i3 designed and supported the implementation of the following programs:
- Established a clinical documentation (CDI) improvement program and team focused on the quality, clarity, and completeness of clinical documentation within Medicaid inpatient records to support consistently accurate Severity of Illness (SOI), Risk of Mortality (ROM), and other quality measures derived from coded charts.
- Customized specialty-specific clinical documentation training for the pediatric hospital's Medical Staff, Care Management, Quality and other departments documenting in the patient's record
- Documentation and coder training for HIM and coders to improve the productivity, quality and accuracy of coding APR-DRG patient records
- Established a specialized program of independent pediatricians remotely reviewing Medicaid inpatient charts and supporting clinical documentation in Epic after discharge and initial coding, but before billing, to assist CDI and HIM departments in identifying opportunities to query physicians on incomplete or non-specific documentation to ensure accurate APR-DRG assignment and resulting SOI and ROM.
During the first 15 months since implementation, this pediatric hospital has experienced a 4.03% increase in its Case Mix Index (CMI) for Medicaid inpatient cases resulting in nearly $2M in incremental reimbursement since the State's conversion to APR-DRGs and an ROI of approximately 8:1 on its project related investments.