Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Practice Management News

90% Report Clinical Documentation Improvement Boosted Revenue

Most hospitals gained at least $1.5 million in healthcare revenue after clinical documentation improvement implementation, a Black Book survey found.

By Jacqueline LaPointe

- Nearly 90 percent of hospitals with 150 or more beds and outsourced clinical documentation functions realized at least $1.5 million in appropriate healthcare revenue and claims reimbursement following clinical documentation improvement (CDI) implementation, reported Black Book Market Research.

Hospitals boosted healthcare revenue and claims reimbursement amounts through clinical documentation improvement projects, Black Book stated

“CDI solutions are the critical link in ensuring full and timelier reimbursements from insurers and payers, as well as avoiding costly penalties for non-compliance, hence hospital chief financial officers have become the greatest advocates for outsourced end-to-end coding,” stated Doug Brown, Managing Partner at Black Book.

The survey of 907 healthcare leaders found that hospitals enhanced quality of care and the organization’s bottom line by choosing to use CDI programs after the ICD-10 transition. Approximately 85 percent of hospitals experienced quality improvements and case mix index increases after CDI implementation.

A majority of hospital financial officers (87 percent) noted that case mix index improvement was the largest motivator for CDI adoption because of its potential to increase healthcare revenue and optimize high-value specialist utilization.

Healthcare leaders also viewed CDI implementation as an effective way to shift more payments to value-based reimbursement. About 88 percent of hospital and physician financial executives said that they were researching vendor solutions for linking care with analytics and outcomes to support the shift to healthcare consumerism and value-based reimbursement models.

“Because of this increased patient engagement, the need for proper clinical documentation improvement driving quality outcome scores has never been more essential,” Brown said. “At the same time, the shift in the settings of care challenges financial leaders who are managing a far more complex enigma centered on optimizing the revenue cycle and reimbursements.”

Healthcare leaders said they were moving CDI implementation higher on their hospital priority lists because of the project’s potential to improve quality, outcomes, and healthcare revenue, according to the survey. Roughly 76 percent of hospitals that have not adopted CDI programs stated that CDI has risen to the top of 2017 budget priority lists, especially since ICD-10 implementation is over.

Researchers added that healthcare leaders at hospitals without CDI programs plan to research outsourced end-to-end coding and coding software solutions.

For community and large hospitals, though, more executives are seeking outsourced CDI services or have already implemented outsourced solutions. Nearly half of hospitals with over 200 beds (47 percent) currently outsource CDI functions, such as auditing, reviewing, and programming.

Since the ICD-10 launch date, the number of community and large hospitals contracting for external CDI solutions nearly doubled, the report stated.

More healthcare leaders are also seeking replacements for CDI and coding solutions implemented prior to the ICD-10 transition, stated researchers. Approximately 40 percent of hospitals and physician groups that currently outsource CDI and coding are thinking of switching to a second or third generation CDI vendor.

Healthcare leaders are pushing for CDI and coding solutions replacement because of physician acquisitions and EHR replacement projects, which have reportedly weakened the sustainability or effectiveness of existing CDI programming software and services.

“EHRs are certainly playing a role in the industry wide movement to increase clinician collaboration and communications,” Brown added. “However half of acute care respondents in the 2016 Black Book survey were not confident that their EHRs effectively captured the patient data to meet developing clinical documentation needs for population health and big data initiatives.”

As a result, 94 percent of hospitals using CDI solutions that have not had a positive impact or those seeing ineffective coding results anticipate partnering with a CDI vendor to help them with post-ICD-10 effects in 2017.

For those looking to implement or replace CDI solutions, the survey also named the leading vendors in CDI services. According to the survey, the top vendor was Nuance Communications with the highest client experience and customer satisfaction scores. Nuance Communications also outperformed other vendors in content management, abstraction, and speech recognition.

Other high ranking CDI vendors included Optum360, nThrive, M*Modal, Navicure, FastChart, Streamline and 3M Health Information.

For outsourced CDI solutions, Optum360 ranked first in outsourced computer assisted coding, while nThrive/Precyse earned top outsourced transcription services.

“CDI is a key step in dramatically improving operational efficiency in healthcare organizations,” said Brown. “Failing to address flaws in documentation processes has resulted in higher incidences of errors, financial losses and diminished patient care, and struggling hospitals will not survive on that old path.”

Dig Deeper:

What Is Healthcare Revenue Cycle Management?

How Clinical Documentation Improvement Saved $550K in a Year

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