Clinical documentation is a vital tool for any healthcare organization. When optimized, a hospital’s documentation processes can directly impact patient health, as well as the strength of the organization’s revenue cycle. Without proper attention and care, organizations risk leaving money on the table and opening themselves up to the risk of RAC audits.

Here’s how clinical documentation, patient care and the revenue cycle interact:

The benefits of clinical documentation improvement

A good clinical documentation improvement program can not only make life easier for the billing department, but also for the patients themselves. In today’s healthcare landscape, clinical documentation is the lifeblood of an organization. If something isn’t documented, it’s like it never happened. And when things aren’t documented correctly, bigger problems arise. With the advent of the Medicare Access and CHIP Reauthorization Act (MACRA) and changes to the Quality Payment Program (QPP), organizations need to refocus on documentation to see the best financial outcome.

“Improved documentation can help the revenue cycle and patient health.”

The Centers for Medicare & Medicaid Services has increased the importance of reporting in recent years, adding more work for organizations that want to get full reimbursements. Likewise, private payers have developed more complicated policies around reimbursements, making life a little more difficult for medical coders and hospital financial officers.

Improving clinical documentation may help an organization financially – but it also impacts patient outcomes. A representative from Heritage Valley Health System, speaking with EHR Intelligence, explained that better documentation and coding reduced the organization’s predicted mortality rate by 27 percent. That’s an incredible improvement, especially when you consider the impact patient health has on not just the hospital system, but also the surrounding community.

RevCyle Intelligence reported that the Summit Healthcare Regional Medical Center in Arizona achieved a 20 percent increase in its case mix index after implementing a CDI program. The organization captured 37 percent more major complication and comorbidity examples, and improved complicating condition identification by 22.8 percent. Altogether, the case mix index improvement resulted in nearly $560,000 in additional revenue in less than a year.

When documentation isn’t optimized, everyone pays the price. Organizations lose out on revenue and patient health suffers. AMN Healthcare Education Services explained that gaps in documentation can harm patients in the future. Likewise, timely documentation can improve the patient experience and result in better care.

Integrated technology is the key

Technology is at the core of any good CDI program. However, not all healthcare technology is created equally – and not every program can talk to the others. For instance, if an organization has the world’s best coding software and top-of-line billing software, it means nothing if those programs cannot communicate with one another.

Healthcare organizations need integrated software that can easily transmit data from one platform to another. In this way, everyone – including patients – has access to the information they need. The billing department gets quick answers from the clinical team, coders increase their accuracy and patients see their complete health record, thus gaining valuable insights.

Looking ahead

As CMS makes additions to the QPP, organizations will need to refocus their attention on improving clinical documentation as well as their reporting abilities. However, not every organization has the same needs. That’s what makes customized technology so important. Whether your hospital or practice is part of an accountable care organization (ACO) or a clinically integrated network (CIN), there’s a unique solution available.

The current healthcare regulation space may be fraught with uncertainty, but a customized solution can keep your organization ahead of the changing tide – no matter what happens in the future.

Tangible Solutions can help your organization determine which process improvements and technology upgrades your organization needs to compete in the modern healthcare landscape. Contact us today to learn more about how tailored technology can improve your revenue cycle.


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