Increase Surgical Revenue – Part 3 of 3 (Case Mix Index)
What is Case Mix Index (CMI)? Medicare and Medicaid created a CMI score to help properly reimburse hospitals for services provided to inpatients (CMI doesn’t apply to outpatients). The CMI is an attempt to measure the resources needed to provide proper care for patients. An article from Health Leaders Media titled CDI Programs Drive Up Case Mix Index, Revenue , “a higher CMI means more reimbursement dollars for providing care because it indicates that a hospital is treating sicker patient population. Increasing the CMI hinges on having clinical documentation that accurately reflects the severity level of patients’ conditions. Without thorough records, hospital can miss out on substantial revenue”.
If you research “Case Mix Index” on the internet, then you’ll see that it can become a complicated topic. CMI’s can be set at a DRG level (more information on what a DRG can be found here), and also at a hospital level. In an attempt to simplify, the end result is that the smallest improvements made to a hospital’s CMI or a CMI for a DRG can result in much more revenue for hospitals. Improvements to a DRG impacts every patient procedure that is performed where reimbursement dollars are being seek for that DRG.
All hospitals are aware of this. The #1 way to improve CMI is through better documentation by staff. Many hospitals have invested money in creating a new group of personnel often referred to as Clinical Documentation Improvement (CDI) specialist. CDI specialists review documentation looking for accuracy and identify gaps or descriptive wording in the documentation that can help bring in more reimbursement dollars.
In order to seek maximum reimbursement for procedures, all the information needs to be present (including what was used in a surgical procedure). As we discussed in Part 1 & 2 of “Increase Surgical Revenue”, Mobile Aspects maximizes charge capture and helps surgeons recall the details of a procedure. This helps fuel better documentation which enables medical coders to seek higher reimbursement for procedures. All of this leads to improved CMI scores.
Inventory for a surgical department is their biggest non-labor cost and takes great effort to manage. As mentioned before, inventory has been isolated from the rest of the business of providing healthcare. Breaking down isolated walls and opening up the visibility of what’s supplies are being used can help increase surgical revenue and also help hospital’s determine their cost for providing care.
If you would like to learn more about CMI, then please check out this YouTube video.
Part 1 & 2 of this article can be found here: