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Clinical Documentation Improvement is critical for Private Practices

April 1, 2014

Clinical Documentation ImprovementClinical documentation improvement, or CDI, is a hot topic in hospital and clinic roundtable discussions but it is also important in the outpatient setting.

An increasing number of insurance companies are submitting queries for more information and denying claims when the institution cannot provide the clinical documentation to support a claim for payment. The government is working harder to catch fraud and abuse then recoup improper payments. Medicare and Medicaid are also requesting more information on claims to reduce abuse.

These changes force healthcare providers to streamline their practices towards providing meaningful healthcare at a low cost. CDI gives outpatient clinics the platform they need to streamline these practices by reducing queries, claim rejection rates and government inquiries.

Then there is the ICD-10 implementation deadline of October 14, 2014. Hospitals and clinics beefed up CDI to meet this deadline but many institutions are still not ready – especially smaller institutions like outpatient clinics. The American Academy of Professional Coders, or AAPC, says “After thousands of ICD-10 assessments, we’ve noticed that only 37 percent of today’s documentation is ready for the transition.”

CDI in the Outpatient Setting

CDI is as relevant in outpatient settings as it is in hospitals and offices. Like other institutions, outpatient practices rely on accurate diagnosis codes for DRG reimbursements and other reimbursement-based programs; CDI provides the information necessary to ensure accuracy in submissions in the outpatient setting. Furthermore, these codes affect physician scoring, healthcare policies and insurance coverage.

Benefits of CDI in outpatient setting include:

  • Fewer claim denials and rejections
  • Increased reimbursement, especially in HCC/risk adjustment coding and quality improvement programs
  • Fewer physician queries
  • Optimized coder productivity
  • Improved documentation
  • Enhanced patient quality measures and continuity of care
  • Improved communication with providers

Enhancing CDI Relevance in Outpatient Settings

Remember that CDI’s relevance goes deeper than simply using the correct ICD-10 code. The Centers for Medicare and Medicaid, or CMS, says that when trying to implement CDI strategies, you should “Identify documentation improvement opportunities that could impact multiple initiatives – don’t focus solely on ICD-10-CM”

The transition process entails more than just translating your handful of ICD-9 codes into the new ICD-10 codes. While creating “cheat sheets” is important, it is more important to learn how to provide proper documentation to back up the codes you use.

Start by creating a CDI position in your outpatient clinic. Hospitals often hire registered nurses to do in-house coding and CDI. Outpatient practices can use this same strategy by training one or two RNs interested in taking an online medical coding program that leads to certification in coding in auditing.

Initiate CDI implementation in your outpatient practice by first performing a few retrospective audits. Grab a handful of random samples from your most common and problematic claims. Determine whether each has the documentation necessary for billing and coordination of care. Create a panel of physicians, billers and coders to discuss how they would have applied the new documentation rules to these older cases.

Establish a means of communicating deficiencies found in reviewed documentation. Be sure your outpatient office electronic health record, or EHR, system can send and receive electronic queries or an HIPAA-compliant email system.

CDI helps you keep track of improvements and spot patterns. Monitor query traffic for the number of queries and the type of information the payer requests. Look for positive and negative patterns, and use what you see there to develop training strategies.

CDI is more relevant in the outpatient setting than ever before. Implement CDI practices as soon as possible to work out the kinks before the October 14, 2014 deadline.


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