Computer-Assisted CDI: Your Secret Weapon to Revenue Generation

ThemarketsizeoftheglobalClinicalDocumentationImprovementmarketis predictedtoreach$7,181.66millionbytheyear2028ata7.40%CAGRduring theforecastperiod.Andforgoodreason.With23statesembracingavaluebasedcaremodeltoenhancetheirhealthcaresystems,thespotlightis stronglyonclinicaldocumentation.

Thelifebloodofhealthcarerevenuestreamsisaccurateclinical documentation.Payersmaydelay,deny,orpartiallyreimburseyouifyou havemissingorincompletedocumentationofdiagnosisortreatment.The accumulationofsuchcasesnotonlymakesitdifficultforhospitalstomaintain theiremergencymedicalservicesbutalsodamagestheirfinancial,legal,and

reputationalstandingbyexposingthemtoallegationsofmedicalfraudand abuse.

Theconsequencesofinsufficientdocumentation,asterrifyingastheyare,can beavoided.Toreduceclaimdenialsandrejectionswhileincreasing reimbursements,hospitalsmustfirstunderstandthefactorsleadingto revenueloss.

Leading Factors that Cut Revenue

Thealarmingnumberofdeniedreimbursementclaimsnecessitatesadetailed analysisoftheflawsthatleadtoclaimsbeingdeniedorrejected:

1. Missed information: Becausethecodingprocessdirectlyimpactsa healthcareorganization’srevenue,accuracyiscritical.Codersmust extractpertinentdatafrommedicalreportsandassignprecise diagnosisandtreatmentcodestoeachclinicalidentifier.However,the accuracyofthecodesisdependentonthehealthcareprovider’s documentation.Errorsandincompleteinformationinthe documentationareaseverethreattohospitals,especiallywith physiciansdealingwithsuchaheavyworkload.Thecodingproblemis madeworsebyincompleteinformation.

2. Under- and over-coding: Under-codingisthepracticeofregistering codesfortreatmentsordiagnosesthatarelessexpensive.Asaresult, hospitalssufferinthelongrunfromlowerreimbursementandclaims thatarefrequentlydenied.In2016,under-codedclaimscostU.S. hospitalsandhealthcareinstitutions$1.2million.Ontheotherhand, over-codingorupcodingviolationsinvolveassigningmoreexpensive diagnosisandtreatmentcodesinexchangeforhigherbillingvalues. Bothactionsareconsideredmedicalfraud,andtheycouldresultin heftyfinesandlegalissues.

3. Unbundling: Unbundlingcodesisanotherfraudulentpractice.This typeoffalsereportinginvolvestheuseofdifferentcodesforprocedures thatbelongtothesamecodecategory.This,likeover-coding,resultsin ahigherbillingvalueandisregardedasmedicalmalpractice.

Billingerrors,missinginformation,andinadequatepatientcoveragehaveall increasedduetotheincreasingcomplexityofcodingguidelines.Ithas impactedoperations,dataanalysis,reporting,andITsystemsthatrelyon diagnosticandproceduraldata.Employeeswhoaren’tuptodateonthelatest changesaremorelikelytocreateincorrectdocumentationduetopoorcoding practices.

Incorrectcodingisalsocausedbyalackofunderstandingofmedical terminologyinthepatient’sdischargesummary.Asaresult,apatientmaybe requiredtoundergomorediagnosticorsurgicalproceduresthanare necessary.

Itcanbedifficulttokeepalltheseconsiderationsinmindwhileoptimizingthe codinganddocumentationframework.However,withnewtechnologies,the healthcareindustryhasbeencompelledtoimproveitscodingand documentationframework.TheintroductionofAI-enabledclinical documentationimprovement(CDI)softwarehasbeenthemostsignificant aspectoftheseadvancements.

Your Secret Weapon to Revenue Generation

AccordingtoBlackBookMarketResearch,90%ofhospitalsboostedtheir revenueby$1.5millionafterimplementingCDIsoftware.

Patienthealthinformation,clinicalstatus,andEHRofficevisitsrepresentdata codeswiththeCDItools.Thesecodestrackdiseases,reportquality,and manageadministrativeandclinicalprocesses,amongotherthings-resulting insignificantrevenuegainsforhospitals.

Words of Wisdom

Toimproveoperationalefficiencyinhealthcare,accurateCDIisnecessary. Increaseddocumentationdemandsintheelectronichealthrecord(EHR) industryhaveresultedinmoreerroneousmanualprocessingoflow-quality redundantdata.Withphysiciansspendingmoretimelookingatscreens ratherthanwithpatients,morethan40%ofhealthcareprovidersare experiencingburnoutanddepression.

WiththehelpofAI-andclinicalNLP-assistedCDI,hospitalscan:

• ImprovelegacyCDItoavoidrevenueloss.

• Evaluateopportunitiesforoptimalreimbursement.

• StreamlinetheCDIprocessforincreasedefficiency.

Some ways strategically chosen AI tools bring new-age transformation in CDI include:

4. Clinical NLP: Analyzingphysiciandocumentationtakesalotoftime. Thetimerequiredincreasesifthereisadiscrepancy.ClinicalNLPcan automatedocumentationprocesses,reducingtheneedformedical note-readingstaffandreducingthetimeitwouldtaketocode.

5. Machine learning: Machinelearningcanhelpmedicalexpertsstay currentastheamountofmedicalliteraturehasincreaseddramatically. Thisartificialintelligence(AI)technologyaidsinfeedbackandtraining, improvinglearningoutcomes.

6. Computer-assisted physician documentation: ThisAItoolexamines physiciandocumentationinreal-timetoprovidefeedbackandcorrect errors.

Asthesetechnologiesevolve,sowilltheirimplementationinthehealthcare domain.AGSHealth’sCDIsolutionsimprovedataquality–resultinginbetter

clinicaldata,compliance,andrevenue.Theyassisthospitalsinestablishing consistentrevenuegenerationbyautomaticallyidentifyingmissingor incompletediagnosesfromanyclinicaldocumentation.Inaddition,itprovides aunifiedserviceplatformthroughwhichhospitalscangaincriticalinsights fromunstructureddata,whichcanquicklyandeasilybeorganizedintoa structuredformatforuseinclinicalanalysis.

Byminimizingcost,time,errormargins,andeffortspentinprocessingand clinicalcoding,AGShelpshospitalsreceivequick,accuratehealthcaredatain near-real-time.

AGS Health

Author

AGSHealthismorethanarevenuecyclemanagementcompany–we’reastrategicpartnerfor growth.Byblendingtechnologies,services,andexpertsupport,AGSHealthpartnerswithleading healthcareorganizationsacrosstheUStodelivertailoredsolutionsthatsolvetheuniqueneedsand challengesofeachprovider’srevenuecycleoperations.Thecompanyleveragesthelatest advancementsinautomation,processexcellence,security,andproblem-solvingthroughtheuseof technologyandanalytics–allmadepossiblewithcollege-educated,trainedRCMexperts.AGSHealth employsmorethan10,000teammembersgloballyandpartnerswithmorethan100clientsacrossa varietyofcaresettings,specialties,andbillingsystems.

Source of content:

https://www.agshealth.com/blog/computer-assisted-cdi-your-secret-weapon-to-revenue-generation/