CMS under its Medical Review Policy holds its contractors such as the Medicare Administrative Contractors responsible for insuring the payment of provider claims accurately with the primary mission of reducing provider billing errors. The primary goal is to pay the claims correctly the first time around. MACs review clinical documentation to prevent improper payments and choose claims for review based on many factors such as the service specific improper payment rate,

I recently talked with a colleague on the phone who has been out of work for over a year now, this despite the fact the economy is performing well on all major indices. Now, granted my colleague has her age going against her as a strong headwind, she has been actively searching for a book-keeping related position day in and day out with little results. My colleague has been a bookkeeper for over twenty-five years with a very stable work history, having been at her last

In my continued quest to provide feedback to physicians on best strategies for enhanced communication of patient care focusing upon medical necessity denials, I notice a common theme, ineffective communication within the record, particularly when consultants are on board. There appears to be little collaboration between physicians on the case attributable to insufficient communication. The attending is not driving the ship, tying all the clinical

Complacency is the main contributing factor that leads to suboptimal performance and achievement of sustainable operational processes and outcomes for any business. Clinical documentation improvement programs have discounted the necessity to evolve with the times, overlooking critical opportunities to contribute to the overall welfare of the healthcare delivery model. A strong CDI program for the right reasons with an underlying commitment to achieving

What many CFOs are being told: “Clinical validation denials and DRG downgrades are the result of egregious, overaggressive payers who ignore official coding guidelines and arbitrarily challenge diagnoses like sepsis, acute respiratory failure, and metabolic encephalopathy.”

Unfortunately, they don’t teach you how to run a business in medical school. As a result, many physicians struggle to manage the business side of their practice. Entrepreneurial skills are essential if you want your practice to thrive! Are you looking for ways to improve your practice and take your business to the next level? Below, Core CDI shares some tips to help you build a more profitable practice and improve patient satisfaction.

CDI’s present-day Key Performance Indicators centered upon reimbursement do not truly reflect a meaningful account of performance in impacting the quality, completeness and effectiveness of medical record documentation. Common KPIs include number of physician queries left, number of queries responded to by the physician, number of queries responded to by the physician that captured a CC or MCC, number of queries responded to by the physician that impacted severity of illness/risk of mortality number of charts opened and reviewed per day, etc.

A major challenge of current clinical documentation improvement processes is the undivided focus upon reimbursement as the primary outcome, something undisputable with a clear review of present day Key Performance Indicators. The expression and reporting of the clinical truth in the record beginning with the Emergency Room Documentation, transitioning into the H & P and continuing with the consultant reports and progress notes culminating in the discharge summary

Clinical documentation improvement spans the entire continuum of care from the time the patient presents to the Emergency Department or is direct admitted to the hospital until the time of patient discharge and the completion of the discharge summary. The CDI specialist’s role in enhancing the quality, completeness and effectiveness of clinical documentation is to recognize and treat the record as a communication tool as opposed to a reimbursement tool.