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By AGS Health
June 15, 2023
In a recent article, we discussed why and how healthcare organizations build a clinical documentation improvement (CDI) program. The second article in this series shares how to measure the value of CDI.
Establishing quantifiable key performance indicators (KPIs) and metrics establishes the business case for CDI. Comprehensive reporting that analyzes and demonstrates the results of CDI efforts ensures a clear understanding of the ongoing value it brings to the table so that support and resources for the program can be maintained.
The most valuable KPIs in monitoring a CDI program’s effectiveness fall under two umbrellas: monetary and non-monetary values. Under monetary values, evaluation metrics include reimbursement and claim denials, cost of care, cash acceleration, and revenue leakage related to exceptions. Meanwhile, non-monetary KPIs include such metrics as productivity and efficiency, patient experience, patient care, and compliance. The chart below provides more detail on each KPI.
Reimbursements and claim denials, including coding, CMI, diagnostic-related groups (DRGs), and appropriate coding of case severity or rate of over- and under-coding.
Operational productivity and efficiency, as a well-designed CDI program, can double coder productivity due to working from comprehensive and appropriate documentation.
Cost of care, particularly cost increases due to lengths of stay (LOS) that exceed contractual agreements and readmission rates without adequate documentation to support the extra days.
Patient experience, as poor-quality documentation can correlate to extended billing times, extended stays, and discharge delays.
Cash acceleration, including days before reimbursement, discharged not final billed (DNFB), discharged not final coded (DNFC), and clean claim rates.
Patient care, as incomplete or inaccurate documentation can impact care decisions, patient education, and the collection and validation of patient safety indicators (PSI) and HACs data.
Revenue leakage related to exceptions, as it can be complicated to code unique cases, resulting in the claim never being submitted due to limited resources for research or because of a lapse in the timeframe to submit the bill.
Compliance, which involves the ability to collect and validate PSI and HACs and can result in financial penalties.
Metrics such as reimbursements and denials are directly linked to documentation quality. Missing or inaccurate details can result in under-coding, resulting in missed revenues or the need for coders to query physicians, which delays claims and slows reimbursement. When the provided documentation doesn’t support the assigned codes (over-coding), claims may be denied by the payer and require a re-work and resubmission, which consumes additional resources and slows reimbursements.
Rather than being a cost center, a comprehensive CDI program powered by the right people and technologies can accelerate and streamline workflows, enabling users to build out the metrics necessary to demonstrate value to the appropriate leadership – including the chief executive officer, chief financial officer, chief medical officer, and chief nursing officer – as well as department leaders (health information management, managed care, compliance, etc.). An effective, technology-enabled CDI initiative will ultimately help expand margins and increase revenues via appropriate reimbursements.
Download our whitepaper, Understanding and Demonstrating the Value of CDI, to learn how to educate and demonstrate the value of this investment to senior leadership. Our final article in this series will share how to leverage technology to boost CDI impacts.
AGS Health is more than a revenue cycle management company–we’re a strategic partner for growth. By blending technologies, services, and expert support, AGS Health partners with leading healthcare organizations across the US to deliver tailored solutions that solve the unique needs and challenges of each provider’s revenue cycle operations. The company leverages the latest advancements in automation, process excellence, security, and problem-solving through the use of technology and analytics–all made possible with college-educated, trained RCM experts. AGS Health employs more than 10,000 team members globally and partners with more than 100 clients across a variety of care settings, specialties, and billing systems.