For decades, countless market observers have warned of turmoil in the healthcare space. The upheaval and endless changes have created a cacophony of compliance requirements that leave healthcare providers—both new players and those pursuing improvements—scratching their heads about where to begin.
Organizations focusing on clinical documentation improvement (CDI) must foster an environment of effective compliance from the outset. If they hope to improve outcomes while also increasing revenues and reducing costs, those organizations must evolve CDI practices in support of shifting trends in reimbursement and its documentation requirements.
Get the Workflow Right, and Quality Will Follow
Outpatient CDI efforts are designed to address a variety of needs, including Hierarchical Condition Categories (HCC) capture, quality improvement, risk adjustment and more. Without thoughtful attention to the development of an efficient and effective workflow, however, these goals will compete as varied teams within the organization focus on different aspects.
For instance, what may appear to be an issue with quality may actually be an issue with documentation, or vice versa. Aligning staff around common goals—ensuring not only that they’re tracking the same metrics, but also prioritizing them in the same order—will help teams more quickly identify operational issues and their true causes.
Understand How CDI Efforts Affect Reimbursement
Whether through HCC capture, risk adjustment or other areas, CDI efforts are helping providers better adjust as the healthcare landscape shifts away from fee-for-service and increasingly toward value-based, alternative reimbursement models. But as noted above, leveraging these capabilities requires that teams align around these metrics and how coding and CDI work synergistically to achieve these ends.
Although fee-for-service remains the norm in many settings, even those once-reliable revenue streams are increasingly in jeopardy as a result of penalties surrounding poor quality or, conversely, failure on the part of organizations to properly code and capture reimbursement incentives. Capturing HCCs, in particular, is becoming a vitally important CDI task as the high-value diagnoses play a central role in risk adjustment—requiring ongoing, accurate documentation to reflect patient and population health risk.
Under this new payment paradigm, teams need to understand the relationship of day-to-day compliance, accuracy and the longitudinal effects they have on reimbursement and organizational efficacy.
Understand How Outpatient CDI Affects Population
If your organization has decided to address outpatient CDI, then many of the above strategies become even more vital. Streamlining workflows and organizational compliance is more challenging in the outpatient setting, which places a greater emphasis on effective intra-team cooperation and communication.
On the upside, however, by implementing effective outpatient CDI efforts as part of an overall CDI strategy, healthcare organizations can capture opportunities for medical necessity documentation as well as reduce error-driven medical necessity denials for patients.
For more tips on Outpatient CDI efforts, see our previous blog post. For help designing your organization’s CDI efforts or to learn about PracticePerfect, a platform to help you address outpatient CDI, and Doc-U-Aide, a revolutionary platform for inpatient CDI, contact Saince.
