A Clinical Documentation Practice Improvement to Increase Insurance Reimbursement

• Main Author: Hamilton, Allison R
• Format: Others
• Published: NSUWorks 2019
• Subjects: Social sciences; Health and environmental sciences; CMS; Cost efficient; Documentation; Health outcomes; Mental health; Nursing
• Online Access: https://nsuworks.nova.edu/hpd_con_stuetd/58; https://nsuworks.nova.edu/cgi/viewcontent.cgi?article=1058&context=hpd_con_stuetd

Background: The National Institute Mental Health (2015) estimated there were about 44.7 million people diagnosed with a serious mental illness and 62.9% of those diagnosed were without mental health services. The loss of services was due to unemployment, reoccurring hospitalization, inabilities to care for themselves, and lack of participation in societal norms (World Health Organization [WHO], 2014). According to Insel (2011/2015), the U.S. cost of mental healthcare was an estimated $57.5 billion in 2006. This cost was not due to actual care but associated with the economic burden of job loss and the excessive use of community resources. The Affordable Care Act (ACA) and the Mental Health Equality and Parity Act (MHEPA) has positively influenced access to mental healthcare, but healthcare coverage continues to be deficient. Insufficient clinical documentation practices decrease insurance reimbursement potential. Purpose: The purpose of this quality improvement project was to enhance the current clinical documentation practices and policies and increase insurance reimbursement in an adult psychiatric inpatient unit in a private, non-profit mental and behavioral health organization. Theoretical Framework: The Kurt Lewin’s 3 Step Change Management Theory Methods: A quantitative design guided this project utilized an investigator-developed tool modeled from the CMS Inpatient Unit Worksheet as a data collection tool from the clinical chart documentation reviews. Results: Fisher’s Exact and Chi square tests measured the cross tabulation of pre and post comparison sample frequency of staff’s integration of an evidence-based descriptive documentation method into practice. The results presented with statistical significance of the progress narrative notes. The declined chart claims a p <0.001, and the numbers related to case scenario utilization of the documentation method was p = 1.00. Conclusion: The relationship between descriptive clinical documentation and insurance reimbursement was evident in the usage of the Data, Assessment/Action, Response, and Plan (DARP) method in the clinical documentation progress narratives notes. There was a 24% improvement in insurance reimbursement claims and a 17% decrease in charts declined for the study period.