Clinical Data Integrity

At a high level, a typical CDI program includes many components such as data analysis, stakeholder engagement, governance and oversight, and case reviews. Analyzing data — such as denial reports, claim scrubber reports, and compliance reviews — provides opportunities to target potential risk areas for your organization. As with any new program, involving key stakeholders in the decision-making process facilitates support and longevity. These stakeholders may include project managers, medical staff, executive leaders, physician leaders, health information management (HIM) leadership, CDI leadership, and compliance staff.  Most successful CDI programs includes the following components:

  • Documentation specificity to support medical necessity
  • Coding Accuracy
  • HCC assignment
  • Patient satisfaction
  • Quality incentives
  • Benchmarking

Some organizations ask themselves if they actually need a CDI program when they have a Revenue Integrity program in place – our response, absolutely!!  The focus of the CDI program is specific to these 3 areas:

  • Accurate depiction of the patients condition;
  • Accurate record of care provided, and
  • Accurate quality scores.

The Revenue Integrity Team is focused on the entire revenue stream and a failure in any one of these items above can/will lead to inappropriate reimbursement, denials, compromised patient care, and/or patient dissatisfaction.

Lay the groundwork for your program and promote collaboration with your multidisciplinary team by determining a steering committee (strategic), a task force (operational), an escalation structure, and policies and procedures. A mission and vision provide those in your organization perspective throughout the process. It is important that organizations understand that they must allow technology to assist in the process: Begin by learning what software is accessible to you and how it can help your program.

Now that more and more services are being provided in an out-patient setting vs the In-patient setting from just 3 years ago.  It is essential that organizations either have or are building an outpatient CDI program from the ground up may seem like a daunting process. Like any new initiative, there will be some resistance, so it is best to begin the conversation with the benefits and they ‘WHY’.  However, with a strong organizational understanding of the overall program, efficient workflows, and collaborative communication, along with the executive leadership support from the organization, it will be well worth the effort.

Medical Practice Success can help you get your CDI program in place or provide your organization with a CDI review.  Our comprehensive review includes evaluating your current CDI metrics such as Review Rate, Query Rate, Response Rate, Agreement Rate, HCC capture rate, Denial Rate and overall satisfaction.  Additionally, we will perform an independent evaluation of the actual operational aspect of your CDI program such as:

  • Time of Review (concurrent vs retrospective)
  • Notes to Review (provider, nursing, ancillary staff, lab/radiology or other test results/findings)
  • Documentation elements being captured

Contact us below if you would like to speak to someone about this service.