CDI can be a critical initiative that not only increases reimbursement revenue but also enhances the patient experience.
In the wake of COVID-19, physician practices faced a myriad of challenges creating a contactless and consumer-friendly patient experience, ramping up telehealth services, and transitioning non-clinical staff to work from home. Given these priorities, it’s understandable that clinical documentation improvement, or CDI, didn’t see much attention during the first half of 2020. However, as providers shift from triaging day-to-day patient flow issues to focusing on financial resilience, CDI can be a critical initiative that not only increases reimbursement revenue but also enhances the patient experience.
Now that COVID-19 is beginning to plateau and patients are returning for “in person” visits, providers can once again turn their focus to CDI to achieve the host of benefits it offers. By focusing on quality clinical documentation, such as preventing medical errors and reporting more accurate data to facilitate care-based initiatives related to population health and care coordination, it can help maximize reimbursement by ensuring coding and billing is as complete and accurate as possible. In an era where value-based care is becoming more pervasive—and will ultimately replace fee-for-service models—CDI has become a “must-have” rather than just an additive service.
Across all specialties, medical codes can have as many as 1,000 unique changes in a given year. In cases such as the coronavirus pandemic, coding and billing rules change to reflect market needs. Most recently, rules were altered to add COVID-19 code and billing requirements in order to allow telehealth to be more accessible and affordable.
While medical school may train physicians about coding so they can bill insurance in an appropriate and timely manner, it rarely focuses on CDI. Clinical documentation is essential to many aspects of a physician practice’s success—many of its components impact both reimbursement and patients’ care plans, such as Hierarchical Condition Category (HCC), severity of illness and risk of mortality. CDI enables providers to pinpoint deficiencies in current clinical documentation so they, along with revenue cycle staff, can be better educated, thus fostering more accurate work and capitalizing on opportunities to optimize payer revenue.
While improving CDI can result in major benefits, it’s not a simple or quick-fix endeavor and requires dedicated time and resources. A successful and thorough CDI program must be built with these components and best practices in mind:
Leveraging CDI for a successful financial future
CDI will only become more important as our healthcare model continues to shift to value-based care. The right solution should deliver substantial ROI and pay for itself by pinpointing new opportunities for both patient care and financial improvements. Evaluating solutions and finding a partner who not only delivers the right technology but also provides the optimal workflow and expertise to help achieve every financial and clinical benefit of CDI is key. Only then will you be positioned to succeed and thrive in today’s new and challenging environment.