Chief Financial Officer

In any business, the two primary reasons to incur additional costs are to make money or to reduce risk. In a clinical documentation training program, you invest money in this program for both reasons.
First, there are many regulatory, legal, and accrediting association requirements that stipulate standards for clinical documentation. Second, your clinical documentation is translated into coded data, which in turn determines your reimbursement. Inaccurate documentation means inaccurate reimbursement. If you are being reimbursed at a higher rate than the documentation supports, then you are at significant risk for
noncompliance. However, if you are being reimbursed at rates below what your documentation could support, then your organization is not receiving revenue to which it is legitimately entitled. To further
support this notion, the federal government encourages all healthcare providers to obtain all reimbursement to which they are legally entitled. 

Generally, healthcare systems find that because of lack of education or time, their physicians have been under-documenting in patient records. This lack of documentation may mean that the hospital is not receiving all the reimbursement to which it is entitled. However, it is also important to understand that if, for some reason, your physicians were over-documenting—which is highly unlikely—your organization would find itself in a payback mode. In either case, a correction would be needed, and you would need to invest in a clinical documentation program to get both your revenue and your documentation on the right track.

Pay for performance and quality measures currently have an indirect economic impact on healthcare organizations. Some of the impact comes from patients who use Web sites such as the Joint Commission’s Quality Check, HealthGrades.com, Medicare Quality Indicators, or the Leapfrog Group to choose where they receive care. Over the next several years, however, quality measures will continue to increasingly, and significantly, impact the payment equation. A good example of a subtle, yet real, quality measure with economic impact is the present on admission (POA) requirement. This initial list of diagnoses for which a hospital will not be reimbursed (unless the condition was present on admission) will likely grow. Because of POA and similar regulations likely to be implemented, inaccurate documentation will cost hospitals significantly greater amounts of reimbursement each year.