CMS Readmissions Auditing, Education and Optimization


e4’s readmission audit and education program offers customer-specific solutions and internal staff training to push the organization’s initiatives forward.

With healthcare reimbursement transitioning to a value-based payment model, organizations are continuously struggling to remain ahead of the curve. Clinical Documentation Improvement and Quality teams are challenged with juggling various initiatives without being properly educated on their next undertaking. Alternatively, the lack of focused education can make any initiative daunting and unsuccessful. e4 developed a readmission audit and education program in response to customer needs to understand their readmission gaps and provide education to their staff and improve risk adjustment capture while decreasing HRRP penalties.

Below, view “Reduction of Readmissions with Collaboration of Coding and CDI”, a presentation by e4’s Tara Rogers, BSN, RN, CCDS, Sr. Clinical Documentation Specialist. This presentation was initially presented at the NEPHIMA Quarterly Luncheon Meeting & Education Session on Wednesday, March 14.

Why does e4’s Readmission Audit and Education Program work? 

  1. Our consultants are both clinicians and HIM professionals that are experienced in effectively educating and aligning various departments on organizational initiatives.
  2. Our consultants identify your opportunities for improvement so that we can focus the education process.
  3. Our readmission education is concentrated on findings specific to your facility.


Program Attributes: e4 was engaged to retrospectively review readmission cases by a 662 bed acute care hospital in Central Pennsylvania. The hospital encountered an unexpected aggressive readmission penalty and was looking for recommendations for opportunities for improvement. A retrospective audit was performed on the readmission cases and education was provided to the CDI and Coding teams along with focused, second level DRG validation.


  • 47% of cases identified with query opportunities
  • 14% of cases identified with missing documented diagnoses

Program Outcomes:

  • $80,000 revenue impact attributable to second level DRG validation on Medicare cases without CC/MCC in three months
  • 87.8% improvement in diagnosis capture post-education sessions