Challenge
When a large integrated health system in the western U.S. encountered challenges in demonstrating the value of their newborn clinical documentation integrity (CDI) program, they called on R1 to help explore options. One region in particular experienced historic reviews that had not yielded any substantial benefits. Specifically, the team pinpointed the difficulty of showcasing the intensity of services provided to newborns when coding claims, resulting in problems with denials and reconciliation processes on the back end.
Solution
In collaboration with the health system’s revenue cycle leaders, R1 implemented a comprehensive services solution to address newborn documentation and coding challenges focusing on several key areas:
Rapid response team pilot
To kick off the newborn coding initiative, R1 piloted a rapid response team to focus specifically on baby reviews, emphasizing aspects such as length of stay and special care nursery requirements. This initiative aimed to improve the understanding of service intensity and streamline processes.
Concurrent review process
A concurrent review process was developed for newborns in neonatal intensive care for approximately two days, which enhanced communication with doctors and ensured timely assessment and coordination of care.
Newborn CDI specialists
Newborn CDI specialists were engaged to provide newborn specific education and to understand payer reimbursement methodologies, thereby improving the financial outcomes of the program.
Collaboration with coding teams
Collaboration with coding teams was a critical component of the solution. The involvement of newborn CDI specialists helped address the lack of in-house specialist coders, enhancing coding accuracy and compliance.
Proven performance, real results
$6M in added revenue in one year
Documenting to severity improves financial results
Improved coding accuracy reduces administrative burden
Results
While both the client and R1 were optimistic about boosting top-line revenue through improvement in newborn documentation, the results surpassed expectations and delivered impressive results.
While financial uplift was initially projected at $500K per quarter, actual results netted nearly $6 million in the first year.
The initiative demonstrated how accurately documenting severity of cases and intensity of newborn services contributes to positive financial outcomes.
Improved coding accuracy through collaboration with coding teams, reducing denials and improving reconciliation processes delivers additional benefit in recovered administrative overhead for appeals.
The R1 Newborn CDI program not only addressed the main challenges faced by the client’s newborn CDI program but also achieved remarkable financial results and improved operational efficiencies.
“Newborn documentation and coding are specialized functions, so they need people who understand payer reimbursement methodologies that trigger the appropriate value of services delivered,” said Jennifer Crumb, senior manager of Clinical Documentation Integrity at R1. “A little extra education in documentation requirements specific to newborns goes a long way, and that extends to sharing knowledge and expertise through collaboration with coding teams.”
The R1 Newborn CDI program offers specialized reviews and support for neonatal intensive care units, focusing on improving the accuracy of documentation and reimbursement processes.
