Case Study: Clinical Documentation Integrity Transformation Program

This case study underscores the transformative impact of tailored CDI initiatives in driving financial success and operational excellence within healthcare practices.

Location: Los Angeles, California

Practice Type: Group Practice

Annual Footfall: 20,000+

No. of Providers: 5

Staff: 14

Challenges Faced

In Los Angeles, California, a prominent group practice found itself at a crossroads. With an annual footfall exceeding 20,000 patients and a team of five dedicated providers supported by a staff of fourteen, the practice encountered numerous challenges in optimizing its revenue cycle management. The leadership began to question the efficacy of their Clinical Documentation Improvement (CDI) efforts, especially given the absence of robust data to justify their investments. Quality assurance programs were lacking, leaving the impact of coding and CDI on reimbursement and quality reporting uncertain. Moreover, it had been two years since the last external coding audit, raising concerns about compliance and accuracy.

Productivity emerged as another pressing issue, with an in-house coding team that lacked experience and credentials. The organization urgently needed intervention on multiple fronts to ensure financial viability and regulatory compliance.

The Solution

With the guidance and expertise of Bristol Healthcare Solutions, the organization embarked on a transformative CDI initiative. Leveraging Bristol Healthcare's sophisticated insight tools, we embarked on a comprehensive data analysis, spanning one year's worth of patient encounters and conducting over a thousand in-depth chart reviews. This meticulous review enabled us to identify critical gaps and prioritize actionable tasks, focusing on individual physician performance, service line efficiency, and specific patient cases.

Before our intervention, the CDI specialists primarily focused on reviewing documentation for Diagnosis-Related Group (DRG) assignments. However, we expanded their scope to include a comprehensive assessment of Severity of Illness (SOI) and Risk of Mortality (ROM), meticulously scrutinizing medical records for missing comorbidities and gaps in documentation.

The Results

The impact of our CDI transformation program was tangible and immediate:

$30,000 in Captured Revenue: By optimizing documentation and coding practices, the practice realized a significant increase in captured revenue within the first year of implementation.

28% Reduction in Coding-related Complications: Our tailored CDI approach led to a notable decrease in coding-related errors and complications, enhancing accuracy and compliance.

20% Increase in Coding Productivity: With streamlined billing processes and targeted interventions, coding productivity surged by 20%, enabling the practice to handle increased patient volumes more efficiently.

Conclusion

Through strategic collaboration and a data-driven approach, Bristol Healthcare Services, Inc. empowered the group practice in Los Angeles to overcome its revenue cycle management challenges and achieve sustainable growth. By implementing a personalized CDI transformation program, we not only optimized reimbursement outcomes but also enhanced coding accuracy, productivity, and regulatory compliance. This case study underscores the transformative impact of tailored CDI initiatives in driving financial success and operational excellence within healthcare practices.