How One Hospital Increased Annual Earned Revenue by $3.7M with R1 CDI Solutions

Challenge

A southern hospital with almost $220 million in net patient revenue was struggling with staffing shortages and searching for a specific diagnosis-related group (DRG) to more accurately reflect length-of-stay estimates. Because of their staffing challenges, the average response time to queries reached almost five days, with less than half of all cases reviewed. Due to the long response times, with patients having often been discharged, coders faced pressure to complete final coding and push claims out the door. As a result, clinical documentation improvement (CDI) inquiries were left unanswered, and the hospital had foregone revenue for the care that was provided.

In addition, the hospital queried 13% of cases, reviewing about 4,000 cases annually. They needed a way to keep up with patient demand, improve accuracy and streamline operations, all while putting an emphasis on collecting more earned revenue through accurate and complete clinical documentation.

Solution

R1 recognized the value of providing more than a specific DRG to help address staff and operational efficiencies. R1 worked with the hospital to provide a combination of both people and technology for CDI.

R1 provided staff members to work in the hospital’s systems and help manage their team. The R1 team worked with the hospital to provide guidance on day-to-day operations, process improvements and education for physicians. Revenue almost doubled by bringing together technology and operational expertise to drive results.

In addition to documentation experts, R1 worked with the hospital to use technology to capture the correct DRGs related to length of stay, reimbursement, quality score, CMS rankings and more. This helped the hospital capture how sick each patient was alongside the correct diagnosis codes, which provided additional time for the patient’s care team to spend with them, achieving higher reimbursement through more accurate documentation.

Results

Through implementing R1’s CDI Solutions, the hospital was able to go from 49% of cases reviewed to 89%. Physician query agreement rate improved by 21% — now above the national average — coming in at 86%. Average response time fell from 4.8 days to only 1.4. Best of all, the financial impact after implementing services grew by more than $3.7 million (to $4.6 million annually) due to the streamlined operations with more accurate documentation and faster response times — an increase of nearly 400% over their prior year’s performance of $860,000.