mortality scoring, prevent denials and illustrate the personalized medical decision-making, care delivery and need for resource use while in the facility.
Solution:
The project team initiated the engagement by performing a detailed assessment of the hospital’s CDI processes which included:
- conducting extensive interviews with management and staff, along with onsite observations, to better understand their processes and to identify inconsistencies with workflow requirements;
- compiling, reviewing and evaluating specific data aimed at identifying areas of concern;
- identifying the challenges that may present difficulties going forward given the current resources and magnitude of the opportunities;
- identifying beneficial best practice opportunities for process improvement analysis; and,
- evaluating the current infrastructure and controls as they are practiced within the facility.
Upon completion of the preliminary work, consisting of interviews and test work, the project team prepared an executive summary and detailed report reflecting the findings and recommendations along with exhibits supporting their conclusions on next steps to improve the hospital CDI program.
Results:
The project team identified significant opportunities to improve CDI metrics by the completion of this study.
More specifically,
- the project team hired and trained additional staff,
- project managed a CDI software installation,
- refined CDI policies and procedures to reflect updated CDI goals and
- conducted retrospective reviews to identify areas where additional efforts in billing/coding could result in a financial impact.
This intensive effort resulted in a 68% coverage rate, a 38% query rate, a 94% provider response rate, and an estimated $100,000 in financial impact within 8 months.
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