improve case mix index

Case mix index (CMI) is a critical measurement hospital CFOs and Directors monitor closely. It is the metric by which the relative cost of treating patients covered by Medicare is measured. It also sheds light on the type of patients hospitals are treating. The higher a hospital’s CMI, the more expensive services the hospital is providing. In the end, CMI shows the revenue a hospital produces.

In order to set a hospital’s budget, the CFO and finance department look at the CMI. If it is less than previously predicted, there may be a loss in revenue and improving it will be a priority in order to get revenue back on track.

Hospitals looking to improve their CMI can take specific steps, especially around documentation and coding. Clinical documentation must accurately reflect the patient’s conditions, and if it doesn’t, a hospital may not be paid fully for their services, or payment may be delayed. Imprecise descriptions of patient visits can result in under coding, which will lower the hospital’s CMI and directly impact the bottom line.

Get the Facts

One step a hospital can take is to create a task force or group of personnel for Clinical Documentation Improvement (CDI). The role of this group is not only to review all physician/clinician documentation for accuracy and to eliminate mistakes and lack of precision that impact billing and payments, but also to create processes that eliminate the most common mistakes made in documentation.

To get to the bottom of the most common mistakes, CDIs can start by reviewing patient visits. Often, overtaxed physicians busy inputting data into EHRs leave critical information out during the patient visit. The much lamented deterioration in patient care is also usually linked to a physician having too much to do during their time with patients. Further, mistakes in EHRs and documentation overall cost hospitals regularly, not only in accurate payment for services, but in labor costs to follow up and fix billing issues.

What’s the Solution?

Your CDIs will first fix the inaccuracies that happen in patient visits. One method that can provide immediate results is to hire a medical scribe to relieve the pressure on the physician when it comes to record keeping. Instead of asking a doctor to focus on their patient and their laptop, the medical scribe’s entire job is documenting accurately. A medical scribe shadows physicians with the sole purpose of accurately recording patient visits. They’re specifically trained in recording in EHRs, which will cut down on mistakes and increase revenue and payment cycles.

The second step is to to continue with a robust CDI that continues to review and improve your Clinical Documentation. This is the only way to improve your CMI and both a medical scribe and consistent and thorough DCI program are the sure bets to do this.

Please let us know if we can answer your questions.