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January 25, 2018

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Feds recover funds triggered by clinical documentation improvement

August 17, 2016:

If there was ever any question about the ability of improved documentation and coding to raise provider revenues, the federal law to recover these higher payments that are triggered by clinical documentation improvement (CDI) should provide the definitive answer.

Since FY2014, Medicare payments for inpatient services have been reduced by about one percent each year to offset higher payments received by hospitals for improvements in documentation and coding. The federal law that established the MS-DRGs contained a provision designed address what CMS saw as increased payments to hospitals that were due to the incentives hospital have to improve documentation and coding under the new MS-DRGs, and not due to any real change in patient. What caused the increase? CMS says the new MS DRG system increased the number of DRGs from 538 in FY2007 to 745 in FY2008. The increase in DRGs encourages hospitals to improve documentation and coding, and to more fully take into account patient severity of illness.

CMS believes that the documentation bonus gave hospitals about $11 billion in extra payments during the years 2014 to 2017. Each year CMS has reduced the hospital standard amount by about 1 percent, with a 1.5 percent cut slated for FY2017. The expansion of code assignment options under ICD-10-CM provides similar incentives to improve documentation and coding.

What’s the shortest path to improved clinical documentation? The Clinical Documentation Improvement Desk Reference for ICD-10-CM and Procedure Coding is designed to help physicians and hospitals capture the information needed for optimal code assignment. New for 2017, get 5 CEUs from AAPC when you pass the online CDI exam. For more information visit https://www.optum360coding.com/Product/45960/.


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