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Hospitals with Clinical Documentation Improvement Program Report Increased Reimbursement with New Medicare Coding System.

Hospital Clients of J.A. Thomas & Associates Outperforming CMS Projections; Achieving 5 Percent Higher Case Mix Index with Clinical Documentation Improvement Program

ATLANTA -- J.A. Thomas and Associates, the leader in healthcare clinical documentation improvement, published today a set of benchmarking reports that show 188 hospitals using its Compliant Documentation Management Program (CDMP[R]) have realized an overall 5 percent improvement in case mix index than projected by the Centers for Medicare and Medicaid Services/MEDPAR for hospitals adjusting to the new MS-DRG coding system. To download the full report, visit

In August 2007, the Centers for Medicare and Medicaid Services (CMS) issued final rules to the DRG coding system to better reflect severity of illness, a system by which hospitals receive Medicare reimbursement. The new Medicare Severity Diagnostic Related Group (MS-DRG) coding system, which became effective October 1, 2007, raises the bar for physicians to document with more specificity the principal patient diagnosis and comorbidities, other conditions that increase patient stay or resource consumption, so that coders can code these diagnoses accurately.

As clinical documentation improves, hospitals are able to achieve more accurate coding and better establish severity of illness, which in turn impacts a hospital's case mix index and ensures appropriate hospital/physician profiles. And, an increase in case mix index impacts reimbursement. For example, a five percent increase in case mix index for a hospital with 5,600 annual Medicare discharges could translate into an increase of $4,800,000 in revenue.

"The new coding system required by CMS has basically prompted hospitals to revisit the way they document and code clinical severity" said Joanne Webb, CEO of J. A. Thomas & Associates. "Now, it's critically important for physicians to document while the patient is in the hospital - not after discharge - and be as specific as possible when it comes to clinical diagnoses. Hospitals will not be appropriately reimbursed for acute inpatient visits unless they accurately document severity of illness and when those diagnoses are present on admission."

The performance benchmarks established by J. A. Thomas & Associates are meant to help hospital clients see how they are performing relative to CMS' MEDPAR projections and also how they compare to the firm's other hospitals, or peer groups. According to Ms. Webb, "these benchmark reports are a useful tool to evaluate overall performance and also identify opportunities for more specificity in clinical documentation. We're happy to see that our clients are using our benchmarking reports to measure how well they are transitioning to the new MS-DRG system."

Ms. Webb notes that other than the company's benchmarking report, "there is really no way to know how hospitals are doing at this time."

Six-Month Benchmarking - Summary Results:

Overall, clients of J. A. Thomas & Associates are achieving at least a 5 percent higher overall CMI than projected by CMS and most notably, when one looks at the Medical CMI --which indicates the most vigorous improvement in documentation -- the company's clients have a 10 percent higher CMI than projected by CMS' MEDPAR.

Of further note, when looking at Major CCs (MCC) -- a method to identify diagnoses that significantly increase expected resource consumption -- the overall J. A. Thomas & Associates' client Medical MCC rate is 14 percent higher than MEDPAR, and the surgical MCC rate is 19 percent higher than MEDPAR.

About J.A. Thomas & Associates, Inc.

Since 1991, J.A. Thomas & Associates has become the nationally recognized leader in healthcare compliance and documentation improvement. Our innovative Compliant Documentation Management Program([R]) has helped more than 500 hospitals and 30,000 physicians nationwide improve CMI by an average of 4% - 8%. The firm was founded by clinical professionals who brought together clinical and business insights from doctors, nurses, coders, and administrators. The result is a program that blends clinical expertise with compliance to ensure the accuracy of clinical documentation reflecting the appropriate severity of illness.
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Publication:Business Wire
Date:Aug 11, 2008
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