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CLINICAL DOCUMENTATION & QUALITY IMPROVEMENT

Clinical Documentation Improvement

  • Customized role-based end-to-end query workflow for efficiency and sped
  • Focuses on E&M, HCC/RAF, CCI, CPT and medical necessity deficiencies

Clinical Quality Improvement

  • Intelligent analytics driven custom education platform
  • Actionable and timely reporting with care opportunity insights

Our Approach

Reventics uses widely-accepted, standardized condition definitions based on current medical literature to show both inpatient and outpatient physicians how to document these conditions in the right situation every time. Using this approach, we are able to show immediate demonstrable improvement in clinical documentation. This is followed up with regular feedback to physicians, hospitals and clinic administrators on individual and group performance levels to ensure physicians maintain their documentation improvement over the long term.

Using a combination of qualitative information gathering and proprietary analytics, we determine the most significant reporting opportunities and problem areas specific to the providers. We then utilize online or on-site training Providers and then ensure ongoing review and data analysis to monitor and manage Provider performance. Additional physician-directed training in areas of weakness helps fuel further improvement in quality monitoring and sustain it over the long term.

Capabilities

Highly Efficient CDI Query Workflow

A key component of CDI outpatient program is automated query process workflow enabling CDI specialist, physician, administrator and coder to interact and query document deficiencies for quick turnaround and issue resolution.

The RevCDQI platform offers end-to-end workflow process that enables clinical staff in assigning worklist, conducting chart reviews, sending queries and receiving responses from physician, forwarding resolved cases to coding and tracking the productivity. The proprietary and client customizable - highly interactive platform offers query process with role based access for physician, administrator, CDI specialist and coder with automated alert system for high productivity, quick resolution and ultimately resulting into improved outpatient clinical documentation quality, accuracy and reimbursement.

Intelligent Provider Education Platform

Successful CDI program, education platform that teach widely accepted and standardized coding and diagnosis practices with offer personalized environment, fostering interaction, customized learning style, guided learning and collaboration.

RevCDQI offers customized education platform with diverse learning styles including self-directed modules, tip sheets, webinars, on-demand videos and gaming arcades. Rev CDQI platform leverages proprietary intelligent training framework that identify educational improvement opportunities and automatically assign learning modules based on historic documentation deficiencies. For instance, if a physician has documentation deficiencies relating to E&M – medical decision making, then the platform sends customized notification alerts with education materials relating to concerned area to that individual.

Actionable Analytics and Reporting

RevCDQI platform offers actionable reporting framework to program & provider level summary level and provider/Patient/Measure level dashboards to track the performance at both organization level and at individual provider level. The dashboards and scorecards also compare physician and CDI specialists comparing to their peers both at site level and group level.

Summary dashboards at physician, CDI specialist and deficiency category level enables to monitor overall performance against key benchmarks productivity metrics. Drilled-down dashboards provides individual deficiency level analysis with chart samples.

Solution Overview

RevCDQI solution identifies clinical documentation deficiencies to improve accuracy in E&M coding, HCC/RAF diagnosis documentation, CPT discretionary coding and quality compliance.

E&M coding and documentation Accuracy

Lack of documentation including extent of history, examination, and complexity of medical decision making to support the level of E&M service results in both revenue loss and risk of compliance audits.

RevCDQI solution enables providers to properly document each E&M service to accurately support the reason, medical necessity, and appropriateness using leveraging proactive analytics with focused medical record reviews identifying common documentation deficiency trends.

HCC/RAF Documentation Accuracy

Accurately capturing the disease comorbidity and documenting proper diagnosis codes in outpatient setting is critical to improve the reimbursement. Documenting the diagnosis to the highest level of specificity as supported by clinical evidence results in accurate hierarchical condition category (HCC) assignment, which impacts risk adjustment factor (RAF) scores.

RevCDQI solution empowers providers to accurately capture the ICD diagnosis codes for precise HCC (both CMS and HSS) and RAF score assignment through advanced predictive analytics, comprehensive dashboards and actionable HCC gap reporting.

CPT Code Assignment Accuracy

Capturing procedural specificity in the outpatient setting is vital for accurate CPT code assignment.

RevCDQI platform offers analytics focused tools and algorithms to uncover discretionary procedure level deficiencies, so CDI specialists and physicians can assign accurate CPT codes that reflect the medical necessity and specificity.

Improved MIPS/MACRA Quality Compliance

Accurate clinical documentation in the outpatient setting is essential to maintain high quality scores in the context of MIPS/MACRA.

RevCDQI platform leverages several clinically focused algorithms that utilize set of clinical data including encounter, pharma, laboratory, EHR and custom data files to evaluate against different quality measures, utilization best practices, clinical and operational protocols and patient satisfaction and safety guidelines to measure compliance rates and detect any inconsistencies. Providers are given insight into patient/measure/condition specific metrics and key performance indicators impacting the performance of specific provider.