Over the years we’ve met with lots of CEOs, CFOs, board members and other top decision-makers at hospitals and health systems all around the country. Although each person and place is different, their roles, responsibilities and concerns are similar. Everyone is doing their best navigating the challenges and disruptions going on in the healthcare industry and trying to position their organizations for success.

We’ve developed a “Frequently Asked Questions” sheet to respond to questions we receive about Paramount Health Solutions’ methods and services, and how we’re different than competitor consulting groups.

We’re sharing some of those questions and answers in a set of articles to help readers gain useful information as you compare outside companies for help with CDI, DRGV and HIM processes at your organizations.

This is the first of two articles. Click here to view the second article.

Q: What if I already have staff or another company dedicated to these functions at my hospital?

PHS: Approximately 99% of our clients already have staff and a program which includes concurrent CDI review.  

Our experience has found that there is often a lack of internal training and continued education necessary to keep staff current with changes in the ICD-10 coding documentation. Staff turnover in these functions also creates challenges for many of our clients.

We have yet to find a program that uses physicians for reviewing charts versus other staff. Many of our client’s staff state they are pushed to get bills out and do not have the resources to conduct a 2^nd level of review prior to final billing.

If you already have a third party doing secondary reviews, it is most likely our model is different in the fact we are a physician-led company with physicians who actually review the charts.

Most often, when our clients have an outside vendor already doing secondary reviews, the client will split the work to see how PHS compares with their current partner.

Q: How much time will my staff have to spend on the additional reviews performed by your physicians?

PHS: Based on our model for remote chart review, we will have minimal impact on your current staff.

We will work with your IT staff to set up a work queue in your current EMR system, which might also be an automated system. Your coding staff will then forward the accounts that flag to the focused DRG list. Coding recommendations are sent within the client’s preferred platform, where there is an ability to communicate directly with the coders through messaging.  

PHS auditors always reference coding and clinical guidelines as part of the rationale for the recommendations. This process creates instant educational feedback with the client’s coding team and makes sure that DNFB is not affected or delayed.

When there is a query opportunity, we work with your staff to send a query that will be drafted by our physicians. We communicate with concurrent CDI staff on the opportunities we capture on the 2^nd level review, which also serves as training for them to see what was missed the first time.

During our audits, we need a client liaison to serve as the point person in communicating potential rebuttal/disagreements on our recommendations.  

Q: Does artificial intelligence (AI)/Computer-Assisted-Coding (CAC) help to ensure charts more accurately reflect appropriate CDI and DRG Validation coding?

PHS: AI or Computer-Assisted-Coding (CD) used in CDI and DRG Validation currently helps in efforts to identify charts that may be prone to have opportunity for miscoding.

Algorithms are being developed, modeled, and tested in attempts to look for clinical documentation to assign the appropriate DRG. However, this process is still several years away from being accurate.

Often, only a clinician with experience can spot something in the chart that may lead to a query to the charting physician, who may have forgotten to include documentation in the chart. AI would not have found this opportunity, nor will it educate the physician.

A study by the AHIMA Foundation found that AI/CAC alone without the intervention of a credentialed coder had a lower precision rate. Thus, creating the opportunity for miscoding, increased denials, and lower reimbursement for hospitals.

Paramount Health Solutions has recently developed a Decision Guide to help hospitals rate CDI/DRG Validation consulting firms and compare features and pricing. Click to download the Decision Guide here.