What you can do to optimize your hospital's reimbursement.

By paying attention to how coding is performed and documented, case managers can make significant impact on the hospital's bottom line by helping optimize reimbursement and reduce the number of claims denials. Coding is a particularly important consideration when you're examining data in terms of your case mix index. If coding data aren't accurate, then the strategies you use to improve efficiency and effectiveness might be directed inappropriately. Worse yet, if your case mix index appears to be too high, federal investigators could target your hospital for an upcoding investigation. Pay particular attention to coding issues when designing critical pathways and other performance improvement efforts. Eliminating an apparently unnecessary test may cut costs slightly, but it also may prevent your hospital from validating a high-paying diagnosis.