An Introduction to Outpatient CDI

Improved/integrated clinical documentation in outpatient settings is becoming increasingly popular. Preparation, planning, and leadership are necessary for a successful program, and an outpatient CDI program has numerous critical components.

Choosing a single environment in which to begin your CDI program is a good idea, but remember to start slowly. Remember that the selected department or area will impact your staffing levels when assessing volumes.

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What does CDI mean?

Clinical documentation integrity is a big topic in the outpatient setting regarding improving clinical documentation! Although CDI has been around for a long time in the hospital setting, it is still a new concept in the office context.

As the industry moves toward value-based compensation, we see outpatient CDI efforts in primary care, specialty offices, ambulatory surgery, and emergency rooms. In medical coding, CDI could be an exciting new opportunity to grow your career.

What is outpatient CDI?

CDI programs are typically designed in hospitals with an inpatient focus, but they can also be used to improve documentation in other settings. Now is the time to concentrate on your outpatient services. BDA defines outpatient CDI as ensuring that the codes billed are medically necessary and supported by sufficient documentation in both the outpatient context and the emergency department (ED).

A BDA CDI specialist might focus on diagnoses that affect the Hierarchical Condition Categories (HCCs), a payment technique connected with patients seen in the physician practice setting for those with Medicare Advantage (MA) contracts.

Many chances exist to evaluate provider documentation entered during an outpatient or provider encounter as outpatient CDI is still being established. Outpatient CDI growth is a must.

Why do you need an outpatient CDI?

Many firms lack the personnel and knowledge needed to implement a CDI strategy. There are numerous advantages to working with BDA:

• The inpatient and outpatient settings have a high incidence of payment denials, which can be reduced by implementing the following strategies.
• To Assist in the Appropriate Assignment of Diagnostic Codes: Diagnosis specificity is becoming more critical in the outpatient scenario. To accurately document each diagnosis, clinical documentation should be used to support it.
• These changes will affect the Hierarchical Condition Classification assignment, affecting the Risk Adjustment Factor (RAF) to reflect the patient complexity appropriately. Extensive encounters and procedure notes are essential for obtaining accurate procedure capture.
• For a strong Compliance Department, E/M policies and processes are required. If no record exists, the event never occurred. Denials and fines can be minimized if physician coding accuracy scores are high.

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What can I expect from a CDI role?

Health care documentation must be translated into alphanumeric codes to facilitate reimbursement, risk adjustment, and quality measures. Medical records can accurately represent the patient’s most recent diagnosis and treatments using CDI. Intermediary between clinician and coder is the role of CDI specialist.

Querying

Any CDI software needs a reliable and compliant query process as a foundation. An inquiry is a request for additional information from the service provider. To guarantee that the patient’s record accurately represents their health and the care they get, the query asks for the following details:

When there are discrepancies, inconsistencies, or gaps in the documentation, a question should be asked. Queries can be open-ended, multiple-choice, yes/no, or vocal in nature. Questions should be provided in a manner that does not prompt the provider to make a specific diagnosis, regardless of whether the format is used. It must be flexible enough to allow for the clinician’s personal preferences.

Training and Educating

Respecting the provider’s time is critical to the success of your outpatient CDI efforts. This can be demonstrated by arriving at each CDI meeting well-prepared with relevant resources and reliable references. Use various methods to educate and receive feedback, depending on your audience’s preferences. One supplier may have a more diverse set of requirements than another.

What’s the biggest challenge?

Joining an outpatient CDI team comes with a slew of difficulties. The number of outpatient appointments is the first and arguably the most significant issue. A healthcare provider typically sees a patient every 15 to 30 minutes. There is little time left to guarantee the documentation and coding are supported through query and response.

Primary care, in particular, has experienced an increase in the time clinicians devote to their work. Any additional CDI initiatives should not exacerbate physician abrasion and burnout. Starting or maintaining an effective outpatient CDI department is made more difficult by shifting reimbursement systems, standards, and laws. Changes to ICD-10 codes and the use of telehealth in 2020 have made this very clear.

Is Outpatient CDI the Right Step for Me?

Understandably, if outpatient CDI appeals to you, you’d want to know what qualifications you’ll need to succeed in this fascinating new job.

You’ll need these skills to succeed as a CDI specialist:

• A deep understanding of coding principles and practices. To pass a certification exam, one must know more than the basics. To be a successful CDI practitioner, one must keep up to speed on official coding requirements and trusted resources like federal regulations and Coding Clinic.
• A well-rounded medical education. For many programs, a position within the department necessitates holding some form of clinical accreditation. Numerous programs have also come to respect coding experts in this field. To be a good CDI specialist, you must never stop learning and updating your clinical knowledge.

Understanding the numerous payment methods

Communication and interpersonal abilities that are top-notch are essential. If you’re looking for a part that lets you interact more with clinicians and other leaders, this is the one for you! Communication must be precise, concise, and professional at all times.

These soft skills will allow a CDI expert to deal with difficult situations in a way that produces successful outcomes and an excellent reputation for your outpatient CDI team.

Reduced Claim Rejections

There are more than a few reasons why an insurance company can refuse to cover a patient’s medical expenses. Insurance companies may refuse to pay for medical services provided to patients if their claims are incomplete, illegible, or lack specificity.

A CDI should be used to guarantee that claims are appropriately filled, understandable, and timely filed to lessen the likelihood of a patient’s claim is denied.

Conclusion

Keeping accurate records of a person’s medical history ensures a positive experience for everyone who has to see those records, including medical billing companies and providers of care. Patients will be better cared for due to implementing CDI, as all providers and billing companies will be on the same page.

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