In the last decade, CDI programs have grown to include all payers, all providers, and all care settings. More recently, CDI teams have also begun to review data concurrently and provide critical input to quality teams, case management and utilization.
How do CDI programs increase their reach without sacrificing their core responsibilities? By leveraging game-changing technology. 3M 360 Encompass System for clinical documentation integrity has powerful computer-assisted CDI that helps teams delve more deeply into records and pinpoint the clinical documentation that matters most. This drives process improvement in a value-based health care environment.
Clinical documentation drives much of the data that health care organizations use for analysis, billing and payment. The ability to assess and share this data in real-time is increasingly important as the health care industry transitions to value-based payments. CDI teams play a critical role because they can identify relevant data, identify deficits and share it with other clinical and administrative teams to improve outcomes that directly affect reimbursement and the quality of patient care.
As organizations expand the scope of their CDI programs, many find they simply aren’t staffed to meet increased patient volume. With 3M 360 Encompass for CDI, CDI teams can be even more productive as they strive to improve documentation in the inpatient, outpatient and professional services settings. This will leave more time for teams to spend reviewing cases for quality metrics and scores, clinical validity, denials prevention and risk adjustment.
The computer-assisted CDI features within 3M 360 Encompass System provide CDI teams with multiple workflow enhancement tools that provide users with electronic query capability, prioritized worklists, access to CDI reference materials, auto-suggested queries, and CDI edits. The technology also automates common types of queries directly within a physician’s workflow. In a time of rising budget costs and strained budgets, these tools not only increase physician response rates, but they also boost CDI specialist productivity.
In addition, 3M 360 Encompass System’s top-rated computer-assisted coding tools reveal hidden diagnoses and procedures buried deep within the documentation to help establish patient risk and severity more accurately.
3M’s advanced prioritization algorithm analyzes unstructured data using natural language processing to identify the following types of high-priority reviews:
3M 360 Encompass System not only prioritizes cases, but it also provides insight and clinical logic into why each case is a priority opportunity. Users can customize and define the types of cases for review as well as assign custom hierarchies of worklists (e.g., based on system, facility, team or user). 3M 360 Encompass System also uses machine learning to continually update and improve CDI priorities based on new documentation. Customizable self-service reports allow CDI teams to continually monitor and improve outcomes, impact of the program, and accuracy of the algorithm and priority cases.
3M 360 Encompass System identifies potential quality flags concurrently, helping organizations ensure accurate value-based reimbursement related to the following:
As with 3M’s other artificial intelligence engines, 3M 360 Encompass System provides users with details about each identified quality indicator, such as the inclusion/exclusion criteria, methodology and reason for inclusion. Quality and CDI teams can act immediately to correct documentation or enhance care planning in real time. The Advanced Code Sequencing feature within 360 Encompass automates the process of ordering diagnosis codes in an optimized sequence to generate a code set that best shows the complete clinical picture of a patient. It elevates codes that impact quality measures, including Elixhauser higher in the sequencing order.
For hospitals to meet the rising demands of competition, compliance and patient care, they must have an efficient and accurate revenue cycle management system.
But what does that really look like?
It looks like a single platform coding and clinical documentation, quality and CAPD. This single platform allows visualization into nudges delivered to physicians and the clinical evidence opportunities it presents to CDI teams, by working from the same content and reducing duplication. It looks like facility and professional services coders using one application, putting an end to disjointed workflows and communication breakdowns. It’s timely, complete query responses from physicians and full confidence that HCCs are captured. It’s big-picture insights so hospitals can stay ahead of market changes.
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