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The Exec: Discontinuing Reconciliation with UC Davis Health, Part 2: Garnering Support

Analysis  |  By Amanda Norris  
   December 09, 2022

Discontinuing its reconciliation process was an easy decision for one revenue cycle leader at UC Davis Health.

2022 has been a financial struggle for most hospitals, and revenue cycle leaders have been tasked with helping to improve the bottom line. It’s no secret that one of the areas most closely tied to reimbursement is the middle revenue cycle.

When it comes to streamlining the middle revenue cycle to increase productivity and help that bottom line, one area leaders look to is the reconciliation process.

While some leaders believe the CDI and coding reconciliation process is an important step in proper documentation and denials management, other leaders have said the time spent reviewing the mismatches is not only bad for productivity, but team moral as well.

Tami McMasters Gomez, the director of coding and CDI services for UC Davis Health, made the decision to do away with its reconciliation process, and since she was armed with data, gathering support from other leaders was easy as well.

This is part two of a two-part series. Reread part one here.

HealthLeaders: Did you find it easy to get other revenue cycle leaders on board with your decision to change this process up?

Tammy McMasters Gomez: I did. Once I was able to demonstrate the high accuracy rates of our coding team and show that I believed this process could be done more efficiently, there was a lot of buy in from our C-suite. By changing the way we did it, we had a lot of benefits.

HL: I know that we chatted about the 33% increase in productivity, but what other positive outcomes have you seen since changing this process?

McMasters Gomez: I will say that it allows individuals who are seeking education or feedback on their performance a chance at a daily interaction with a team member who is very direct and has an education background.

Previously, when we left it up to the coder and the CDI specialist to go back and forth and provide education to each other on why there was a DRG mismatch, it wasn’t very helpful because coders and CDI specialists don't necessarily speak the same language.

I think this new process has provided that direct feedback that’s easily digestible and referenced by material that is specific to that person. I think it's created a better understanding from the team because some of the feedback I got was: “I don't understand what the coders are saying,” or the coder would say “we don't code based off a clinical findings, we code based on documentation.” There was a lot of that back and forth.

Now all of that is done in a nice write-up format and presented back to the team, and in my opinion, it’s irrefutable because there's evidence, documentation, and all of the coding or CDI resources are presented back to the teams. It's created a great educational opportunity. And again, the CDI teams can now spend more time doing clinical reviews.

Also, that productivity piece has allowed us to spend more time looking at some of the more complex things. This change didn’t just increase team productivity, but it increased the integrity of the reviews and the type of reviews that we're doing. As the landscape is kind of moving more towards quality outcomes, we're able to better measure that performance.

HL: When taking on such a large endeavor like reworking an entire reconciliation process, revenue cycle leaders can be very hesitant. Can you give them any advice on moving forward and taking those first steps towards something like this? What can they say to their CDI or coding directors to get them on board?

McMasters Gomez: I think I would start by really looking at the time being spent on reconciliation and the impact it has on the teams.

And make sure you have a strong coding team first—it really does start with high coding accuracy rates. If you have a coding team that's not strong, the process you have in place may work.

That's how I think it evolved for us—we already had such a high accuracy rate, it didn't really make sense to have a reconciliation process in place where the CDI specialists were questioning the coders, because 99% of the time the coders were right already.

That’s why for us it was about making sure that we were more efficient in how this process was conducted. It's about efficiency.

I would tell revenue cycle leaders to demonstrate how the process is currently working when looking for buy-in on a change like this. Is it efficient? What's the time being spent on it? And then ask about those coding accuracy rates. If you have a very high coding accuracy rate and your coders are accurate 99.9% of the time during that DRG mismatch review, does it make sense to continue this reconciliation process?

“That productivity piece has allowed us to spend more time looking at some of the more complex things. This change didn’t just increase team productivity, but it increased the integrity of the reviews and the type of reviews that we're doing. As the landscape is kind of moving more towards quality outcomes, we're able to better measure that performance.”

Amanda Norris is the Revenue Cycle Editor for HealthLeaders.

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