Getting Ready for Outpatient CDI

February 16, 2016 Streamline Health

By Julius Blum
Vice President, Portfolio Architecture & Integration, Streamline Health, Inc.

Clinical Documentation Improvement (CDI) programs are commonly used for inpatient admissions, but as more services shift to the more cost-effective and convenient outpatient setting, providers are seeing the value of leveraging CDI for outpatient services.

In addition to finding opportunities to uncover potentially lost reimbursements for outpatients, other benefits of outpatient CDI reviews include reduced denials, fewer audit findings, and improved cash flow. All of these will positively impact the provider’s financial performance, while also providing a more complete record of patient encounters for more comprehensive documentation.

As outpatient services represent a different—and often larger— segment of business for providers, getting the best results from CDI will require a different approach to the process, starting with automation rules. The ability to customize workflows, electronically submit and manage queries, and develop unique impact calculations are all key to outpatient CDI success. Collaboration of CDI specialists with providers, coders and quality specialists will become more important. CDI solutions that provide for this communication and auditing will position the organization to quickly realize the benefits of outpatient CDI.

Another key consideration in outpatient CDI is the changing business model of care delivery in America. As reimbursement models shift to quality driven payments, value-based reimbursement, and risk based payments, it is more important than ever to have the documentation and coding accurately reflect the medical necessity of tests being ordered, as well as capturing the severity profiles of patients. Outpatient activities have often been the outlier in terms of documentation, but CDI can help close the loop for a more accurate picture of an organization’s overall efforts.

In addition to helping hospitals, outpatient CDI can benefit physicians as well. Better documentation will ensure proper E/M levels and accurate reporting of hierarchical condition categories (HCCs).

Whether the focus is on reimbursement, compliance, quality, risk, medical necessity, or all of the above, adding outpatient CDI will help all stakeholders in care delivery. Empowering the CDI specialists will be key to realizing these benefits, and the recommendations above will help ensure you pursue the best CDI technology options for this endeavor.

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