by Barry Matthews, Vice President, Health Information Management, HCTec
Saint Francis Health System is a successful and growing integrated delivery network, serving as Tulsa’s largest private employer. In the transition to value-based care, Saint Francis, like many other organizations, was ready to overhaul its outpatient CDI program to improve quality, reduce denials, and ensure accurate payment for the services it performed.
Specifically, providers at the Warren Clinic, which has nearly 350 physicians, were struggling to document and code Medicare Hierarchical Condition Categories (HCC) diagnoses to specificity. The clinic’s “pink sheet program” addressed the problem by capturing all HCCs that primary care physicians documented through Medicare Advantage and other programs.
However, as CMS started to use the HCC risk score for more quality programs, the clinic needed a comprehensive approach to help providers document and code its most challenging conditions. It also needed support identifying coding and documentation hotspots, reducing a backlog of provider audits, and pursuing the clinic’s vision of a formal ambulatory CDI program.
HCTec partnered with Saint Francis Health System to implement an advanced outpatient Clinical Documentation Improvement model at the Warren Clinic, establishing new auditing processes and resolving key documentation and coding challenges. The partnership was focused on these three key elements:
- Accurate documentation, coding, and auditing
- improve coding and documentation for complex HCC diagnoses
- identify and address the key conditions—diabetes, hypertension, and stroke—that presented documentation and coding problems
- complete audits to demonstrate success and identify areas for further improvement
- Physician queries and education
- create the framework for a formal physician query process to address documentation questions
- offer physician education on documenting and coding HCCs
- develop a physician newsletter focused on common clinical documentation issues
- Strategic support for new CDI department.
- develop key data points on how a permanent ambulatory CDI program will benefit the clinic
- create a strong ROI by delivering accurate diagnosis coding and HCC risk scoring
- positively impact quality projects
With a new infrastructure, the Warren Clinic quickly enhanced CDI oversight, creating new documentation, coding, and auditing processes while improving accuracy.
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Barry Matthews, Vice President, Health Information Managemen, HCTec
With over 18 years of staffing experience in the health information management field, Barry continually works to diversify HCTec’s offerings in coding, clinical documentation improvement and case management. Click here to learn how HCTec can help improve your coding accuracy and your bottom line.