Reference no: EM133241154

The hospital clinical documentation improvement (CDI) specialist reports to you, the HIM manager of Anywhere Hospital, that the hospital has been receiving reimbursement penalties. The physician documentation is not appropriately identifying specific conditions that CMS has identified as hospital-acquired conditions (HACs). In most cases, these conditions are present in patients before they are admitted. However, physicians are documenting these conditions later in the patients' stays, making it appear that the patients have acquired these conditions from the hospital. The hospital is being financially penalized because these conditions are considered to be preventable if the hospital follows national treatment standards and guidelines.

Anywhere hospital has a robust EHR. Many documentation improvement initiatives have been leveraged by the technological capabilities of the EHR. As the HIM manager, you wonder if something could be done from a technology standpoint that could assist physicians with identifying, upon admission, those conditions that are causing the reimbursement issue, and appropriately documenting the conditions. Physicians appropriately capturing and documenting these conditions would demonstrate that the hospital is following the national treatment standards and guidelines and that the patients are not acquiring these conditions in the hospital. You assemble a multidisciplinary team consisting of physicians, revenue cycle representatives, HIM, and information systems representation.

Why do you think that CMS picked these conditions?

What is the benefit of developing an EMR solution for this issue?

How does the adherence to the treatment guidelines for the prevention of the conditions identified as hospital-acquired relate to other pay-for-performance initiatives?