News: Value-based purchasing initiatives require CDI focus on pre-bill reviews
“Ever since CMS announced its goal of transitioning payments to alternative and value based care models, hospitals and healthcare systems have been implementing new processes and technology to support the shift from fee-for-service to value based reimbursement. Most are already participating,” according to a recently released position paper from Enjoin.
The central theme to many of these related measure is documentation, the paper states, citing a May 2016 HealthLeaders Media survey, which indicated that facilities considered leveraging CDI to for value based payment its second-most important role and an October 2016 Black Book survey of more than 1,000 hospital and physician leaders, which called CDI programs “imperative.”
Conducting record reviews pre-bill with CDI staff can help capture value-based payment vulnerabilities and create cohesive documentation improvement efforts throughout the entire revenue cycle, according to the paper, which offers four tips including:
- Perform a 30-day documentation and coding assessment to determine CC/MCC capture rates for all MS-DRGs—particularly high-frequency or high-impact DRGs
- Incorporate common errors into a daily pre-bill review process
- Use pre-bill reviews to drive concise and pertinent education for physicians
- Leverage pre-bill audits to guide education for coders and CDI specialists
Value based care will push CDI programs beyond the traditional focus on CC/MCC capture and case mix to evaluate documentation improvement opportunities across the care continuum—including pre- and post-acute care.