Clinical documentation improvement (CDI) specialists are among the many unsung heroes of modern healthcare. The work of these specialists “helps to paint an accurate picture of the severity of a patient’s illness and the extent of the care required.”
As the shift to value-based care continues, “data accuracy and improvements with clinical documentation and coding are becoming crucial to maximizing revenue and improving quality of care.” And the value of outsourced CDI professionals in fostering those improvements is certainly unmatched. CDI supports organizations’ efforts to maximize reimbursements and continues to grow as an industry as healthcare continues to narrow its focus on:
- compliance and regulations
- managed care profiles
- payments for services rendered
- quality of care improvement measures
- liability exposure
According to Juliet B. Ugarte Hopkins, MD, CHCQM-PHYADV, Vice President of the American College of Physician Advisors, “hiring someone from outside your facility may sidestep the fear of pushback that an existing staff member might have.” By getting key stakeholders on board, adopting the right strategies, and bringing in the right experts, realizing CDI’s potential gains can actually happen quicker than many providers imagine.
Let’s look at 5 essential ways to maximize revenue with clinical documentation improvement.
#1) Improves operational workflows
Healthcare workflows are complex enough on their own before considering how the ever-changing regulatory environment impacts them. With EHRs alongside CDI programs, experts in the field can enhance overall documentation quality and ensure greater physician buy-in since these solutions make their jobs easier.
This is essential since physicians have reported significant burnout linked to documentation, inefficient workflows, and administrative tasks, among other things. CDI teams simplify the workflow so clinical team members can shift their focus back to delivering excellent patient care.
#2) Enhances quality of patient care
CDI programs provide physicians with greater flexibility to perform their duties. But such gains also translate across other departments.
Through facilitating accurate and detailed documentation, providers are better informed about patient conditions and can more easily identify and remedy care gaps. This supports improved patient care and satisfaction. Providers can also gain more meaningful insight across essential metrics throughout the documentation and coding procedures.
Outsourced experts don’t have existing relationships with physicians and are less likely to fear saying what needs to be said in the name of patient care. In the end, providers are likely more willing to accept the feedback and make changes.
#3) Reduces errors and protects quality
CDI teams encourage data integrity and accuracy in documentation throughout all steps of the patient journey. Protecting quality is crucial, as errors such as missing notes, incorrect patient demographics, and coding mistakes slow down the reimbursement process. They also have ripple effects that can hurt the quality of patient care.
It’s not only a form of QA itself but CDI also fosters an environment that makes quality assurance protocols much easier to execute and evaluate.
#4) Improves denial management
Denied claims have various causes and require a team who can identify all types of denials as well as the root causes for appeals, recovery, and prevention. In some cases, the cause may be that procedures were coded improperly. Other times, care may have been performed outside a patient’s network. Electronic claims are also not immune to errors.
CDI professionals reduce error rates and streamline denial and reporting processes. They also bolster denial prevention while improving efficiency, helping ensure continued hospital revenue cycle stability.
#5) Breaks down silos between team members
There can be a barrier between non-clinical and clinical staff members. Successful implementation of CDI programs help break down barriers between coders, documentation specialists, and clinical staff through training, CDI ambassadors, and dedicated team members who can foster communication across departments.
The result can be more effective communication as well as improved workflows that allow providers to leverage their resources better across all aspects of operations.
Implementing CDI success
Ultimately, CDI professionals represent a vital shift in the healthcare industry that providers must continue to implement and value. Payers are demanding more accurate clinical and provider data to improve the reimbursement process as well as drive an overall gain in the quality of care.
What revenue goals will CDI solutions help you accomplish? Pave your way to revenue cycle stability and growth with our CDI solutions today.