From the Forum: Reporting queries’ negative financial effect for compliance’s sake

Show me the money. The Jerry Maguire quote is a phrase CDI professionals are likely also familiar with. Originally, CDI programs cropped up under the financial department with the goal of ensuring accurate reimbursement for the services provided to the patients. Of course, the CDI world has since evolved into areas such as quality, denials prevention, and many more, but healthcare executives still want to know the CDI program’s effect on the facility’s bottom dollar.

So, what happens when a CDI query results in a negative financial effect? It’s a question that’s been energetically discussed for the last couple months on the ACDIS Forum.

“I believe it is good to show that even though CDI intervention may have resulted in a negative dollar impact, the goal is having a correct account for that patient visit, including appropriate principal diagnosis and MS-DRG assignment,” said Claudine Hutchinson, RN, the sole CDI specialist at the Children’s Hospital at Saint Francis.

From a compliance standpoint, all the parties within the conversation thread agreed: reporting negative financial outcomes is the right thing to do.

“I feel this is an important element of compliance given some CDI workflow (clinical validations as one example) will result in lower, but proper payments,” said ACDIS Advisory Board member Paul Evans, RHIA, CCDS, the CDI leader at a large healthcare system in San Francisco.

Of course, as with many things in CDI, the reporting method for queries with a negative financial effect can vary from facility to facility. While some people said they report them along with all their other financial metrics, others separate them out in their own document or spreadsheet.

“I’m pushing to create a bucket for the ‘negative impacts’ and report them two ways—the ‘compliance catch’ and the ‘denial averted.’ I will attach the entire DRG payment amount to the ‘denial averted’ metrics,” said Mark Dominesey, RN, BSN, MBA, CCDS, CDIP, the manager of CDI at Children’s National Medical Center in Washington, D.C.

Regardless of how the negative financial effect of queries is captured, though, it should happen somehow, in order to demonstrate the overarching mission of CDI: Accurate documentation for each individual patient.

“Our primary goal is always to capture the most accurate picture of the patient,” said Kelly Harney, RN, BSN, MA, CCDS, a CDI specialist at St. Joseph Health System in Santa Rosa, California. “From a compliance perspective, if you ever needed to demonstrate the integrity of your program, it will be evident when all impact is combined.”

Editor’s note: To read the entire ACDIS Forum thread on this topic and join the conversation, click here. To learn how to participate in the ACDIS Forums, click here.