AHIMA Presentation Recap: Integrating Clinical and Financial Process and Data to Drive Revenue Integrity

By Denise Johnson, Vice President of Process Excellence and Amy Rector, Senior Director of CDI and Charge Audit | Posted: 10/14/2019

nThrive CDI healthcare solutions

Last month, at the 2019 AHIMA Annual Conference, Denise Johnson, nThrive Vice President of Process Excellence and Amy Rector, Senior Director of CDI and Charge Audit, shared top tips on how to utilize CDI technology for continuous improvement and how to collaborate between medical coding and providers results in merged clinical and financial processes for best outcomes.

The integration of clinical and financial processes and health care data is critical to a sustainable provider organization. The effective transformation of clinical processes and data into financial processes and data is still a considerable challenge for most healthcare provider organizations. The opportunity where these two domains blend often creates incomplete and sometimes inaccurate patient and clinical information, leading to suboptimal reimbursement, compliance risks and potential government-imposed penalties.

CDI’s role in denial prevention is to verify clinical evidence within the medical record documentation to ensure diagnoses that are most vulnerable to clinical validation denials. It is important to note that supportive documentation is not necessarily the same as the diagnosis being documented throughout the health record; rather, the documen¬tation should support that the diagnosis under review complies with appropriate, established clinical criteria.

Implementing value-based reimbursement models are also key to incentivize quality of care over quantity of services. This assists in boosting patient satisfaction while promoting coordination, integration, and the sharing of health information. Also, it pressures health care providers to manage clinical and financial data convergence and focus on providing the right care, right provider and the right value. Clinical documentation provides the only opportunity to demonstrate the quality of care that was provided and is the best way to leverage the value-based model.

What Does Success Look Like?

  • Aspiring to strengthen the revenue cycle by capturing every entitled dollar and driving early adoption of middle revenue integration
  • Improve performance by improving the integrity of cdi solutions and accuracy of coded data
  • Reduce duplicate clinical record reviews and data abstraction by delivering data to be shared across the revenue cycle, drive clinician engagement and integrate capabilities delivered to push data analysis and quality review to a concurrent process supported by Analytics and Machine Learning

What Will Be Needed for Success

  1. Payer and Provider clinical data collaboration will require an integrated platform to create efficiencies among and between providers and payer
  2. Robust data to support process improvement and public reporting
  3. Reimbursement maximization through denials mitigation, denials management and avoiding revenue shortfall

This new era of revenue integrity requires close monitoring of clinicians’ ordering, documentation practices, and clinical significance, in order to ensure appropriate reimbursement, avoid denials and improve public quality reporting.

To learn more about nThrive’s powerful CDI technology solutions and services that can help your health care organization build revenue cycle success, contact us at solutions@nthrive.com or call us at (678) 323-2500 to speak with an nThrive expert.