Guest Post: Using coding, CDI to transform hospitals’ revenue integrity, part 2

by Amber Sterling, RN, BSN, CCDS, and Jana Armstrong, RHIA, CPC

Seven lessons learned in physician education

The following lessons were learned at KRMC and proved to be instrumental in improving communication between physicians, CDI staff, and coders:

1. When changes are implemented, keep all three disciplines in the loop and remember they are all essential in making the process work.
2. Coach and train CDI staff on how best to present findings to physicians and what data sets to use.
3. Ask what specific documentation changes coders and CDI specialists need to communicate to physicians.
4. When presenting coding and documentation improvement requests to physicians, know the hot-button topics that get their attention (i.e., mortality rates, resource utilization, public reporting). Frame conversation around these attention-getting topics.
5. Set up a specific time to meet with physicians—and make sure it’s not during rounds. Schedule a time when physicians won’t be distracted by other tasks and will be able to listen and understand why your request is important. Then give them time to absorb the information.
6. Show physicians two cases, with varying query outcomes, to demonstrate how a case can change with a positive physician response to a CDI or coder query. Quantify the effect of query responses on coding and public reporting in dollars and public reporting metrics.
7. Practice what you want to say to physicians and how best to say it.

Bringing it all together

The final critical piece in the revenue integrity model is bringing all the data together and communicating it in a way that makes sense for the organizational structures and workflows already in place. In the case of KRMC, findings across coder education, CDI, and physician education were presented together, with key findings highlighted.

The HIM director developed provider-specific scorecards for clinical documentation performance and reviewed them with the chief executive officer of each hospital location. Because physicians already knew they would be held accountable, ongoing data and specific examples were used to conduct meaningful conversations with the medical staff, emphasizing before and after CDI reports and why the latter represents stronger data.

Revenue integrity: The final analysis

It’s important to conduct training across all three spectrums simultaneously. Data analysis and communication can take place on specific cases, and all three constituents can visualize their roles at the same time.

CDI audits should consist of cases for each CDI specialist, including an analysis of each DRG and any denial trends to target individual education. Concurrent CDI audits show documentation weak spots while the patient is in-house so gaps can be addressed and remedied with physicians in real time.

A strong, proactive approach to revenue integrity takes a coordinated effort and senior management support. All stakeholders must be equally engaged and committed.

Editor’s note: This article is part of a two-part series. To read the first part, click here. Sterling is the director of CDI services for TrustHCS, where she consults with clients to develop and improve CDI programs. Armstrong is the executive director of consulting for TrustHCS. She received her bachelor of science in health information management from Arkansas Tech University. This article originally appeared in HIM Briefings. Advice given is general. Readers should consult professional counsel for specific legal, ethical, clinical, or coding questions. Opinions expressed are that of the author and do not necessarily represent HCPro, ACDIS, or any of its subsidiaries.