Clinical Documentation Improvement (CDI):

Programs, Specialists, and Their Importance to

Healthcare Success

ASSIGNMENT 7.3
MICHELE M. HORNICK
MEDAILLE COLLEGE

AUTHOR NOTE
THIS PAPER WAS PREPARED ON 5/3/2016 FOR
REIMBURSEMENT METHODOLOGIES -HIA407E-07,
TAUGHT BY TERESA REINHARDT.
Table of Contents

Introduction
Importance of a CDI program
Characteristics of an Effective CDI Program
Who is your CDI Specialist?
Cost Vs. Benefit
What to Consider When Implementing
Conclusion
References
Introduction

As the healthcare system in the United States continues to evolve into

the technological era, a greater emphasis is placed on documentation.
This becomes apparent as you become more familiar with ICD-10 and
the specificity that is required by it. Clinicians who have been in
practice for many years may find it difficult to adjust their
documentation practices to comply with this new information
intensive environment. As a result it is critical for facilities to surround
their clinicians with systems that ensure their documentation
accurately reflects the patient care that they are delivering. In doing so,
the facility can be assured that they are being reimbursed for their
services accordingly. Facilities that implement a proper Clinical
Documentation Improvement Program will reap the benefits of
enhanced documentation, decrease in denials, and accurate and
complete reimbursements for both the facility and the physician.
Even if the
quality of the
care that is
provided is the
same, if the
documentation
cannot be
interpreted then
the care was not
sufficiently
provided. Understanding the Importance of a
CDI program
Importance of a CDI program

There is a growing trend on denials and take-backs from RACs and other post-
payment audits

As a result, claims integrity has been pushed to the top of CFOs agendas

Many of the denials are rooted from poor documentation

Insufficient clinical documentation can prevent hospitals from obtaining full

reimbursement

millions of dollars are lost in annual missed revenue capture opportunities

Synchronization of the documentation and coding will lead to a significant

decrease in the number of denials, as well as improve upon revenue preservation
Characteristics of an Effective CDI Program
Characteristics of an Effective CDI Program

A well run CDI program will consist of five common care

characteristics
1. The primary focus of the CDI program is to ensure accurate DRG
assignment
Adding core function beyond this will only decrease revenue capturing opportunities

2. Focus on chart reviews for all DRG payers

Broadening the scope of the program and maximize revenue opportunities

3. Provide detailed visibility into the productivity of the specialist and

the accuracy of their work
To further enhance the accountability and inevitably the results of the program

4. Provide a balance relating to physician education and querying

processes
To combat the reluctance of the established providers

5. The program also needs to be staffed appropriately

This should include physician staff and program staff
Who is your CDI Specialist?
Who is your CDI Specialist?

A CDI Specialist is a trained professional that helps to

bridge the gap between the HIM department and the
clinical staff
This is done by ensuring the integrity of the documentation that is provided by the clinical
staff to the HIM department
The CDI specialist can be a certified CDI specialist, a
medical coder, a nurse, or other specially trained
individual
CDI specialist must possess certain specific skills, which
include:
Responsibility for reviewing approximately 30 to 35 charts per day
approximately 25% of these charts will require a query
receive and process 85 to 90% of the responses to the queries
Cost Vs. Benefit

On average a CDI specialist earns between $60,000

and $80,000 in annual salary
They also return about a $500,000 in annual
incremental revenues
The numbers dont lie, investing in a professional
CDI specialist is a wise decision
What to Consider When Implementing
What to Consider When Implementing

When initiating a CDI program, the task can seem

daunting and overwhelming. As a result facilities may
opt to hire a CDI consultant
Benefits of a CDI consultant includes:
A consultant can provide their expertise while policies and
procedures are being developed
They can guide the facility in identifying and addressing the
needs of all of the individual departments within the facility
All hope is not lost if a consultant is not in the budget:
There are plenty of resources available to properly develop an
effective CDI program
Conclusion

CDI programs are rapidly becoming a critical component to the

success of any healthcare facility. They not only decrease the
number of denials that a facility receives, but they also enhance
revenue capture. Accurate documentation has also proven to
improve upon the quality of care that is provided. Much like a
domino effect, the increase in the quality of care that is
provided will prompt a positive effect on the physician and
facility quality profile. As patients are becoming more aware of
their healthcare options, the increased quality profile will
ultimately draw more patients to their practice.
References

Company, T. A. (Director). (2013).

EnhancingClinical Documentation [Motion Picture].
kindredhealthcareinc (Director). (2011). Clinical
Documentation Improvement [Motion Picture].
Schraffenberger, L. A.-P., & Kuehn, L. M.-P. (2011).
Effective Management of Coding Services The
Clinical Coding Mangager's Handbook - Fourth
Edition. Chicago: AHiMA.