Category: Clinical Documentation Improvement

Maximizing Inpatient Reimbursement and Quality of Care with Innovative CDI Solutions: A Comprehensive Approach

Clinical Documentation Improvement (CDI) solutions and services are essential for ensuring that clinical documentation is accurate, complete, and specific. Inpatient CDI services focus on improving documentation for patients who are admitted to a hospital or other inpatient facility. In this article, we’ll explore the benefits of inpatient CDI solutions and services, and how they can improve patient care.

One of the primary benefits of inpatient CDI solutions and services is that they can help improve the accuracy and completeness of clinical documentation. This can have a significant impact on patient care, as accurate documentation can help ensure that patients receive appropriate treatment and monitoring. In addition, accurate documentation can help reduce the risk of errors and omissions, which can lead to incorrect diagnoses, treatment plans, and medication orders.

Another benefit of inpatient CDI solutions and services is that they can help improve coding and billing accuracy. Accurate coding is essential for proper reimbursement and can help ensure that healthcare providers are fairly compensated for the care they provide. By improving documentation, inpatient CDI solutions and services can help ensure that the correct codes are assigned to each patient encounter, which can reduce the risk of denials and appeals.

Inpatient CDI solutions and services can also help improve patient outcomes. By improving the quality of clinical documentation, healthcare providers can more accurately diagnose and treat patients, which can lead to better outcomes. For example, if a patient is admitted to the hospital with pneumonia, but the clinical documentation only mentions respiratory distress, the care team may not realize the severity of the patient’s condition. However, if the documentation is accurate and specific, the care team can provide appropriate treatment and monitor the patient closely to ensure they are recovering.

In addition to improving patient care and reimbursement, inpatient CDI solutions and services can also help healthcare organizations comply with regulatory requirements. For example, the Centers for Medicare & Medicaid Services (CMS) require hospitals to report quality measures, which are based on clinical documentation. Accurate and complete documentation is essential for compliance with these requirements, as well as other regulatory standards.

One key feature of inpatient CDI solutions and services is the use of technology to improve the CDI process. For example, natural language processing (NLP) can be used to analyze clinical documentation and identify areas where documentation can be improved. This can help streamline the CDI process and improve the accuracy of clinical documentation.

Inpatient CDI solutions and services can also provide education and training to healthcare providers. This can help providers understand the importance of clinical documentation and how to improve their documentation practices. By providing education and training, inpatient CDI solutions and services can help ensure that providers are equipped with the knowledge and skills they need to provide high-quality care and documentation.

Overall, inpatient CDI solutions and services offer a range of benefits to healthcare providers, patients, and healthcare organizations. By improving the accuracy and completeness of clinical documentation, improving coding and billing accuracy, improving patient outcomes, and supporting regulatory compliance, inpatient CDI solutions and services can help improve the overall quality of healthcare delivery. As healthcare continues to evolve, it’s likely that inpatient CDI solutions and services will become an increasingly important component of healthcare delivery, helping to support healthcare providers in providing the best possible care to their patients.

Hospital Outpatient Departments: Effective July 1, 2020 you must request prior authorization for certain hospital Outpatient Department (OPD) services

For dates of service beginning July 1, 2020, you must request prior authorization for the following hospital Outpatient Department (OPD) services:

  • Blepharoplasty
  • Botulinum toxin injections (when paired with specific procedure codes)
  • Panniculectomy
  • Rhinoplasty
  • Vein ablation

Medical necessity documentation requirements remain the same and hospital OPDs will receive a decision within 10 days.

While only the hospital OPD service requires prior authorization, CMS wants to remind other providers that perform services in the hospital OPD setting that claims related to/associated with these services will not be paid if the service requiring prior authorization is not eligible for payment. These related services include, but are not limited to, anesthesiology services, physician services, and facility services. Only associated services performed in the hospital OPD setting are affected. Depending on the timing of claim submission for any related services, claims may be automatically denied, reviewed, or denied on a postpayment basis.

For botulinum toxin injections, consult the list of codes that require prior authorization for more details. Generally, the use of botulinum toxin injection codes paired with procedure codes other than 64612 or 64615 will not require prior authorization under this program.

Saince announces the launch of tele-medicine feature within its clinical documentation solution

Doc-U-Scribe clinical documentation solution now comes integrated with tele-medicine workflow. Physicians and administrators can create tele-consultation sessions with patients seamlessly from within the application. This process eliminates the need for providers to use separate solutions – one for clinical documentation and another for video session.

The COVID-19 public health crisis has accelerated the use of tele-medicine solutions among healthcare provides across the nation. However, many small hospitals and physician offices do not have access to a single solution that takes care of all their needs. Physicians are forced to use multiple solutions to complete their tele-medicine workflow. They are often finding this process frustrating and cumbersome.

Doc-U-Scribe clinical documentation solution which is used by hundreds of hospitals and physician offices across the country provides an integrated and seamless workflow for clinical documentation as well as tele-medicine.   This new HIPAA compliant tele-medicine solution can cut costs, increase efficiency, and improve physician satisfaction significantly.

Saince announced that this new feature will be available to all their existing customers immediately. Saince also announced that with their plug and play model, any new hospital or physician office can be up and running with their tele-medicine program within 48 hours.

When Pursuing CDI, Using Risk Adjustment Is Vital

As healthcare has moved away from fee-for-service reimbursement models toward a more value-based system, the idea of using risk adjustment to account for individual patient risk and chronic conditions has become far more important for providers seeking to maximize quality of care.

In today’s healthcare environment, providers are often required to fight simultaneous battles on several fronts. For those pursuing clinical documentation improvement (CDI), they must balance sometimes-conflicting regulatory demands, workflow needs, etc. Further exacerbating the problem is the persistent shift of care provision to the ambulatory setting and the increasing demands it places on provider organizations.

As we have discussed in previous blog posts, outpatient CDI efforts face a number of unique challenges, such as decidedly larger case volumes than most inpatient settings and far shorter clinical visits. These shorter visits produce less usable patient data and offer a condensed window during which multiple team members must work in synchrony—accurately and efficiently—to gather that data. Outpatient providers must also go further, factoring in risk adjustment for each individual in their larger patient populations as well.

Often, problems with risk adjustment appear when inaccurate or incomplete diagnosis coding slips through the documentation workflow. For instance, failure to capture patients’ Hierarchical Condition Categories (HCCs)—and recapture year-over-year—can greatly skew risk scores for individual patients and potentially the overall population. Such mistakes can filter downstream to errors in patient care and increasing claim denials and, potentially, wreak havoc on pay-for-performance reimbursements.

This dynamic puts increased pressure on physicians to capture correct documentation at the point of care—getting it right the first time without a great deal of revision. Many have addressed the issue through Computer Assisted Physician Documentation (CAPD), which provides a number of CDI features. CAPD improves accuracy and lessens physicians’ burdensome workflow by precluding the need to rehash previously captured documentation.

The goal of these products is to allow physicians to complete patient care documentation faster and spend more time with their patients. Unfortunately, many traditional products, which were designed for inpatient settings, lack effective integration of risk adjustment. As a result, many providers are prevented from seeing the most accurate picture of the population they serve—and value-based care programs are not as successful as they could be.

To learn about PowerSpeak+RAPID—a CAPD platform combining powerful front-end medical speech recognition software (PowerSpeak) and Risk Adjusted Physician Documentation (RAPID)—contact Saincesaince inc logo

When Pursuing CDI, Using Risk Adjustment Is Vital

As healthcare has moved away from fee-for-service reimbursement models toward a more value-based system, the idea of using risk adjustment to account for individual patient risk and chronic conditions has become far more important for providers seeking to maximize the quality of care.

In today’s healthcare environment, providers are often required to fight simultaneous battles on several fronts. For those pursuing clinical documentation improvement (CDI), they must balance sometimes-conflicting regulatory demands, workflow needs, etc. Further exacerbating the problem is the persistent shift of care provided to the ambulatory setting and the increasing demands it places on provider organizations.

As we have discussed in previous blog posts, outpatient CDI efforts face a number of unique challenges, such as decidedly larger case volumes than most inpatient settings and far shorter clinical visits. These shorter visits produce less usable patient data and offer a condensed window during which multiple team members must work in synchrony—accurately and efficiently—to gather that data. Outpatient providers must also go further, factoring in risk adjustment for each individual in their larger patient populations as well.

Often, problems with risk adjustment appear when inaccurate or incomplete diagnosis coding slips through the documentation workflow. For instance, failure to capture patients’ Hierarchical Condition Categories (HCCs)—and recapture year-over-year—can greatly skew risk scores for individual patients and potentially the overall population. Such mistakes can filter downstream to errors in patient care and increasing claim denials and, potentially, wreak havoc on pay-for-performance reimbursements.

This dynamic puts increased pressure on physicians to capture correct documentation at the point of care—getting it right the first time without a great deal of revision. Many have addressed the issue through Computer-Assisted Physician Documentation (CAPD), which provides a number of CDI features. CAPD improves accuracy and lessens physicians’ burdensome workflow by precluding the need to rehash previously captured documentation.

The goal of these products is to allow physicians to complete patient care documentation faster and spend more time with their patients. Unfortunately, many traditional products, which were designed for inpatient settings, lack effective integration of risk adjustment. As a result, many providers are prevented from seeing the most accurate picture of the population they serve—and value-based care programs are not as successful as they could be.

Power Speak - Speech Recognition and Reporting Software

To learn about PowerSpeak+RAPID—a CAPD solution that combines powerful speech recognition technology (PowerSpeak) with real-time risk adjustment using HCCs (RAPID), please contact Saince.

Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes for 2018

On November 1, CMS issued the CY 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule with comment period, which includes updates to the 2018 rates and quality provisions and other policy changes. CMS adopted a number of policies that will support care delivery; reduce burdens for health care providers, especially in rural areas; lower beneficiary out of pocket drug costs for certain drugs; enhance the patient-doctor relationship; and promote flexibility in healthcare.

CMS is increasing the OPPS payment rates by 1.35 percent for 2018. The change is based on the hospital market basket increase of 2.7 percent minus both a 0.6 percentage point adjustment for multi-factor productivity and a 0.75 percentage point adjustment required by law. After considering all other policy changes under the final rule, including estimated spending for pass-through payments, CMS estimates an overall impact of 1.4 percent payment increase for providers paid under the OPPS in CY 2018.

CMS updates ASC payments annually by the percentage increase in the Consumer Price Index for all urban consumers (CPI-U). The Medicare statute specifies a Multi-Factor Productivity (MFP) adjustment to the ASC annual update. For CY 2018, the CPI-U update is 1.7 percent. The MFP adjustment is 0.5 percent, resulting in a CY 2018 MFP-adjusted CPI-U update factor of 1.2 percent. Including enrollment, case-mix, and utilization changes, total ASC payments are projected to increase approximately 3 percent in 2018.

Physician Fee Schedule Final Policy for Calendar Year 2018

On November 2, CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2018.

The overall update to payments under the PFS based on the finalized CY 2018 rates will be +0.41 percent. This update reflects the +0.50 percent update established under the Medicare Access and CHIP Reauthorization Act of 2015, reduced by 0.09 percent, due to the misvalued code target recapture amount, required under the Achieving a Better Life Experience Act of 2014. After applying these adjustments, and the budget neutrality adjustment to account for changes in Relative Value Units, all required by law, the final 2018 PFS conversion factor is $35.99, an increase to the 2017 PFS conversion factor of $35.89. 

Highlights of Quality Payment Program for Year 2 (Calendar Year 2018) Under MACRA

Here are the highlights of the Final Rule for QPP for Year 2 under MACRA as announced by CMS yesterday:

• Weighting the MIPS Cost performance category to 10% of your total MIPS final score, and the Quality performance category to 50%.
• Raising the MIPS performance threshold to 15 points in Year 2 (from 3 points in the transition year).
• Allowing the use of 2014 Edition and/or 2015 Certified Electronic Health Record Technology (CEHRT) in Year 2 for the Advancing Care Information performance category, and giving a bonus for using only 2015 CEHRT.
• Awarding up to 5 bonus points on your MIPS final score for treatment of complex patients.
• Automatically weighting the Quality, Advancing Care Information, and Improvement Activities performance categories at 0% of the MIPS final score for clinicians impacted by Hurricanes Irma, Harvey and Maria and other natural disasters.
• Adding 5 bonus points to the MIPS final scores of small practices.
• Adding Virtual Groups as a participation option for MIPS.
• Issuing an interim final rule with comment for extreme and uncontrollable circumstances where clinicians can be automatically exempt from these categories in the transition year without submitting a hardship exception application (note that Cost has a 0% weight in the transition year) if they were have been affected by Hurricanes Harvey, Irma, and Maria, which occurred during the 2017 MIPS performance period.
• Decreasing the number of doctors and clinicians required to participate as a way to provide further flexibility by excluding individual MIPS eligible clinicians or groups with ≤$90,000 in Part B allowed charges or ≤200 Medicare Part B beneficiaries.
• Providing more detail on how eligible clinicians participating in selected APMs (known as MIPS APMs) will be assessed under the APM scoring standard.
• Creating additional flexibilities and pathways to allow clinicians to be successful under the All Payer Combination Option. This option will be available beginning in performance year 2019.

EMRs Taking Away Close to One-Third of Physicians’ Work Time – AMA

The EMR Time Crunch

A common complaint among physicians across practices and specialties has been the amount of time that was previously spent attending to patients is now being occupied by clinical documentation.  These time disparities can have adverse effects on physician-patient relationships, and also limit the number of patients able to receive care from a physician or practice. Value-based purchasing models are frequently the basis for physician reimbursements, and because these models require extensive documentation to accurately report the quality and cost of care, the EMR software physicians are required to use is becoming increasingly complex and time consuming.

AMA Findings

A recent study conducted by the American Medical Association focusing specifically on the use of electronic health records in academic centers concluded that an average of 27% of the participating Ophthalmologists’ time spent on patient examinations was occupied by EMR use. On average a total of 5.8 minutes per patient and 3.7 hours was spent working in EMR on any given full day of clinic.  The study also found a negative association between the amount of time spent on EMR per patient encounter and overall clinic patient volume.

The AMA study concluded what many physicians have been expressing for years: doctors have limited time to spend with patients while they are spending more time within EMRs. Aside from the strain EMR places on physicians’ time and patient relationships, it is also creating cumbersome clerical burdens when completed incorrectly or hastily. Large swaths of copied and pasted text create bloated and messy records, and a lack of training and technical knowledge can result in incorrect coding, medical errors, and frequent interruptions in the documentation process.

Physician Dissatisfaction

The amount of physician dissatisfaction has also grown with the increased implementation of EMRs. Nearly half of all physicians report feeling unsatisfied with their work-life balance, and 57% of physicians display signs of burnout. The additional time requirements of clinical documentation are a significant factor in both of these statistics. Physicians are spending an increasing amount of time outside of regular work hours completing EMRs, and an increasingly less amount of time on actual patient care and interaction. This has led to heightened levels of stress and job dissatisfaction.

Looking Forward

While the path hasn’t always been an easy one, electronic medical records are here to stay, and they do present a plethora of benefits to clinical documentation, patient care, and bottom lines. The challenge that needs to be addressed is how to make EMRs efficient and thorough, while minimizing the amount of time physicians are required to spend on them.  Perhaps the solution for better EMR efficiency lies within a hybrid workflow — a workflow that combines the traditional model of medical transcription, where physicians dictate patient encounters and trained transcriptionists and coders review the reports for accuracy and sufficiency, combined with the advantages of using a modern day EMR is the most efficient way to ensure document quality and lessen the time burden EMRs place on physicians. When the responsibility of clinical documentation is not placed solely on the physician, doctors will be able to attend to more patients, improve patient relationships, and increase their job satisfaction.

SAINCE TO PARTICIPATE IN THE 89TH ANNUAL AHIMA CONVENTION AND EXHIBIT

Saince Will Be Exhibiting Several of Its Clinical Documentation Solutions at This Year’s Convention in Los Angeles, CA – October 7-11

Alpharetta, GA, October 2, 2017– In the ever-changing world of value based healthcare, hospitals and health systems are scrambling to keep up with the rapid shift from predominantly inpatient revenues to outpatient revenues. In today’s healthcare system, the ability to track patient risk pools across care settings (outpatient, inpatient, and ER) is crucial for hospitals to maximize their reimbursements, increase their quality scores, and improve patient outcomes. In this climate, the quality of clinical documentation is paramount. The challenge many care providers are faced with is how to efficiently and seamlessly expand their current inpatient CDI programs into outpatient settings, and ensure that physicians in outpatient settings are appropriately and adequately documenting the care provided to patients.

 

Saince, Inc. will be participating in the 89th annual American Health Information Management Association’s (AHIMA) Convention and Exhibit demonstrating several of its revolutionary clinical documentation improvement solutions specifically designed to effectively manage and improve hospital workflows and productivity in both inpatient and outpatient settings. Among the programs being demonstrated, Saince will also reveal the newest version of PracticePerfect, Saince’s groundbreaking outpatient CDI technology.  Convention participants can visit Saince at booth number 905 to learn about the clinical documentation and integrity solutions that are helping hospitals across the country to improve their case mix index and protect reimbursements.

 

PracticePerfect™- The industry’s first and most advanced outpatient CDI solution — fast, easy, and efficient.

 

Doc-U-Aide – The most advanced clinical documentation improvement technology available on the market today, designed by CDI specialists for CDI specialists.

 

Additionally, Saince invites everyone who will be attending the AHIMA convention to participate in their Twitter scavenger hunt which will take place in and around the Los Angeles Convention Center.  Participants are eligible to win prizes and the winner will be gifted the grand prize of a Google Home at the end of the convention on Wednesday!  Play and follow along by following @Saince_inc on Twitter and using hashtag #Saince2017.

 

This year’s convention will run from October 7-12 in at the Los Angeles Convention Center in Los Angeles, California.

 

About Saince: Saince is a 15-year-old, award winning clinical documentation solutions and services company based in Atlanta, GA. Saince is well recognized for its innovative solutions that help healthcare providers navigate and thrive in the fast, changing healthcare industry landscape. Saince helps hospitals of all sizes and specialties – from critical access hospitals to large health systems- in saving costs, improving reimbursements, and enhancing quality of care.