Almost 30 percent of hospitals say they are denied for outpatient coding errors, writes Bonnie Cassidy, senior director of HIM innovation for Nuance, for HIT Consultant, and that sort of lack of efficiency can wreak havoc on a company's financial plan.
Ms. Cassidy says there are five important steps you can take that will curb expenses you're levying on dealing with those denials:
1. Assessing your clinical documentation improvement program
"As the industry continues to see a dramatic increase in outpatient volume and outpatient claim denials, initiating an outpatient CDI program is necessary to ensure the right information is being accurately captured in a timely fashion, particularly since the patients leave immediately after their visit."
2. Pinpointing the source
"Take a look at your denials and analyze the data. Where are they coming from? Are they tied to documentation issues or coding issues? ICD-10 will compound any existing problems, so taking the time to determine the primary source of the denials will help you proactively address any future complications."
3. Synthesizing your HIM, CDI and revenue cycle
"Denials affect all players in the revenue cycle: from health information management teams to financial teams, so analyze your outpatient denial trends. Outpatient CDI should be focused initially on the areas that are most impacted by denials. Collecting information about your outpatient denial trends and patterns will help you determine which services need more education in order to improve documentation."
4. Engaging physician CDI champions
"Physicians and clinicians must understand and embrace outpatient clinical documentation requirements, especially those that are a prime target for RAC auditors. Accurate clinical documentation impacts clinicians through better patient care, and impacts your organization by helping to improve financial stability — and this is especially important as we transition to ICD-10."
5. Embracing health IT technology
"Many outpatient clinical documentation issues can be resolved by educating clinicians, CDI specialists and coders. Another essential component, however, is reviewing workflows and redesigning processes with the addition of automated solutions and technology, and utilizing and enhancing EHR templates designed to capture comorbid conditions and severity of illness, when appropriate."
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