Adequate clinical documentation is crucial for hospitals, as mistakes in this area can cost millions of dollars.
GE Healthcare, a medical technologies and services provider, estimates payers may deny up to 1 in 5 claims due to inadequate clinical documentation and lack of medical necessity. Avoidable claim denials can cost hospitals between 2 percent and 5 percent of net patient revenue.
But Miami-based Baptist Health South Florida, a nine-hospital system in Miami/Dade, Palm Beach and Monroe Counties, aims to stay on top of the issue with Nuance Communications' clinical documentation improvement program.
The program — highlighted by Baptist Health South Florida's corporate medical director, Lorena Chicoye, MD, and Nuance Vice President of Clinical Services and Education Mel Tully, MSN, at the Becker's Hospital Review 6th Annual CEO + CFO Roundtable in Chicago — was deployed across system hospitals and allows physicians to get clarifications and make adjustments to clinical documentation in real-time, according to Nuance. Additionally, Baptist Health South Florida hired CDI specialists known as "CDI: Miami," all international physicians with clinical documentation certification and training. The specialists' overall goal is "to make sure the final codes accurately reflect the complexity and severity of the patient ensuring accuracy and higher quality of the medical record along with correct reimbursement," said Dr. Chicoye.
The program has been successful for the system. In November 2016, Baptist Health South Florida reported seeing $45 million in increased appropriate reimbursement since the program's 2011 implementation. The system also has received national recognition for the program and saw return on investment in less than six months.