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With the push toward value-based reimbursement, your clinical documentation improvement (CDI) program is more important than ever.  Many health systems have very focused Inpatient programs that leverage the multi-day stays of an inpatient admission to capture maximum reimbursement for the complex care delivered.  In this setting, a relatively small group of CDI professionals can review and query the Provider staff to obtain the most accurate coding and thus align reimbursement with the quality care delivered.

However, most of the care given to patients occurs outside of the inpatient setting.   Physician offices, outpatient clinics, and ambulatory care centers provide the majority of patient care throughout the US.  Most have invested in EHR/EMRs expecting to see the ROI hit the general ledger.  But many programs lack the processes, tools, and training for Providers to reap maximum value-based reimbursements in all patient care settings.

Organizations must focus on CDI in all patient areas including the office, clinic, ambulatory care centers as well as the inpatient care arena.  Office practices have providers dispersed to different locations and providers are struggling to see more complex patients in less time.  This brings the priority of documentation in a fast and efficient manner to the forefront.  Documentation must include the state of the patient, the decision making of the provider, and the plan of care for the patient.  Workflow and documentation tools are the base for accurate billing and reimbursement.

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How can you achieve success in the value-based reimbursement future?

  1. Invest in an Optimization assessment that reviews your care organization’s workflow process and the documentation tools used to capture the visit or stay.
  1. Define a plan to optimize your documentation system and processes for efficiency and accuracy as well as compliance with quality of care. Consider a third-party firm to perform an independent Gap analysis and assessment of your current:
  • Clinical Documentation, Quality performance, and Reimbursement methods;
  • EHR/EMR adoption and tools available to your staff; and
  • Clinical and care management workflow processes.

Through objective review and analysis of your current state, you’ll identify opportunities in your CDI strategy that you can leverage into a plan of action.  What you can anticipate is efficient documentation that accurately reflects the valuable care you provide, improved diagnosis capture, improved case mix indices and maximum reimbursement.

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