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Clinical Documentation for Higher Reimbursements

Karen Minich-Pourshadi, for HealthLeaders Media, October 29, 2012

To determine how large the opportunity was in the organization’s clinical documentation, Oliva needed to do a measurement gap analysis by comparing Borgess Health’s MS-DRG codes against a benchmark. 

"I looked at a couple of different variables and measured the MS-DRG couplet and triplet percentage performance at Borgess Health based on high-to-low severity within 40 MS-DRG groups," he explains. He compared those numbers against his experience and data he'd seen while working at two previous organizations of similar size and make-up. 

"That comparison showed me that there was a potential reimbursement increase of about $6 million if we took a more clinically focused documentation approach," he says. 

But doing so required Oliva to get physicians to see where they were missing documentation and to work with documentation specialists and coders on accurately coding clinical work. No easy task, since it meant that physicians needed to spend extra time to do this, but it was the physicians’ outcomes that were the key to moving this program forward. 

 

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1 comments on "Clinical Documentation for Higher Reimbursements"


Matthew Shafiroff (11/1/2012 at 4:17 PM)
This is an extremely interesting article, especially in the light of the recent CMS accusations of physician upcoding with the use of EMRs. Perhaps articles like this will help shed light upon the fact that big data (from EMRs) allows us to understand where we have been chronically under-documenting for years.