Clinical Documentation Improvement

AE & Associates offers the following revenue cycle consulting services:

Education, Training, and Knowledge Sharing 

  • Provide ongoing physician clinical documentation education, training, and knowledge sharing on best practice principles and standards of documentation. 

  • Provide training, education, and knowledge sharing in E & M assignment with a specific focus upon communication of fully informed coordinated care.

  • Conduct ongoing assessment of the quality and completeness of physician documentation through the use of a valid and reliable clinical documentation scorecard.

  • Tailor and implement clinical coding education and training to coding staff utilizing up-to-date official ICD-10 and CPT coding guidelines, policies, and procedures.

Clinical Documentation Improvement

  • Assessment of hospital’s current CDI initiatives using a blended approach of traditional and nontraditional methodologies for purposes of gaining an accurate true picture of the effectiveness of the established CDI program.

  • Training and mentoring of new and experienced CDI professionals incorporating a holistic approach to chart review and documentation improvement that puts the patient at the center of communication.

  • Conduct regular offsite second level reviews of CDI previously reviewed medical records for purposes of validating accuracy.

Clinical Coding Assessment

  • Conduct a clinical coding review of professional and facility records providing an assessment of overall clinical coding accuracy incorporating elements of the adequacy of clinical documentation and potential risks of medical necessity denials, clinical validation denials, and DRG down-codes.

  • Provide client with a detailed report of findings with the inclusion of a Management Action Plan outlining actionable items to address any identified process concerns including but not limited to documentation insufficiencies and inadequate coding.

Observation Rate Review & Analysis  

  • A detailed and expert review of Observation cases for the purpose of assessing clinical appropriateness of “observation level of care” using all the available information in the medical record. The assessment consists of a thorough review of 100 observation cases to make a determination as to whether the patients were appropriately placed in observation.

  • The report and Executive Summary includes Quantifiable results with Management Action Plan and clear recommendations and next steps to compliantly achieve the proper Observation Rate for your Hospital.

Chargemaster Reviews

  • Conducting of thorough chargemaster review identifying and addressing any inconsistences, problematic areas, and other issues.

  • Restructure chargemaster as needed to bring all charge codes within cost-justified transparency.

  • Updating all elements of the chargemaster as needed with specialized focus and emphasis upon educating and training department staff who utilize the chargemaster to understand and properly use the appropriate charge codes within their department, recognizing that the chargemaster is a form of code assignment tool.

Denial/Appeal Assessment & Modernization

  • Assessment of current hospital and/or physician practice denials and appeals processes, identifying and determining limiting factors contributing to inefficiencies and inability to effectively overturn appeals.

  • Focus upon identifying and determining root cause analysis with development and implementation of process improvement strategies farther up the revenue cycle that alleviate and minimize denials in the first place.

  • Transform denials management to denials avoidance through the initiation of cultural changes within the organization, emotionally connecting physicians and other healthcare stakeholders with their patients.