Case Study: Acute Care Facility Partners with OnPoint Healthcare Solutions
Background
The county-owned teaching hospital is a 196-bed general acute care facility offering of inpatient services including general medical/surgical care, high risk obstetrics and neonatal intensive care, pediatrics and acute physical medicine and rehabilitations.
Due to increasing complexities in coding and Clinical Documentation Improvement (CDI) processes, the organization decided to outsource coding management, emergency room coding, inpatient coding, and CDI to OnPoint Healthcare Solutions.
Challenge
The hospital was facing challenges in maintaining coding accuracy and productivity, reviewing charts for appropriate clinical documentation, and achieving proper reimbursement. The existing in-house coding and CDI teams were struggling to keep up with the workload. Leadership recognized the need for specialized expertise to address these issues effectively.
Solution
OnPoint, a reputable vendor with a track record of success in healthcare coding and CDI, was selected to take over the management and leadership of these critical functions. The vendor proposed a comprehensive solution that included the following components:
Staff Augmentation: OnPoint provided experienced ED and inpatient coders and CDI professionals to supplement the existing terms. These experts brought specialized knowledge and skills to improve coding accuracy and documentation quality.
Process Optimization: OnPoint conducted a thorough assessment of the existing coding and CDI processes and identified areas for improvement. They implemented best practices, streamlined workflows, and introduced solutions to enhance efficiency and accuracy.
Training and Education: OnPoint organized training sessions for the in-house coding and CDI teams to upgrade their skills and knowledge. They provided ongoing education on coding guidelines, documentation requirements, and regulatory changes to ensure compliance and quality.
Quality: OnPoint established robust quality review processes to monitor coding accuracy, documentation completeness, and compliance with regulatory requirements. Regular audits and feedback sessions were conducted to identify and address any issues proactively.
Reporting and Analytics: OnPoint implemented reporting and analytics tools to track key performance indicators, identify trends, and measure the impact of their interventions.
Results
After OnPoint took over coding management, ED coding, inpatient coding, and CDI, the organization experienced several positive outcomes.
“OnPoint takes the time to understand what our needs and goals are, and invests in finding the right individuals who can support our revenue cycle vision. Through weekly meetings, support with audits, and educational programming, OnPoint consistently demonstrates their commitment to our success,” said the HIM Director. “Their partnership goes beyond simply providing staff, as they actively manage and strategize for seasonal coverage, vacations, and staff turnover. It feels like we’re a real team working together towards a shared goal.
The comprehensive solution OnPoint implemented positively impacted the following areas:
Improved Coding Accuracy: Coding accuracy rates increased significantly, leading to better reimbursement and revenue integrity for the organization.
Enhanced Documentation Quality: CDI efforts resulted in more thorough and accurate clinical documentation, supporting improved patient care and accurate code assignment.
Increased Compliance: The organization achieved better compliance with coding guidelines, regulations, and payer requirements, reducing the risk of audits and penalties.
Efficiency Gains: Process improvements and technology solutions led to increased productivity and reduced turnaround times for coding and CDI tasks.
Cost Savings: By outsourcing the management and leadership of coding and CDI, the hospital saved on training costs, technology investments, and overhead expenses associated with in-house management.
Metrics of Success:
The amount held up in DNFC accounts fell significantly from 60 million to 6-10 million on average.
CDI Physician query response rate increased from 75% to averaging 95-99% response rate.
The CDI team realized over 2 million dollars in the first year of the contract.
Partnering with a specialized vendor like OnPoint Healthcare Solutions proved to be a strategic decision for the organization to overcome coding and CDI challenges effectively. After seeing the results of the partnership, the HIM Director stated, “My appreciation and thankfulness for the success we’ve experienced goes to OnPoint and the team that they brought in ready to rock and roll. They are so awesome—it’s amazing to see the results.”
The collaboration resulted in improved quality, compliance, and efficiency, ultimately benefiting both the organization and its patients.