A California hospital was missing out on millions of dollars in uncaptured revenue while risking audits and penalties for compliance issues.
Challenge
At a community hospital in California with a high Medicare population, an underperforming and understaffed Inpatient Clinical Documentation Integrity (CDI) team was reviewing less than 50% of Medicare discharges – with some months being as low as 25%.
The hospital’s Health Information (HIM) leadership faced a dilemma. The understaffed CDI department lacked the bandwidth to capture the revenue necessary to support budgeting for more CDI staff. At the same time, the area’s high cost of living meant finding experienced talent at salaries the hospital could afford was nearly impossible. Adding to the urgency were quality of care challenges from incomplete documentation obscuring critical details about patient conditions.
Without expertise in CDI, it was challenging to establish key performance indicators and escalation policies to measure the underperforming CDI team. Executive leadership was concerned about their decreasing Case Mix Index (CMI), capturing the appropriate patient conditions, and establishing baseline expectations to evaluate where the team was adding value.
Solution
The client partnered with Harmony Healthcare to augment their CDI department to ensure 100% Medicare coverage. By transitioning the staff-level roles to Harmony, the hospital saved on salary and benefit costs while operating an appropriately staffed department. The CDI team now had the staff and experience to capture significant missed revenue through appropriate documentation and queries.
Harmony staffed three full-time CDI professionals for the hospital. This allowed hospital leadership to leverage an expert CDI team without the additional costs of training or new leadership.
The Harmony Difference
Within the first month, Harmony’s expert CDI consultants doubled the amount of completed reviews and had a combined total of $550,000 in financial impact. Within the first three months, Harmony identified more than $1.5 million in financial opportunity for the hospital. Harmony’s consultants have been able to educate client leadership on quality and documentation trends and the impact it has on the entire hospital.
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