Editor’s Note: Accurate and complete clinical documentation becomes more important as CMS increases the number of value-based care bundles. Physician Advisory Reviews identify opportunities and gaps in meeting medical necessity criteria and CMS regulation compliance. Meet with one of BHM’s experts and assess if your network is maximizing reimbursement potential. CLICK HERE and schedule time with our Healthcare Experts.

Clinical DocumentationClinical documentation is critical for Centers for Medicare and Medicaid Services (CMS) bundles. As CMS adds more bundles to their list, clinical documentation improvements increase in value. From before admission through up to 90 days post-discharge, these bundles capture the entire patient experience.

“With more bundles comes the need to capture more comprehensive clinical documentation across the entire enterprise to support coding, billing, quality reporting, cost management and reimbursement distribution spanning the time period of the bundled payment…All this begs the question: Considering the new bundled payment options, where are the CDI “gotchas” with CMS bundled payments and how can we avoid them?“

– Amy Czahor, RHIT, CDIP, CCS, in a story for Advanceweb.com,

Many facilities do not budget enough resources covering the number of admissions during a 24 hour period. CDI specialists try covering as many as possible, because ensuring an accurate and complete record of care from the beginning will increase the accurate processing of reimbursements, especially with the new CMS bundles.

The Advanceweb.com article continues, “It will be critical to focus on trends for specific documentation gaps as we shift from case mix monitoring to watching quality outcomes for bundled-payment patients. For example, CDI teams must know which cases and physicians are most notorious for documentation insufficiencies. Continually evaluating the query process and associated query rules is another critical step within the CDI process to stay ahead when participating in bundled-payment programs.”

There are three important steps to consider for effectively managing CMS bundles.

  1. Know Ahead of Time
    • Know which physicians have the most complex procedures and identify specific trends in their documentation for education and monitoring.
  2. Put Proactivity in the CDI Process
    • Use technology to help identify encounters where patients meet CMS bundle criteria and there’s a strong propensity for documentation gaps – before the case is documented and coded.
  3. Conduct Targeted Physician Education
    • In establishing a continuous feedback loop to the medical staff, specialty by specialty, you can begin to shift patterns.

For the entire article, click HERE.

Accurate and complete clinical documentation becomes more important as CMS increases the number of value-based care bundles. Physician Advisory Reviews identify opportunities and gaps in meeting medical necessity criteria and CMS regulation compliance. Meet with one of BHM’s experts and assess if your network is maximizing reimbursement potential.

CLICK HERE and schedule time with our Healthcare Experts.