How effective is your inpatient charge capture? Really.

Implementing streamlined, effective inpatient charge capture processes is critical to your organization. Although 80%-85% of inpatient healthcare facilities in the U.S. use some form of clinical documentation integrity modeling, the application and integration of CDI solution varies widely in terms of their effectiveness and efficiency. Inpatient CDI must follow many facets of regulated guidelines and compliance protocols, making it difficult to thoroughly address the many challenges inpatient charge capture professionals encounter daily. 

It’s proven that organization and priority leveling of CDI priorities can help organizations more accurately address issues related to documentation, coding, and billing gaps. But how? Organizations need to consider a CDI approach that will re-evaluate their current structure, organizational approach, documentation evaluations, and physician culture. 

Why does CDI matter? 

In short, it’s crucial. Appropriate reimbursement is determined by your EHR documentation. Therefore, accurately documenting all comorbidities and surgical procedures during a patient’s hospital stay is paramount. The documentation must depict and measure the patient’s acuity and length of stay and justify the patient’s use of resources and relative cost of care. 

Several challenges get in the way of achieving effective CDI, however. Those challenges include not understanding CMS’ Medicare Severity Diagnosis Related Groups system and changing regulatory requirements to incomplete (or inaccurate) documentation, increasingly complex coding systems, and workforce shortages. 

Addressing CDI challenges 

In our experience, achieving an effective CDI program requires knowledge—and solutions—to help address common documentation and coding and billing concerns. Kodiak’s CDI approach aims to review and identify your organization’s CDI characteristics to identify gaps in documentation and opportunities for improvement in areas such as DRG systems, severity and mortality depiction, and Medicare/government funding billing policy and activities. Through a three-part strategy (assessment, implementation, and monitoring), we customize a solution that addresses your organization’s unique charge capture challenges. 

1. Assessment involves reviewing the customer’s current CDI state and identifying areas of missed documentation and opportunities for CDI operational improvements. This process entails a thorough review of patient records and evaluation of CDI department operations. 
   
   
2. Implementation. After assessing the organization’s current CDI state, Kodiak specialists will outline, collaborate with you, the customer, and then implement a CDI plan based on the assessment findings. Examples of improvements to be implemented include staff education, structural changes within your CDI department, operational improvements, and staffing modifications. 
   
   
3. Follow-up and monitoring. During this step, Kodiak’s specialists evaluate your current data analytics and then identify and incorporate key metrics to be tracked to ensure accountability and ROI of the newly implemented improvements. 
   
   

Increasing efficiency with CDI: 2 case studies 

The following two case studies illustrate how, by implementing a three-step CDI improvement initiative, two healthcare organizations increased efficiencies and improved bottom-line value in their CDI programs. 

 

Case study No. 1 

Assessment 

While assessing a health system, Kodiak’s specialists found that hospitals within the same healthcare enterprise were conducting CDI concurrent reviews using dissimilar organizational methods.  

Discovery 

Kodiak’s team discovered that staff were using two different approaches to determine which records should be reviewed first. The CDI department at Hospital A was reviewing patient records from a date of admission prioritized method, with no other prioritization considerations. Hospital B, on the other hand, was reviewing records from a service line/composite numbering prioritization method. 

Implementation 

Kodiak specialists determined standardization was needed across the health system to achieve more efficient record review and that all enterprise hospitals would benefit from using Hospital B’s method. The assessment findings unveiled numerous operational opportunities, including: 

• Designating a consistent method of patient record review for CDI specialists enterprisewide. 
• Prioritizing diagnosis codes and procedures to drive to an Agency for Healthcare Research and Quality designation review. 
• Measuring staffing efficiencies using a supervised learning approach, decreasing staffing efforts by 15%. 
  
  

Case study No. 2 

Assessment 

A large healthcare enterprise was seeing a decline in the case mix index metric within one of its high-volume service lines. 

Discovery 

After reviewing historical trends, case types, and provider documentation, Kodiak’s specialists discovered inconsistent use of Decompensated Heart Failure Definition, Hypovolemic Shock, Liver Shock, and other codes. In addition, new physicians and residents were not aware of enterprise-specific comorbidities definitions. These findings were prevalent across several hospitals. 

Implementation  

The Kodiak team determined that all enterprise hospitals would benefit from review of and education on Comorbidity, Complication or Comorbidity/and Major Complication or Comorbidity designated definitions. The information would be service-line specific, with each hospital’s chief medical officer provided with information and educational materials. Kodiak provided the healthcare enterprise a comprehensive education module recording and was available for live presentations as needed. In addition, the team established metrics for ongoing tracking of these implementations’ results. 

Streamline your CDI 

Accurate inpatient charge capture is not only essential for accurate reimbursement, quality ratings and patient safety indicators, but it also plays a vital role in hospitals’ ability to fulfill their missions to deliver safe, quality patient care. 

When something is this important, your organization cannot afford to miss quality, structural, and financial opportunities. We can help. Contact Kodiak’s inpatient charge capture experts today to find strategies and solutions to help streamline and improve your CDI performance.