The New Math of Healthcare: CDI + CAC > ICD10

September 17, 2014 Streamline Health

As part of Streamline Health’s participation in NHIT Week, this is the second in a series of daily blog posts addressing the question: What is the value of healthcare IT?

The New Math of Healthcare: CDI + CAC > ICD10

Julius Blum, Vice President, Portfolio Architecture & Integration, Streamline Health

CDI: Clinical Documentation Improvements (CDI) refers to how healthcare providers optimize the specificity, accuracy, and completeness of their clinical documentation. CDI has always been important, but with healthcare reform driving the transition to value-based care, CDI is at a critical juncture for financial, compliance, and patient care concerns.

More detailed documentation allows coders to code more accurately to reflect the proper severity and complications, which enables providers to realize the full reimbursement due for services provided.  As scrutiny and auditing continue to increase, without the proper documentation, so will the denials. And by increasing the accuracy and completeness of documentation, the quality of care delivered is also enhanced.

An effective CDI initiative needs to be augmented by a software solution that includes ways to track clinical indicators for opportunities, query physicians electronically for more specificity, and have the ability to demonstrate the financial and other impacts of CDI. Concurrent queries reduce the need for retrospective queries.

CAC: Once CDI is established, Computer Assisted Coding (CAC) using Natural Language Processing (NLP) will provide the foundation for overcoming the challenges that ICD10 will bring. CAC increases the number of codes used, which will typically increase the case mix index. Another important benefit that many overlook is the audit trail provided as to where the codes were found in the documentation. This is an operational asset for providers in the transition to value-based care delivery.

Order of Operations: The order of this equation is important since an NLP engine is only as good as the documentation that is provided to it. Having a well-established CDI program will provide better CAC results for the coder.

Don’t wait for ICD10 to start building this equation.

  • Regardless of the coding methodology used, CDI will reap financial, quality, and patient care benefits for your institution.
  • For those who feel you can’t take advantage of CAC now because you still have a high percentage of charts on paper, scanning solutions and optical character recognition (OCR) can overcome those barriers and begin your transition to optimized coding, more complete reimbursement and enhanced quality of care.

Where are you in the equation?

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