Are There Hidden Clinical Documentation Improvement (CDI) Problems Crushing Your Bottom Line?

By Mark Hendricks, MBA, RHIA, Vice President, Product Management, HIM Solutions | Posted: 09/27/2017

As a health care professional, you realize that Clinical Documentation Improvement (CDI) is a fundamental cornerstone for data quality and accurate reporting, streamlined claims reimbursement and robust public health information tracking. More than an essential component of the health care system, CDI quantifiably affects revenue. According to Black Book Market Research, 90% of hospitals with 150 beds or more that outsourced clinical documentation functions realized at least $1.5 million increase in revenue and claims reimbursement.

Depending on how well equipped your organization is at solving the most prevalent CDI challenges, you may not be collecting the reimbursement to which you are entitled.

Here are four problems affecting clinical documentation improvement (CDI):

1. Incomplete or inaccurate documentation.

DRG assignments and codes affect billing and, if assigned erroneously, can lead to denied claims or inaccurate reimbursements. Truth time – how thorough is your physicians’ documentation? The latest health care technology can recommend potentially missed clinical indicators or documents lacking required specificity that, if caught early, can lead to higher quality care, exact coding and accurate reimbursement.

2. Physician query fatigue.

The extraordinary time demands placed upon physicians is no secret. They are frequently pulled in multiple directions and workflows, whether it’s a request from the patient care team, a required signature, or patient order clarification suffice to say physicians are spread thin. An EMR workflow provides physicians the ability to answer all requests in a single platform.

3. Communication gaps between CDI specialists (CDIS), coders and auditors.

Physically and organizationally, CDIS and coders may work in two different areas, making collaboration difficult. A single technology platform that encompasses workflows for all stakeholders and provides visibility into the same work queues eases the burden of rework and redundancies. With the platform, DRG recommendations are shared with coders quickly, and auditors can expedite resolutions, and avoid discrepancies, re-billing and denied claims. The CDIS can instantly see the coder’s recommendations, and proactively assess, then sign off on the DRG selection. Conversation between the CDIS, auditor and coder are retained and viewable, easier for tracking the reconciliation of issues or concerns.

4. Prioritization of work.

How do CDIS know what to do first? Are they reviewing the most impactful cases that require immediate attention or are they selecting the easiest ones and tackling them first? Improve productivity by implementing a workflow that surfaces the most valuable cases first with automated case prioritization. The user can quickly parse out different review types – by DRG, patient status, length of stay or query status. Cases flagged by an auditor or coder are visually identified so they can be addressed first.

The right CDI technology eliminates problems that impede quality and reimbursement success. Without it, your quality scores could be undermined and cash flow unnecessarily diminished.

Mark Hendricks

Mark Hendricks, MBA, RHIA

Mark Hendricks, MBA, RHIA, is the Vice President of Product Management for HIM Solutions at nThrive. He is a Health Care Information Technology professional with over twenty years of operational, technical, consultative sales, and sales management experience in leadership positions for Precyse, 3M Health Information Systems, Inc., SoftMed Systems, Inc., Helix Health System, First Consulting Group, KPMG Peat Marwick, and Ferranti Healthcare Systems Corporation. He has extensive experience in technologies supporting health information processes and workflow including coding, abstracting, revenue cycle management, dictation, transcription, speech recognition, document imaging, case management, and clinical documentation improvement. Mark has demonstrated success and proven results to solve health care operational challenges and HIM business issues by designing, selling, and delivering solutions which include the appropriate mix of technology, applications, operational redesign and change management.

Hendricks holds a Bachelor of Science in Health Records Administration from the University of Pittsburgh. He also has a Master of Business Administration from Loyola University in Maryland.