Financial impact of CDI program

kara.masucci

Hi

Other then vendor software, does anyone have any tips/tools/ideas on how
to show the impact of a CDI program via revenue?

We track CMI, Mortality, query rates -- but, were asked also to produce
this. We don't have vendor software.

Thanks,
Kara


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cynthia.a.goewey

For me this is a manual process. After the visit is coded I check to see if the cc/mcc I queried for and received was the only cc/mcc for the stay. If it is I then calculate the RW difference from what the DRG would have been w/o my query to what it was with my query. I then multiply this rate times our blended rate which gives the financial impact of the query. If I queried for a diagnosis or procedure I use the same process as above, what would the DRG have been w/o my query and then calculate the RW difference and multiply times the blended rate. I track this monthly in a spread sheet created in excel.
Cindy

gail_marini

Good morning Kara,
If you send me an e-mail I will take a look at what you already have and
see if I can help.
Gail
Gail_Marini@sshosp.org

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

paxneros

We also use an Excel Spreadsheet to reflect the financial impact of queries.

As Cindy mentioned, it is for accts where the CC or MCC I queried for is the only one which affects the DRG. If the Dr. Documents other MCCs or CCs then basically it becomes null and void for financial impact.

Our Spreadsheet is set up to reflect pre-prompt DRG, Post prompt DRG, and final DRG.

Post Prompt DRG RW - Pre Prompt DRG RW x Blended Rate = $$

We present it monthly.

NBrunson, RHIA, CCDS

robert.hodges2

Do you track DRG changes? If you are capturing CC/MCC's that can give you a financial change for your DRG payers. Just a thought.

Robert

Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602

dbutler

Agree with the many great comments.
Focus on what (if any) difference the ICD-9 code that was added to the
record due to CDI activity as many have commented upon.
Would be glad to talk directly, please contact me by email to set up a
call.

In the forms & tools library:
2012 MS-DRG Table -- http://www.hcpro.com/content/269376.xls
Sample clinical documentation improvement chart (This sample chart,
provided by Wendy De Vreugd, senior director of case management, west
group, for Kindred Healthcare, provides an excel spreadsheet for
tracking the impact a clinical documentation improvement specialist can
have on a hospital’s case-mix index. See "Key to sample clinical
documentation improvement chart" for an explanation of its use.)
http://www.hcpro.com/content/206459.xls
and Key to sample clinical documentation improvement chart (This
document, provided by Wendy De Vreugd, senior director of case
management, west group, for Kindred Healthcare, provides an explanation
of the sample clinical documentation improvement spreadsheet above.)
http://www.hcpro.com/content/206461.doc

It is also helpful to use MS Access if you have it, as can set up to
reference the RW's, etc. to decrease the amount of actual manual data
entry.

Don

Donald A. Butler, RN, BSN
Manager, Clinical Documentation
PCMH, Greenville NC
dbutler@pcmh.com

kara.masucci

Thank you all for your input!

Have a wonderful day,
Kara

lspryszak

Does anyone add a "disclaimer" to DRG revenue reports (measured by capture of CC or MCC or PDx change) stating that actual revenue may vary +/- ~ 25% based on patient discharge status? Just a thought: if the DRG is a transfer DRG, you would not be receiving the full reimbursement, thus affecting what the actual increase in revenue actually is.

Unknown

Here is another thought, put in a disclaimer that revenue subject to recoupment from the RAC due to their specific interpretation of the record and/or inconsistent clinical documentation in the record related to CDI clarified documentation appearing only once in the progress notes.

Just some food for thought

sharon.cole

That one needs a "LIKE" button!

Sharon Cole, RN, CCDS
Case Management
254.751.4256
srcole@phn-waco.org