Top 10 CDI/DRGV Pain Points for Hospitals and Health Systems: The PHS Fix (Part 2)

Paramount Health Solutions (PHS) knows the steep challenges hospitals and health systems are facing.

PHS was founded and is owned and operated by physicians and other experts who have a combined 50 years of experience in healthcare, clinical documentation improvement, DRG Validation, auditing and compliance, denials management and training. We’ve held leadership positions in well-known hospitals and health systems and large consulting agencies.

We knew there had to be a better way than what was currently offered in the market to work effectively with in-house physicians and staff to improve the mid-revenue cycle process and capture more revenue opportunities. That’s why we launched Paramount Health Solutions!

Find out about how we developed and launched our physician-led consulting firm here.

In this two-part article, Paramount shares the top 10 issues we’re seeing in the industry – and how our practical solutions mitigate the sting of these challenges. Part 2 covers issues 6 – 10 from the list below. Click here to see Part 1 of this article, which focuses on issues 1-5.

Top 10 pain points at hospitals and health systems identified by PHS:

  1. Increased payor denials
  2. More OIG audits
  3. Thin margins
  4. Unpredictable revenue cycles
  5. HIM staffing difficulties
  6. Physician clinical documentation errors/omissions
  7. Ever-changing standards and regulations
  8. Coding compliance issues
  9. Limited window for coding and billing
  10. Missed coding, upcoding and severity opportunities resulting in lost potential revenue

How Paramount can improve Pain Points 6 through 10 on the list:

  1. Physician clinical documentation errors/omissions – Physicians don’t receive CDI/DRGV training in medical school. Our MDs earned certifications in this area and keep up with all the latest coding guidelines. We respect the hospital physicians’ time and only discuss what pertains to their area of specialty. Through our query data and CDI analytics, we identify trends and the providers that require in-depth education on documentation improvement. We tailor our education to meet the specific needs we find during our chart reviews. We have 80% and better acceptance rates of our recommendations from hospital physicians.
  2. Ever-changing standards and regulations – the Paramount Health Solutions team has more than 50 years of combined experience, and have been credentialed in CDI, DRG Validation and Coding. We keep abreast of all the latest guidelines and changes. In addition, our MD auditors can review the chart and understand things non-clinical coders and computer-assisted coding might miss, such as how the documentation relates to the current stay and if the patient has additional conditions that may have impacted their current condition for admission.
  3. Coding compliance issues – our DRG validation service ensures a second level of CDI/Coding review by industry-leading physicians and coding auditors to capture the most appropriate reimbursement, severity of illness and risk of mortality. We see our role as not only finding reimbursement opportunities, but also looking for errors, omissions, and items that need to be upgraded or changed for a clean, accurate chart that is coded correctly and is compliant.
  4. Limited window for coding and billing – Paramount is hyper-aware of the time crunch. We guarantee pre-bill chart review and response within 24 hours or less from the time it is received. Our audits will not have a negative impact on your discharged not final billed (DNFB) accounts.
  5. Missed coding, upcoding and severity opportunities resulting in lost potential revenue – Our full scope review process means our reviewers comb through the details in every chart. Our team looks for coding errors as well as incomplete or missing documentation to ensure that the best practice workflow is being implemented. We are highly skilled in capturing the severity of illness, comorbidities, major comorbidities, and any missed opportunities that we find in the charts. This results in millions of potential revenue opportunities that would otherwise have been missed.

Our clients have all experienced a positive return on investment because of partnering with us.

We offer a no-risk 90-day audit to enable your hospital or health system the opportunity to find out if we’re as good as we claim to be. There is no out-of-pocket expense for this service.

We guarantee that at the end of the pilot if we don’t find enough additional revenue to cover our fees, we will reduce our fees to the amount of additional revenue found. Therefore, you will not have any out-of-pocket costs.

To initiate a 90-day audit from Paramount Health Solutions, please find the request form here.

To get a free copy of our Interactive Decision Guide, click here.