Harnessing Internal Data for Quality Risk-Adjustment Improvement

10/24/2024 at 10AM PT / 1PM ET

Optimizing DRGs through accurate severity assignment is no longer the sole focus of clinical documentation integrity (CDI) initiatives.

While accurate reimbursement will always be an essential outcome of precise severity documentation, the growing importance of risk adjustment demands a more focused and sophisticated approach to ensure specific clinical conditions are properly reported.

This opportunity lies within your very own claims data, but it cannot be fully leveraged using traditional analytical benchmark methods and/or approaches that rely solely on medical record review.

Join us on October 24, 2024, as we explore how advanced analytics applied to your data can uncover insights beyond traditional benchmarking and chart reviews, empowering physicians to play a crucial role in this process.

Introducing

The ClinIntell Model

To understand our model, let’s review the traditional approach.

Traditional Severity Reporting

CDI, Quality, and Coding are engaged in initiatives that passively involve physicians to optimize severity reporting for individual patient encounters—e.g., queries, education.

the bigger picture

Instead of focusing on individual claims, ClinIntell looks at the entire population of claims. This ensures that ClinIntell’s insights are grounded in statistically sound principles.

Providing insights

Our analytics identify opportunities that are specific to your inpatient population, taking the form of both performance and actionable data from the health system down to the level of individual physicians.

a new, collaborative model

Physicians are empowered by data to play anactive role in improving severity reporting of their patient populations and are not solely reliant on impact achieved via the documentation query process.

the clinintell cycle

Population-based severity metrics are used to set organizational goals around quality risk adjustment and revenue based on realistically achievable opportunities. The impact of a now-collaborative severity reporting team can be assessed monthly towards achievable goals.