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Transformational HIM strategies: A fresh approach to clinical documentation excellence

HIM-HIPAA Insider, June 1, 2015

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Historically, the healthcare revenue cycle has been dominated by fee-for-service (FFS) payment arrangements that reimburse providers for the volume of care they provide. These reimbursement models have always been tempered by medical necessity determinations to ensure that the care delivered to patients is in fact medically necessary. Over the past several decades, healthcare costs have been rising precipitously. In response, new payment models have been developed to curb that trend and to deliver more cost-effective care with higher quality and better outcomes.

FFS reimbursement has been on the decline in recent years in favor of new and innovative value-based reimbursement models. These value-based arrangements are structured to allow providers and payers to share both the risks and savings associated with care delivery with both parties having vested interest in better care at lower costs (for more information, read "Shifting reimbursement models: The risks and rewards for primary care" available at http://tinyurl.com/mz6zxmx). Most of these value-based contracts pay providers to care for a population of patients under a per-member-per-month reimbursement model, or pay case rates for certain conditions or treatments.

Just as healthcare reimbursement models are rapidly evolving, the healthcare revenue cycle is also undergoing major shifts to build the infrastructure and to deal with the necessary adjustments to be successful and financially viable in this new era. Unfortunately, many providers are behind. Over the past decade, while payment methodologies and the revenue cycle have been evolving, providers have focused on other initiatives such as implementing new health information and electronic medical record systems, meeting meaningful use criteria, and working toward ICD-10 compliance, all of which are a consistent pull on providers' resources. Few providers have proactively built the operational infrastructure to thrive in the new payment models.

Continue reading "Transformational HIM strategies: A fresh look at clinical documentation excellence" on the HCPro website. Subscribers to Medical Records Briefing have free access to this article in the April issue.

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