Mid Revenue

 Managed Service

CDI is an ongoing effort that needs continuous focus. We at Catsol, use industry accepted, well defined conditions based on the latest medical literature to establish standards for both inpatient and outpatient physicians on how to document these situations accurately. 

Clinical Documentation Improvement

With increasing adoption of “Pay for performance” initiatives, it is imperative to embark on this journey of improving your clinical documentation standards. We deliver a comprehensive set of services aimed at improving your clinical documentation. With years of clinical experience, our clinicians ensure evidence-based care is accurately reflected through precision documentation for value-based reimbursement. Our experienced and certified physicians/RN/coders can be engaged to conduct Retrospective Reviews, Initial Health Record Reviews, Follow Up Reviews, and Post – discharge pre-bill Reviews.
Our suite of CDI solutions includes:

Inpatient CDI

  • Address your unique documentation gaps with customized programs

  • Improve documentation quality with frequent record reviews

  • Design and develop physician specific education that is clinically relevant

  • Stay ahead of quality driven initiatives—readmissions, mortality, PSI, value-based payments, appropriate risk-adjustment capture—all essential to your CDI program

Outpatient CDI

Just as patients deserve the benefits of precise and complete documentation while inpatients, they are equally deserving of the same precision in the outpatient setting. Thankfully, ensuring this is relatively easy for CDI. Using the elements contained within the three key components, outpatient CDI efforts can positively affect the specificity of the patient’s condition(s) using ICD-10-CM verbiage and the documentation of complete and detailed medical decision-making.

Taking ED as an example, the following illustrates the advantages of developing an outpatient CDI program

  • Accurate capture of facility ED level charges (i.e., facility E/M) ¬

  • Accurate capture of facility ED level charges (i.e., facility E/M) ¬

  • Improved documentation of infusions and injections ¬

  • Improved accuracy of present on admission (POA) indicators ¬

  • Improved patient safety due to a complete and comprehensive health record ¬

  • Addressing and correcting fragmentation or gaps in patient care during the ED encounter ¬

  • Improved documentation supporting observation services as well as observation start times ¬

  • Proactive capture of data elements associated with quality of care measures that may be specific to the ED setting (i.e., ED transfer communication) or that also impact the inpatient setting

Provider education

Integrating clinical documentation and medical coding nuances help enhance data integrity. We work with the CDI & Coding staff to develop education programs with clearly articulated purpose, with identified focus areas that the CDI team would review.  

CDI for Case Management

Case managers are tasked with multiple and often conflicting goals. They work with physicians and staff to facilitate and coordinate care, review medical necessity for inpatient stays, move patients efficiently through the continuum of care, and ensure the care given is high quality—all while advocating for the best interests of patients and families. These are not easy tasks. Collaborating with our clinical documentation improvement (CDI) specialists can make their job a bit easier.

  • Our CDI specialists help physicians clarify documentation of diagnoses in patient charts to appropriately reflect the severity of patients’ conditions. Documentation accuracy influences the predicted mortality rate and reimbursement for care.

  • When a patient is admitted to an acute care setting, our CDI specialist reviews the chart for clear documentation of the principal diagnosis that necessitated admission. This review supports the medical necessity of the admission and provides case managers a clear picture to share with insurers.

CDI for Denials and Appeals

The involvement of our CDI professionals in the denials process can assist denials specialists in identifying appeals opportunities. Our CDI professionals can also incorporate the reasons for denials into their daily health record documentation reviews. This can in turn assist in reducing the number of denials by getting the documentation right the first time.

Implementing CDI programs is one key element to preventing denials that are due to missing documentation and/or clinical evidence. The information gained from tracking denials can be vital in denials prevention. When you know why something is happening then changes can be implemented to prevent it from occurring in the future.

Medical Coding

Accurate medical coding is the key component in HIM and is the most critical factor influencing a hospital’s / Physicians’ cash flow and revenue. Our compliant, domain centric approach helps maximize your revenue. We hire experienced and certified coders, after taking them through a rigorous process of evaluation. The solutions we offer include:

  • Domestic, US based coders, working remotely

  • Domestic, US based coders, working onsite at client location

  • Offshore, India based coders

Our team consists of coders with areas of specialization that includes inpatient (IP DRG), Outpatient – ED, Anesthesia, OB/GYN, Ambulatory Surgery, and many more.

Risk Adjustment/HCC

Accurately capturing the disease comorbidity and documenting proper diagnosis codes in outpatient setting is critical to improve the reimbursement. Documenting the diagnosis to the highest level of specificity as supported by clinical evidence results in accurate hierarchical condition category (HCC) assignment, which impacts risk adjustment factor (RAF) scores.
Our solution empowers providers to accurately capture the ICD diagnosis codes for precise HCC (both CMS and HSS) and RAF score assignment through advanced predictive analytics, comprehensive dashboards and actionable HCC gap reporting.

Compliance

Accurate clinical documentation in the outpatient setting is the key to achieving high quality scores with reference to MIPS / MACRA.