Untangling healthcare's Gordian knot

The “threads” of clinical documentation, ICD-10 codes, quality measures, and meaningful use have become so tangled that it seems that healthcare revenue cycles have become a veritable Gordian knot. But carefully following the strands of education, coding, and clinical documentation may reveal that this massive knot that has been tying up reimbursement may be all one piece of the same string. When attempting to untangle any knot, it is important to be cognizant of how, when pulled, each individual strand can tighten, increase the tension, and impact the dynamic of the whole.

There is still almost a year until ICD-10 goes into effect, and with proper clinical documentation strategies, organizations can take the right actions to protect their revenue cycles and safeguard their bottom lines. Here are some guidelines that will help keep revenue cycles undisrupted throughout the coming changes:

Educate. Policies and deadlines can change, so keeping all employees informed and providing them with training will help your organization anticipate and overcome hurdles as they arise. As providers look to establish accurate and efficient processes across the board, many are taking a physician-first approach to capturing the correct clinical documentation information the first time around. Trinity Health recently adopted this physician educational model and, according to Don Bignotti, M.D., senior vice president and CMO, “We’ve had great success collaborating and educating our physicians on the importance of improved accuracy of documentation within the new world of ICD-10.” Using a physician-first approach not only prepares clinical staff, but more importantly ensures that the patient’s story is accurately captured at the point of care.

Implement a clinical documentation improvement program. Clinical documentation improvement (CDI) programs enable organizations to identify and target gaps in documentation and more accurately capture a patient’s story. After implementing a CDI program, St. Luke’s University Health Network, which comprises six hospitals, saw an average of 21 percent improvement in their case mix index (CMI) and a marked improvement in both quality and severity of illness scores. Cheryl Davidson, clinical documentation manager at St. Luke’s, asserts, “There is so much at stake, and accurate clinical documentation is critical to safeguarding the quality of our patient care, addressing compliance regulations, and ensuring appropriate reimbursement.”

Dual code. With ICD-10 threatening to severely impact productivity levels, experts suggest that, in addition to educational training, employing a dual-coding strategy that focuses on diagnosis-related groups (DRG) relevant to each individual hospital’s population is important to preparing coders for the ICD-10 transition. Dual coding will help expose any points of confusion coders are having and allow organizations to protect against the risks of improper coding, denied claims, lost revenue, and/or raising red flags for external audits.

Prepare clinical documentation specialists. Coders are not the only group being directly impacted by the October 2014 transition – clinical documentation specialists (CDS) also need to be supported through this process. Implementing a dual-CDI program means specialists work both in ICD-9 and ICD-10, which better prepares them for any potential procedural changes and allows health information management teams to identify any challenges, schedule additional training, and work through problem areas. Additionally, these programs help both HIM teams and physicians acclimate to the new procedures and indexing process.

Use technology to drive workflow improvements. The impact technology can have on streamlining workflows is incredible, if used properly. But frustrations can quickly mount when a system doesn’t produce the desired results.

If an organization doesn’t have a CDI program in place, installing a computer-assisted coding (CAC) program isn’t going to yield optimal results. The codes will only be as good as the information being entered into the system, so implementing a CDI program that integrates with established physician workflows is essential.