Computer-assisted CDI: Your Secret Weapon to Revenue Generation

1
(No Transcript)
2
The clinical documentation improvement (CDI)
market is set to reach USD 4.5 billion by 2023,
at a compound annual growth rate (CAGR) of 7.9.
And for good reason. With 23 states embracing a
value-based care model to improve their
healthcare systems, the spotlight is firmly on
clinical documentation. Appropriate clinical
documentation is the lifeblood of healthcare
revenue streams. Missing or incomplete
documentation of diagnosis or treatment could
result in delayed, denied, or partially paid
reimbursements from payers. 
3
A build-up of such cases not only makes it
difficult for hospitals to sustain their
emergency medical practice, but also causes
financial, legal, and reputational damage through
charges of medical fraud and abuse. As
terrifying as the consequences of inadequate
documentation are, they can be avoided. In order
to minimize claim denials and rejections, and
maximize reimbursements, hospitals need to
understand the factors that could lead to loss in
revenue.
4
Leading Factors that Cut Down Revenue The
alarming number of rejected reimbursements calls
for serious consideration of the loopholes that
lead to denied or rejected claims  Missed
information Since the coding process directly
impacts the revenue of healthcare organizations,
accuracy is imperative. Coders need to extract
relevant information from medical reports and
assign accurate diagnosis and treatment codes for
each clinical identifier. The quality of codes
is, however, reliant on proper documentation by
the healthcare provider.
5
Under- and over-coding Under-coding involves
registering codes for treatment or diagnosis that
cost less. As a result, hospitals suffer in the
long run from reduced, and often denied claims.
In 2016, the cost of under-coded claims cost
hospitals and healthcare institutions USD 1.2
million. Over-coding or upcoding violations, on
the other hand, involve assigning costlier
diagnosis and treatment codes for higher billing
values. Both these practices are considered
medical fraud and could result in hefty fines and
legal complications.
6
Unbundling Another fraudulent practice is to
unbundle code. This refers to false reporting
that involves using separate codes for procedures
that fall under one code category. Like
over-coding, this leads to higher billing value
and is considered medical abuse. The transition
to ICD-10, and the subsequent complexity, as a
result, has further contributed to billing
errors, missing information, and inadequate
patient coverage. It has affected operations,
data analysis, reporting, and IT systems that use
diagnostic and procedural information. Employees
who are not up to date with the changes are more
prone to create erroneous documentation due to
inaccurate coding practices.
7
The transition to ICD-10, and the subsequent
complexity, as a result, has further contributed
to billing errors, missing information, and
inadequate patient coverage. It has affected
operations, data analysis, reporting, and IT
systems that use diagnostic and procedural
information. Employees who are not up to date
with the changes are more prone to create
erroneous documentation due to inaccurate coding
practices. A lack of understanding of medical
terminology in the patients discharge summary
also leads to inaccurate coding. As a result, a
patient may have to undergo more than their
required diagnostic or surgical procedures.
8
Your Secret Weapon to Revenue Generation
According to Black Book Market Research, 90 of
hospitals reportedly boosted their revenue by at
least USD 1.5 million after implementing CDI
software. The CDI tools help represent patient
health information, clinical status, and EHR
office visits as data codes. These codes are
used to report quality, process reimbursements,
track diseases, and manage administrative and
clinical processes. This results in revenue gains
which are significant for hospitals.
9
Words of Wisdom

• Accurately coded CDI is a necessity in boosting
  operational efficiency in healthcare. Increased
  documentation demands in the electronic health
  record (EHR) sector, has seen an increase in
  erroneous manual processing of poor-quality
  redundant information. With physicians spending
  more time looking at screens rather than with
  patients, more than 40 of healthcare givers are
  experiencing burnout and depression.
• With the help of AI and clinical NLP-assisted
  CDI, hospitals can
•     Improve legacy CDI to minimize revenue loss.
•     Identify opportunities for optimal
  reimbursement.
•     Streamline the CDI process for increased
  efficiency.
• Some of the ways that strategically chosen
  AI-tools are bringing in new-age transformation
  in CDI include

10
Words of Wisdom

1. Clinical NLP Much time is consumed in analyzing
   physician documentation. In case of a
   discrepancy, the time required is more. Clinical
   NLP can automate documentation processes,
   reducing the need for medical note-reading staff,
   and drastically bringing down the time required.
2.  Machine learning With a dramatic increase in
   medical literature produced, machine learning can
   help medical experts stay up to date. This AI
   technology helps with feedback and training,
   enhancing learning outcomes.
3.  Computer-assisted physician documentation This
   AI tool analyses physician documentation to
   provide real-time feedback and resolve
   inaccuracies.

11
Words of Wisdom
As these technologies evolve, so will their
implementation in the healthcare domain. ezDIs
CDI solution (ezCDI) solution allows for the
transformation of clinical data into
opportunities for quality and compliance and
revenue improvement. By automatically identifying
missing or incomplete diagnoses from any clinical
documentation, the ezCDI software can help
hospitals establish steady revenue generation.
Alongside this, the ezNLP offers a cohesive
service platform from which hospitals will gain
crucial insights from unstructured data which can
then be quickly and easily organized into a
structured format for use in immediate clinical
analysis. By reducing cost, time, error margins
and effort spent in processing and clinical
coding, ezNLP will enable hospitals to receive
quick and accurate healthcare expertise in
near-real-time.
12
Words of Wisdom
To learn more about ezCDI and what it can offer
you, follow the link here. For more information
on ezNLP, also follow this link. To learn more
about ezDIs AI-based mid-revenue cycle
management solutions visit www.ezDI.com and to
see the live product demo of our Clinical
Documentation, Coding, Compliance/Auditing,
Quality Measures, Encoder, and Enterprise
Analytics request a live demo.
13
Contact us
Visit Our Website- https//www.ezdi.com/ Address
- 12806 Townepark Way, Louisville, Kentucky 40243