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Insight Paper 8.31.2023

Revenue Cycle Management: Clinical Documentation Improvement

Benefits and keys to success.

Revenue Cycle Management: Clinical Documentation Improvement

In today’s healthcare landscape, operating margins are slim, and patient price transparency is more important than ever. A well-optimized revenue cycle is critical to maximizing insurance payment collection and reducing burdensome patient payments, while maintaining a healthy bottom line.

In a previous Trexin Insight Paper, No Margin, No Mission, I discussed the multi-faceted approach to revenue cycle management optimization. In this paper, we will take a deeper look at one of those optimization opportunities, Clinical Documentation Improvement.

CLINICAL DOCUMENTATION IMPROVEMENT (CDI)

Clinical Documentation Improvement, or CDI, refers to the process of reviewing and improving the accuracy, specificity, and completeness of clinical documentation in patient records.

CDI supports the delivery of high-quality patient care by more accurately reflecting the patient’s condition, treatment, and care plan, and is also increasingly important for ensuring accurate coding, billing, and reimbursement for health systems.

CDI can also help healthcare organizations comply with regulatory requirements, including quality reporting and value-based care.

CLINICAL DOCUMENTATION GAPS LEAD TO DENIALS

Physicians are trained on how to administer patient care, not how to manage payer rules for clinical documentation, utilization review or any other factors that may impact revenue, and as such, are often unfamiliar with the coding process, and how clinical documentation impacts claims reimbursement.

With CDI, healthcare organizations can improve the quality of their clinical documentation to better support charges and claims, and reduce administrative burden through more efficient billing and payment.

Through a robust program and supporting tools, health systems can reduce the risk of unnecessary denials due to misinterpretation.

KEYS TO SUCCESS

While CDI is an ongoing process, proper planning at the outset can lead to improved CDI outcomes long-term. Implementing a successful CDI program requires thorough preparation and collaboration from multiple stakeholders and groups.

This includes defining goals and objectives, understanding current state and completing roadmap planning, implementing changes, and monitoring metrics for continuous improvement.

HOW TREXIN CAN HELP

Assessment – Trexin performs critical Risk Assessments in partnership with your RCM teams to determine your Documentation gaps.

    • Identify and prioritize gaps in documentation
    • Determine impact to your organization
    • Identify needed technology and strategy for implementation

Operationalize – Trexin defines immediate, actionable plans to improve your overall RCM Strategy.

    • Implement technology that aligns with RCM goals
    • Enable technology to identify missed revenue opportunities
    • Provide training and education to users on implemented technology

Interested in learning more, or want advice on how to get started with CDI to improve revenue cycle health? Trexin can help. Connect with an Advisor here:

Contact a Trexin Advisor

Tagged in: Healthcare & Life Sciences, Optimized Operations