Inpatient physician documentation and coding – two essential building blocks for capturing the maximum financial reimbursement to which your organization is appropriately and legally entitled. Documentation of the patient's clinical condition must accurately reflect the severity of the patient condition on admission and throughout the stay to support effective care delivery, resource utilization, and revenue realization.

This evaluation occurs over a 3-4 day period during which an expert reviews a pre-determined number of Medicare charts to review the quality and completeness of documentation as well as the accuracy of DRG assignment, identifying those cases in which improved clinical documentation in the medical record would support the assignment of a more appropriate DRG. This program focuses on the robustness with which the organization currently documents and codes cases prior to Medicare billing. The end products include:

• A snapshot of the current effectiveness of the coding team, potentially highlighting the need for additional education of this invaluable group.
• An estimate of the extent to which the organization's Medicare Case Mix Index could increase with improved documentation and coding. This has a profound effect on the financial health of the organization.
• A clearer picture of patient acuity, creating a more accurate Case Mix Index adjusted length of stay target and mortality rate for the organization, improving publicly reported outcomes data.
• The potential to bill the reviewed cases at a higher rate if the bills have not already been dropped.
• A review of exposure to compliance issues related to OIG, Medicare and JCAHO requirements.
• A potential for physicians to increase their reimbursement through adjusting their office (E&M) billing related to the increase in severity of illness reflected in the medical record.

Based on the assessment findings, CCM staff is available to work with your institution to develop compliance based solutions, educate staff, develop effective tools and worksheets for documentation staff, determine staffing models, and monitor program effectiveness.

For more information or to schedule an evaluation, please call The Center for Case Management at 781-446-6980 or send an email to info@cfcm.com.