ROI realized from reviewing documentation and coding before billing



Photo: Helen King / Getty Images

According to Enjoin CEO Dr James Fee, Enjoin CEO Dr James Fee can increase hospital ROI by 700%.

Hospitals and healthcare systems can improve their revenues through a pre-billing review before claims are submitted, according to Fee. Enjoin does this job as a documentation and coding-focused revenue cycle consulting firm.

One of the first things Enjoin’s doctors check is that the patient’s care has been recorded correctly.

“We are never taught how to communicate with those who record our work, so that it can be captured in the coding system,” said Fee, who continues to practice as a physician in Baton Rouge, Louisiana.

Second, hospitals must verify the accuracy of the representation of that patient.

“You want to make sure that the severity of the patient is justified to get proper reimbursement,” Fee said.

WHY IT IS IMPORTANT

Documentation and coding is in the middle of the revenue cycle. By pre-billing the 30-50% of estimated cases chosen for review at this stage due to their complexity, organizations can ensure that documentation supports coding compliance, MS- accuracy DRG, quality performance data and other metrics.

The results showed an impressive return on investment of 700% on average and in some cases 1000%, according to Fee. On average, the process shows a 17% drop in rejection rates.

Hospitals already have clinical staff in the rev cycle. Doctors add a review layer.

“We have medical practitioners who understand the disease process,” Fee said. “We are reviewing a case to make sure the diagnosis is correct. What was the goal of care for this hospital stay? It requires a level of clinical interpretation.”

Enjoin, which has been around for about 30 years, does not offer a software product, but uses an analytics platform. He partners with clients as consultants in a technically agnostic manner.

Fee will speak on the topic “Mid-Revenue Cycle Drives Financial Stability during COVID19: How One Academic Medical Center Prospered,” in person at the Healthcare Financial Management Association’s annual conference on Monday, November 8 in Minneapolis.

AUTOMATING

As revenue cycle managers look to automate, this is done more easily at the start and end of the revenue cycle rather than the mid-cycle process, according to Fee. This is an area that will have to wait for AI to allow interpretation of the data seen by doctors and other clinicians, he said.

“Automation is easy to say as a one-stop-shop for a simple solution, but you have to understand what you are automating,” he said.

There may be an element of automation in the prioritization of reviews, which Enjoin plans to bring to market soon.

“Automation will continue to grow rapidly,” said Fee, “but there will always be that human component.”

THE BIGGEST TREND

As in other areas of healthcare, COVID-19 has brought a level of uncertainty as to the appropriate tests and diagnoses recorded in the revenue cycle.

During the latest wave of COVID-19, many hospital intensive care beds were full again and health systems were again canceling elective surgeries, resulting in lost revenue.

Higher spending on labor, drugs and supplies, as well as continued delayed care, is expected to cost hospitals an estimated net income of $ 54 billion in this year, according to the analysis by Kaufman Hall published last month by the American Hospital Association. .

“The biggest impact for reimbursement has been the loss of patient care,” Fee said. “We were in a fee-for-service model and the margins were dictated by elective surgeries.”

COVID-19 has also shifted business dominance from margins towards lower-paying government reimbursement as employees lose their jobs, according to Fee.

During the first wave of COVID-19 in 2020, CFOs asked, he said, “How can I adjust to this? Many sought to avoid financial leakage by using the resources they already had.

“This is where the CDI (improved clinical documentation) comes in handy,” Fee said.

Twitter: @SusanJMorse
Email the author: [email protected]


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