Optimizing pediatric care and reimbursement with accurate documentation
Episode 7
Shannon Martin is the Senior Principal Product Consultant and the Lead Architect for Nuance. In her role, she oversees and writes all of the content for their pediatric content. She shares why documentation is so crucial in the pediatric setting for accurate reimbursement and patient care.
Episode summary
Pediatrics are not little adults
Shannon highlights that a major difference between acute care hospitals and pediatric hospitals is in the way payments are made. Pediatric hospitals are paid mostly by Medicare payers and acute care hospitals are made by private or self-payers. In addition, the disease processes are also different in children than in adults, as pediatric hospitals are often working on congenital conditions. Even similar diseases have different pathophysiology in children than adults, so what happens behind the scenes and the care they recieve differs as well.
Pediatric documentation
Nuance tools help Clinical Documentation Improvement (CDI) teams and physicians focus on capturing secondary diagnoses in children that will impact the reimbursement or severity of illness or risk of mortality and in turn, quality. Shannon emphasizes that while this is vital for reimbursement, it is also part of ensuring that the patient receives the care that they need.
3:45 “In the last few years, one of the biggest reasons for admission in pediatric hospitals has been acute bronchitis…If you think about acute bronchitis in an adult, that disease process is something that an adult is at home with...So we are looking at those other opportunities that made that child sick enough to be admitted into the hospital…acute respiratory failure or some time of aspiration…We are looking for other opportunities to just paint a better picture for the physician that shows why that seemingly simple diagnosis is at that level that they need to be admitted to the hospital...When you leave off the details, you open yourself up for misdiagnosis.”
Misdiagnosis is a huge problem in pediatrics and this can lead to litigation, or denial from insurance companies to cover important care. Digging further into the chart and providing these details only benefits the health and well-being of your patients and your organization.
Optimize documentation and revenue recovery
8:45 “In a pediatric facility, we’re getting paid, but we’re getting Medicaid paid. So, you want to make sure that the chart is accurate to make sure that you’re optimizing how much Medicaid is going to pay you within those limits.”
Shannon shares that this is one reason why supporting your CDI team and providers with software that helps them deep dive and look for clinical indicators and evidence that builds their patients’ cases will optimize documentation and financial recovery. Nuance tools provide the software, education, and resources to make this happen.