With the number of coding regulations to keep track of, it’s easy to understand how facilities can be at risk for claim denials and audits. The transition to ICD-10 presents even more challenges, as your HIM staff faces an inevitable learning curve and risks to productivity. By reviewing the codes entered into your coding solution, Clintegrity Compliance ensures healthcare compliance with ICD-9 and ICD-10 CMS regulations, Office of Inspector General (OIG) targets, Revenue Edits, Data Quality Edits, as well as AHA and AMA coding guidelines. With its comprehensive knowledge base of clinical, financial, and statistical information and rules, Clintegrity Compliance will reinforce coding accuracy and quality data capture.
Clintegrity Compliance will alert you to potential coding and abstracting issues that may impact the reliability of your reimbursement process with built-in revenue edits. Additionally, Compliance enables real-time monitoring of documentation issues during the coding process, just as issues are identified. Your staff can create standard and ad-hoc reports on these issues to support your documentation improvement program. This also helps educate coding and provider staff, and facilitates sharing information with executive management.
As more and more patients are admitted through your Emergency Department, accurate documentation is becoming critically important. Due to the complexity of ED cases, the hectic work environment and the need to make rapid decisions, in many cases patient acuity is inaccurately reflected by under-documentation of the patient's clinical situation. Staff may accurately document the injury that brought the patient in, but miss secondary diagnoses and/or pre-existing conditions. What's more, a problem list isn't usually created until the patient is moved onto the floor...if ever. Improving the quality of the clinical documentation promotes better communication and creates an opportunity to positively impact clinical outcomes.
Nuance has developed a powerful solution and a new clinical staff position to help you ensure better clinical outcomes and accurate reimbursement.
Because documentation of critical information starts in the Emergency Department, the Point of Entry program starts there too - evaluating the severity of illnesses, assessing present-on-admission (POA) conditions, determining patient status (observation or inpatient), ensuring compliance with quality core measures, creating a problem list at the point of entry, and enabling more accurate documentation. The Point of Entry program builds on the foundation of Clintegrity CDI; and takes it even further, providing comprehensive clinical integration management.
With this new solution comes a new clinical role - the Clinical Integration Specialist (CIS). This individual works closely with your clinical team to ensure all clinical observations are documented appropriately from the ED to discharge.