Inpatient CDI programs have been in place for many years, but there’s still a lot to be learned in the outpatient CDI space. Hospitals’ share of revenue from outpatient services continues to increase. Yet, due to inaccurate, vague or delayed documentation in outpatient settings, many providers and healthcare organizations are losing money to denials and audits. Evidence shows that using an outpatient CDI program can benefit your healthcare organization from a financial standpoint while providing patients with the highest quality care possible.
- Ensures documentation is accurate, precise and timely. A physician’s top priority is to perform quality patient care that is properly addressed and documented to ensure the pathway of care is complete. CDI helps guarantee documentation meets the payer requirements so the care facility can provide the highest quality care and documentation to satisfy patients and payers. By facilitating accurate, precise and timely documentation, CDI programs reduce denials and audits.
- Acts as a support system and gateway between physicians and coders. CDI professionals often have an in-depth clinical knowledge due to their medical background, which aids in communication between providers and coders. The knowledge and expertise to translate between providers and coders provides a comprehensive view of clinical care transferred to documentation. Bridging the gap between physicians and coders creates a more cohesive, collaborative and positive working environment for all.
- Saves money. Eighty-six percent of denials are avoidable while 24 percent are not recoverable (ICD-10-Monitor). Accuracy from the beginning reduces audit requests and denials, yet many health systems lack sufficient staff to address these issues, and many must work overtime, which leads to revenue loss. A CDI program addresses these issues up front, saving your health system from unrecoverable revenue loss. Audits have increased by 11 percent since the third quarter of 2020 because payers are looking to recoup financial losses after the height of COVID-19. Accurate documentation that ensures proper use of modifiers helps your organization stay off payer radars.
- Reduces physician abrasion and increases retention. Physicians may become dissatisfied or leave a practice if they are frustrated with documentation or see that reimbursement is not appropriate based on code. Because outpatient specialists are highly sought after, retention is especially important. Creating an opportunity for physicians and coders to discuss documentation in detail and develop a plan for proper coding is critical to fostering productive relationships and understanding. CDI professionals help reduce queries and form more cohesive relationships. They also have a more holistic view of the clinical and coding perspectives, creating an understanding of “why” and “how” the pieces fit together.
- Adjusts for risk. According to an ICD-10-Monitor article, CDI is essential to hierarchal condition category coding. “Whether your healthcare organization is large or small, outpatient CDI programs focused on improving clinical documentation in physician clinics and across the care continuum to support HCC diagnosis capture represent a vital component of risk adjustment.” CDI reduces your organization’s risk of denials and audits, and therefore, improves revenue cycle. It improves documentation and payment outcomes while HCC coding adjusts for risk. The two work hand in hand to improve revenue cycle.
As denials and audits continue to rise, an outpatient CDI program is a valuable tool to improve reimbursement and the quality of patient care. Accuracy, timeliness and cost effectiveness are reasons that CDI is a beneficial part of the health system—working between providers and coders to meet the needs of patients and payers.
Not sure if your organization is ready for OP CDI? Here are four red flags that your health system might need an outpatient CDI program.