Four Red Flags that Your Health System Might Need an Outpatient CDI Program

Research from The Change Healthcare has found that nearly 50% of denials are caused by front-end revenue cycle issues. An outpatient CDI program can help your organization adapt to the shift in the healthcare industry and provide accurate, efficient and timely documentation.

The long-term shift from hospital-based care to the delivery of more treatment in the home and ambulatory centers picked up pace during COVID-19. This trend is expected to gain momentum, pressuring revenue growth and margins in the hospital sector, according to new research from Moody’s Investors Service.

Reimbursement changes, risk-sharing and investment in outpatient services including ambulatory surgery centers are among the forces driving the movement away from more expensive hospital inpatient care.

This industry shift shines a light on the increase in outpatient procedures and the documentation that keeps it all flowing. Providers need a documentation improvement program in place now more than ever. If you haven’t considered implementing an outpatient CDI program for your organization, here are four signs that the time is right.

Denials. Since the onset of COVID-19, denials have risen 11% nationally. Denial management is critical, especially in specialty care. If your organization is facing increased denials, this is a sign that documentation is lacking accuracy and timeliness. You could benefit from an outpatient CDI program to address and reduce denials.

Appropriate reimbursement. Even if you do not have a denial issue, you could have a reimbursement problem. Though your billing may not have been flagged by payers, there are other factors that affect appropriate reimbursement. Denials are not the only indicators that your health system could be losing revenue. Some of your money is going to time out because you didn’t have the time or staff to get to it. The benefits of an outpatient CDI program include the ability to find discrepancies.

Provider responsibility. Providers can be disenrolled from payers simply due to incomplete or inaccurate documentation. This places a heavy responsibility on providers to ensure accurate documentation and coding. A CDI program acts as a bridge between coders and providers to mitigate losses due to payer denials.

Compliance issues. If your organization encounters compliance issues, this is another indicator that an outpatient CDI program can help you get on track. CDI ensures the facility is complaint in terms of coding rules, laws, and guidelines and protects against liability. Making sure your documentation supports what you actually did is essential. Outpatient CDI is about reading what the physician is saying and properly interpreting that for the coding team, which helps organizations stay compliant with documenting care.

The revenue cycle of your health system supports your ability to provide high quality, effective and efficient patient care. Accurate documentation and follow-up can improve the perception and reputation of your care facility. If you are experiencing any of these four red flags in your organization, it’s a sign to reevaluate your documentation and coding with the help of a CDI expert.

Implementing an outpatient CDI program can help your healthcare organization save time and money. Read these five benefits of using an outpatient CDI program.