How a baseline became a springboard to documentation, coding improvement

What gets measured, gets managed. An old business truth … but we don’t always think of the inverse. 

Without a baseline, you won’t know where to focus. 

An integrated healthcare system comprised of county-owned hospitals and clinics suspected it was leaving severity and revenue on the table, but wisely didn’t want to dive straight into education without a clear starting line. 

With its provider and coding teams busy delivering care and getting claims out the door it turned to Norwood for help. 

 

Our work 

Our work was conducted for three hospitals and 112 providers operating in both inpatient and outpatient settings. Over nine months on and offsite, our team: 

• Audited more than 1500 accounts, approximately 10-15 per provider. 

• Analyzed ICD-10-CM, MS-DRG, CPT (including E/M) and HCPCS code assignments. 

• Provided transparent reporting on code assignment accuracy and projected financial and quality impacts of improved documentation 

 

Inpatient findings: CMI and quality left on the table 

Each case we reviewed included both MS-DRG and APR-DRG impacts from coding accuracy. The results showed positive movement in all key quality and financial metrics. 

• Based on audit findings for the limited sample reviewed, organizational CMI was underrepresented by as much as 17%. 

• The average CMI shift was 0.23 per inpatient case, representing approximately $2,400 opportunity per case reviewed  

• Expected length of stay: 16.5% improvement potential 

• Severity of illness 7.3% change; risk of mortality 6.7% change potential 

 

Outpatient findings: CPT accuracy and E/M undercoding 

• The organization’s overall CPT accuracy rate by provider was 85%–below industry standard 95%.  

• 33 of the 79 providers had an accuracy rate at or below 80%. At least 3 of the 15 cases reviewed for each provider had an opportunity 

• We estimated that 11% of outpatient visits for the 80 providers were under coded, typically level 2 or 3 instead of a 3 or 4. The total financial impact was $374K in missed E/M opportunities. 

 

Custom education 

Armed with baseline data at the hospital and provider level, we created custom coding and provider education for individuals and departments, presenting chart review findings and documentation gaps from actual cases. This included: 

• Inpatient: 32 1:1 education sessions and 16 group education sessions  

• Outpatient: 80 1:1 education sessions and 16 group education sessions 

 

Our partner now has a re-energized provider staff and coding teams and a clear-eyed, objective assessment of their work. Armed with this baseline we know they will experience significant ROI. 

In fact, they already are. A broad look at the organization’s CMI and E/M shows rising performance in Q4. 

 

Contact us for a no-strings conversation    

We’d love to set up a zero-pressure discovery call to discuss your organization’s unique needs.   

Contact us at consulting@norwood.com