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The Challenge
With limited Clinical Documentation Improvement (CDI) staff and an expansive coverage area, an e4health customer faced a unique set of challenges. Leadership sought to pinpoint opportunities within three distinct service lines: Trauma, Orthopedics, and Neurosurgery, aiming to enhance documentation and disseminate educational concepts among providers. Concurrently, the Case Management department was grappling with transitions, particularly the implementation of new Utilization Review (UR) AI software that coincided with a spike in medical necessity denials.
The e4health Solution
Understanding the intricacies of the customer’s situation, e4health’s Subject Matter Expert (SME) listened attentively to their needs, pairing their CDI service issue with a tailored solution for remediation. By sharing insights from previous successful projects with other customers, the SME was able to offer a comprehensive project price that aligned seamlessly with the customer’s budget constraints.
Results and Insights
The collaboration yielded impressive results:
- Nearly $32,000 of opportunity was identified.
- CDI coverage rate identified as 68%.
- CDI Working DRG Accuracy rate 89%.
- Query Compliance Rate was near perfect at 91%.
- UR Opportunity was identified, resulting in a status change from outpatient to inpatient for 2 cases.
Conclusion
These outcomes not only demonstrate e4health’s commitment to empowering better health through innovative solutions but also underscore the tangible impact of collaboration and expertise.
How Can We Help?
For nearly two decades, e4health has been redefining the standards for Clinical Documentation Integrity. The e4health CDI Team is here to cater to all your CDI needs, including Inpatient and Outpatient CDI staffing, auditing, assessment, education, and CDI consultative services. Schedule a call today with our CDI Leaders who are eager to address your concerns and simplify your tasks.