Tracking Revenue losses

Unknown

Hi Everyone,

I realize this may be a silly question but I was asked to see if anyone in the CDI community, software or manually, tracks revenue losses. I just need some feedback.

I personally feel that SOI/ROM should be our focus but we are manual and have no way to show that information other than revenue increases. Carla Heyn, RHIT, BS CDS

dbutler

I have tried to do this -- but my data structure and analysis is also manual, so it adds another block of time required.

Found it helpful when attempting to focus on the impact of a relative lack of participation by individual or specialty group. Especially useful in that light if the data also showed a 'lag' for that group in mortality or LOS index against peer groups on a national level. (We are members in UHC, so use that data source for the index data as well as cc/mcc capture).

Do need to be very careful on how this type of data is handled and shared. Can back fire.

Am wondering if there is anyone out there who could share about the reporting abilities of some of the bigger software or consultant vendors (thinking of 3M with CDIS software, as well as others).

Don

tpeyton

The JA Thomas software will track negative and no response impacts for us.

Tracy M Peyton RN, CCDS
Case Management
Bradford Regional Medical Center
Upper Allegany Health Systems
116 Interstate Parkway
Bradford, PA 16701
814-558-0406

gail_marini

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Many institutions don't have the extra money to invest in a company to do
the tracking for you but you can easily do this on the same spreadsheet
you are using to track the impact. If a query or an interaction does not
result in a simple clarification or capturing a more definitive diagnosis
than you formulate your excel sheet so that the case weight comparison is
the potential compared to actual instead of actual with the impact (and
the impact means it is the ONLY reason that the DRG changed). I have been
tracking case weight changes like this for years and the data keeps me in
tune to which physician or physician group I need to revisit, which query
might need an update, which CMS change is affecting our CMI and where we
are about getting it right and complete.
If you don't love statistics like I do ... ask for help on how to set it
up from somebody in your facility.

Gail Marini MM, RN, CCS
Manager Clinical Documentation (CDI)
Finance Department
781-624-8413 (4:30am - 1pm)
B- 7757

Unknown

Hi Don,

I'm glad to hear from you.

Well, we have a mortality review committee and sometimes we do not agree on the DRG. Once reviewed we sometimes go with the lower DRG because it is the right thing to do. So it is a loss eventhough we may gain an increase in SOI/ROM. Of course, we do not know exactly if it does since we do not have any software. We gained a increase in money but there is a question to minus the losses in this number for presentation to administration. I do not feel comfortable with reporting this because I can not off set it with actual data of SOI increase so I do not wish to report it. This would be the same for tracking monthly $ increases as well. What do you think on this?

dbutler

My general take on the situation where action by CDI (or Mortality review committee, etc.) results in a lower financial return....don't count it as a negative financial impact -- one's actions in these cases are to 'get it right', and thus the 'negative' financial impact is NOT a true impact in the first place: the higher weighted DRG is one that the organization SHOULDN'T have received in the first place.

A common example is the downward shift from sepsis to complication of a urinary catheter with the patient with chronic foley. Query for the relationship because it is the RIGHT thing to do, even if it may in the short term appear to mean lower revenue.

Not sure if you are also asking about some sort of financial gain secondary to the increased SOI/ROM -- not sure how that happens if the final DRG is lower weighted?

Don

dbutler

Tracy -- which version of the software are you using? The access based or SQL? or do they have a third version?

We are using the older access based software, and are considering options going forward for software upgrade.

Thanks,
Don

tiffany_susan

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We track negative impact, more to show compliance and the focus of the
program. We have worked really hard to make it know that we are focused on
quality than financial.
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
"Twenty years from now you will be more disappointed by the things you
didn't do than by the ones you did do. So throw off the bowlines. Sail
away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
Discover." Mark Twain

catladyrn

I am really glad to see that people are tracking their negatives, and more importantly, are willing to go out there and "take money away" in the pursuit of an accurate chart. Yes, JATA software does measure negative dollars, but it will subtract from positives, which incentivizes the CDS not to ask, and makes a mockery of the first word in their software title, Compliant. We have the old software, so maybe SQL doesn't do that? Tracy, when you say it measures negatives, do you mean the physician said no, or do you mean that your query improved the chart but brought the RW down?

It would be really interesting to do a study of cases where the RW was lowered to see if the SOI/ROM was affected upward or downward as well. But with the program we have, I am pretty sure not many negative dollar impact queries are asked. There's too much of a culture to bring in money.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

stacy.vaughn

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we also track negative impact. The goal is quality and accuracy.

Stacy Vaughn, RHIT, CCS, CCDS
Data Support Specialist/DRG Assurance
Aurora Baycare Medical Center
2845 Greenbrier Rd
Green Bay, WI 54311
Phone: (920) 288-8655
Fax: (920) 288-3052

robert.hodges2

As usual, I'm with you Renee. The goal has to be a complete and accurate medical record. While I track potential impact, I don't include the dollars in my reports from our new software package primarily because they are not accurate, but also because that's not where the focus needs to be. Of course it does make it easier when you can show some potential impact, but I always qualify it with a "best guess" statement since I don't do billing and never know for sure what that impact is.

Robert

Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
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Saginaw MI 48602
 
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-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 07, 2011 9:56 AM
To: Hodges, Robert
Subject: Re:[cdi_talk] Tracking Revenue losses

I am really glad to see that people are tracking their negatives, and more importantly, are willing to go out there and "take money away" in the pursuit of an accurate chart. Yes, JATA software does measure negative dollars, but it will subtract from positives, which incentivizes the CDS not to ask, and makes a mockery of the first word in their software title, Compliant. We have the old software, so maybe SQL doesn't do that? Tracy, when you say it measures negatives, do you mean the physician said no, or do you mean that your query improved the chart but brought the RW down?

It would be really interesting to do a study of cases where the RW was lowered to see if the SOI/ROM was affected upward or downward as well. But with the program we have, I am pretty sure not many negative dollar impact queries are asked. There's too much of a culture to bring in money.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center



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tpeyton

Renee I mean the cases which we clarify for a lower wt drg

Tracy M Peyton RN, CCDS
Case Management
Bradford Regional Medical Center
Upper Allegany Health Systems
116 Interstate Parkway
Bradford, PA 16701
814-558-0406

tpeyton

Don
We are currently using sql....

Tracy M Peyton RN, CCDS
Case Management
Bradford Regional Medical Center
Upper Allegany Health Systems
116 Interstate Parkway
Bradford, PA 16701
814-558-0406





________________________________________

sears.kelley

We use navigant software and it does track the negatives. We were trained to
have the chart be coded accurately and reflect accurately, so the negative
variances are what they are. I personally have them every month.





________________________________
From: CDI Talk
To: sears.kelley@yahoo.com
Sent: Tue, June 7, 2011 11:11:04 AM
Subject: RE: Re:[cdi_talk] Tracking Revenue losses

Renee I mean the cases which we clarify for a lower wt drg

Tracy M Peyton RN, CCDS
Case Management
Bradford Regional Medical Center
Upper Allegany Health Systems
116 Interstate Parkway
Bradford, PA 16701
814-558-0406





________________________________________
From: CDI Talk [cdi_talk@hcprotalk.com]
Sent: Tuesday, June 07, 2011 9:55 AM
To: Peyton, Tracy
Subject: Re:[cdi_talk] Tracking Revenue losses

I am really glad to see that people are tracking their negatives, and more
importantly, are willing to go out there and "take money away" in the pursuit of
an accurate chart. Yes, JATA software does measure negative dollars, but it will
subtract from positives, which incentivizes the CDS not to ask, and makes a
mockery of the first word in their software title, Compliant.

Unknown

Nice discussion here, just wanted to throw out for discussion does anybody track the amount of monies taken back by the RAC, CERT or MAC based upon their interpretation of the diagnoses in the record or perhaps a CC or MCC obtained through the query process that maybe is only documented once in the record or is intepreted to be of little clinical significance.

kmckaig

Our RAC coordinator tracks all monies taken back. As well, whenever we get a RAC denial for DRG downgrade, the coding director, the CDI's, RAC coordinator and a coder review the case and meet as a group to discuss whether we agree or need to appeal. So far, I have had 2 DRG downgrades appealed and overturned at the first level.

Also, our system does track "QA" cases and the money involved. These are cases where we have queried for a lower wt DRG and the physician agreed and the amount of money impacted. We actually have quite a few every month although the higher wt queries very much outweigh them.

catladyrn

We have not been involved in the appeal process; probably because in this region at least, the RAC is still just having a field day with medical necessity and not so much with DRGs, but I have asked that we be included in the feedback loop so that we can educate physicians on what kind of documentation might help avoid the denials in the first place. No response, though.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

Unknown

Renee, What region are you in for RACS We are in A and we have very little DRG reviews.

Carla Heyn, RHIT, BS
Elliot Hospital, Manchester, NH

catladyrn

We are in region D, Arizona.

Renee

Unknown

Renee,

Since you are using JAThomas, what exactly do your losses include and how is it calculated?
Is it after the bill goes out or prior to the bill?

Carla H.

catladyrn

Carla, with the old JATA software that we use, if I ask a query that lowers the RW, such as asking if sepsis due to cellulitis was POA, changing it from an MCC to the PDX, the software shows a negative dollar impact. Unfortunately, the culture here is that you don't ask a question if it doesn't increase revenue, so nobody's tracking it, AFAIK.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

dbutler

Similarily for us, we will and encourage those type of questions -- but will mark it as a severity and don't put into the software an initial, potential and final DRG. The final worksheet will have the query, response, and only one DRG (that resulted from the query). This way we do not have a negative financial impact on our finance metrics, but are still getting 'credit' for the query activity and are documenting the query from a compliance perspective.

Don