Benefits for Outpatient CDI in Healthcare

Outpatient Clinical Documentation Integrity Programs (OP CDI) are quickly becoming the gold standard of patient care for healthcare providers nationwide.

OP CDI programs offer innumerable benefits, but most importantly, they can help to streamline your healthcare organization’s operations. While many additional benefits will make themselves known in the long term, we have identified seven immediate advantages to implementing a robust OP CDI program.

Advantages to implementing a robust OP CDI Program:

  1. Documentation & Coding Accuracy
  2. Minimizes Overpayment
  3. Capture HCCs and Improve Risk Adjustment Scores
  4. Reduction in Claims Denials
  5. Documents, Captures, and Supports Social Determinants of Health
  6. Supports Well-Educated Staff
  7. Supports Investment in Population Health

Documentation & Coding Accuracy

OP CDI programs are proven to increase accurate documentation and coding at all levels within your institution.  OP CDI programs educate providers to document at the highest levels of specificity with clinically relevant support, ultimately leading to higher levels of patient care.

Additionally, OP CDI allows medical coding teams to conduct faster, more reliable, and more precise medical reviews, and more accurate code assignments, streamlining the documentation process and ensuring the most reliable and up-to-date patient records possible.

Minimizes Overpayment

A robust OP CDI program can establish safeguards against many common liabilities plaguing healthcare institutions, particularly overpayment.

The OIG (Office of the Inspector General) scrutiny of overpayment of unsupported diagnoses is cause for an institution to be proactive in accurate documentation of targeted diagnoses.

Clinical documentation support is critical for an institution’s readiness to minimize overpayment while maintaining the integrity of the patient record.

Capture HCCs and Improve Risk Adjustment Scores

Risk Adjustment Scores, also recognized as Hierarchical Chronic Conditions (HCCs) capture, is another trending contemporary healthcare topic. In short, Risk Adjustment supports institutions and healthcare providers to paint a holistic picture of a patient’s current and future health status, consequently providing the highest level of care throughout a patient’s health journey.

OP CDI programs support the maximization of HCC capture, resulting in a more accurate patient record and a better prediction of the health of the organization, which also maximizes reimbursement.

Reduce Claims Denials 

Insurance companies can deny claims for any number of reasons, resulting in healthcare facilities not being adequately reimbursed for the care they provide. Although a single denied claim is financially negligible for a healthcare practice, many denied claims can quickly lead to major financial implications.

A robust CDI program will work with providers to ensure diagnoses are documented to the highest level of specificity and clinically supported in the medical record, thus minimizing denials.

Documents, Captures, and Supports Social Determinants of Health

Social Determinants of Health (SDoH) are the non-medical conditions in which people are born, grow, work, live, and age, as well as the wider set of forces and systems that shape the conditions of daily life and create systemic differences in the health status of different population groups.

OP CDI programs emphasize accurate medical documentation but encourage the capture of SDoH through Z code submission and subsequent identification of higher risk populations.

By better understanding a given population’s SDoH, healthcare organizations can gain new insight into the causes of and solutions to SDoH and, therefore, positively affect the health of larger patient populations.

Supports Well-Educated Staff

Education is undoubtedly one of the most critical components of a vigorous OP CDI program. To keep an OP CDI program healthy, providers must always be well-informed on documentation best practices, HCC specificity, and compliant with the latest regulatory changes.

Instituting an OP CDI program at the clinical level supports the education and continued development of ICD-10 CM-compliant best practices, educational materials, and proper training. This focus on continued education ensures providers are well-informed which, in turn, yields higher-quality patient outcomes.

Supports Investment in Population Health

It would be a mistake to assume that OP CDI’s benefits are purely financial. Some would argue that the greatest return on investment in OP CDI is a broader understanding of and investment into population health and its associated initiatives.

The investment into population health cannot be overstated, as a strong OP CDI program will better assess population needs, address inequities in under-resourced areas, and identify health trends, which ultimately leads to better quality patient and population care.

Get in touch with Harmony Healthcare today to learn more about how they can take your healthcare business to the next level.

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