How Tech-enabled CDI Solutions Boost Compliance & Revenue

Accurate Medical Records reinforce Compliant Coding and Increased Reimbursement

In this era of digital transformation of health systems, clinical data is of paramount importance to physicians.  Comprehensive documentation is crucial for medical decision-making, competent coding, mitigating claims denial, and increasing reimbursement while enhancing compliance.  Physicians often find documenting clinical data arduous due to reimbursement policy updates, seemingly arbitrary insurer decisions, addition of new acronyms to healthcare vocabulary, high workload, etc.  The consequent suboptimal documentation leads to under-coding, claims denial, and revenue loss.  Physicians stand to gain by scrutinizing their documentation practices to identify deficiencies and explore opportunities for improvement.  Implementing a technology-driven Clinical Documentation Improvement (CDI) solution such as Reventics’ RevCDI™ provides near real-time actionable documentation improvement opportunity for compliant coding and subsequent increase in reimbursement while reducing administrative burden and elevating quality of care.

Quality Documentation in Medical Coding 

The revenue cycle performance of a physician practice is augmented considerably with competent medical coding.  Coders often fail to code a patient encounter accurately when pertinent data is missing, which subsequently results in reduced reimbursement for services rendered.  Typically, in evaluation and management (E&M) and critical care settings, identifying and recording detailed history, review of systems, exam, medical decision-making, diagnostic/therapeutic interventions, plan of care, findings of lab tests/imaging/ECG, etc, are essential for E&M coding, critical care coding, hierarchical condition categories (HCCs) assignment, risk adjustment factor (RAF) score calculation, etc.  Similarly, documenting the complexity and intensity of care furnished during the patient encounter is crucial to capture professional fee codes.  By empowering coders with comprehensive documentation to support the precise code level for services rendered (level 3 versus level 5, for example), physicians can maximize the value of work relative value units (wRVUs) and increase compliant revenue.

Technology in CDI and Coding 

Solutions such as RevCDI-led coding from Reventics ensure document integrity and compliance with ICD and CPT coding guidelines resulting in better reimbursement and margins.  Reventics engages CDI specialists, leveraging technological tools such as RevCDI™, to review charts and provide CDI feedback to physicians.  CDI specialists work directly with physicians to assist in capture of all relevant elements of patient encounter to commensurate with latest reimbursement guidelines and compliant ICD, CPT, E&M, professional fee, critical care coding, etc.  RevCDI™ uses a clinically focused and analytics-led approach to review charts and provide near real-time actionable CDI feedback to enhance compliance, improve wRVUs, and increase reimbursement in fee-for-service and value-based care settings prospectively, while also providing physicians with chart-specific performance reporting on compliance, customized education materials, and comparative dashboards on deficiency levels retrospectively. 

Conclusion:

Clinical documents protect patient, physician, and payer interests and are utilized for a variety of clinical, medicolegal, and commercial purposes such as to identify and treat patients, promote quality of care, billing and reimbursement, audit and denial defence, etc.  Physicians need to ensure their clinical documents are compliant with regulatory and reporting standards to match the level of granularity required to triumph in appeals of claims denials.  Physicians cite numerous reasons for suboptimal documentation such as busy with patient care, lack of time, complicated electronic health record systems (EHRs), burnout, unfamiliarity of how documentation and coding contribute to reimbursement, etc.  Clinical documentation directly impacts the revenue cycle performance of a physician practice.  Implementing a technology-driven solution such as RevCDI-led coding from Reventics empowers physicians to reinforce the quality and content of clinical documents for compliant coding resulting in increased reimbursement and compliance outcomes.