Taking a CDI program to victory
This case study came across my email and felt compelled to share with others in CDI and the revenue cycle. What comprises and defines victory in CDI? According to this infomercial by 3M, their CDI software achieved the CDI program to accomplish the following:
1- Increasing CDI productivity
2- Prioritizing records with the greatest impact for reimbursement bump
3- Improving documentation with artificial intelligence (AI) auto-suggested codes and queries
4- Simplifying the reconciliation process for accurate financial impact
5- Reporting vital CDI metrics to administration and each individual CDI specialists
Victory in CDI is defined by the following:
1- 50% principal diagnoses impact increase
2- 6,600 major complication or comorbidity (MCCs) added
3- 193 procedures added
4- Reduction in the number of unnecessary cases reviewed
5- 15% more complication or comorbidity (CCs) added
6- 15% financial impact increase
I submit to all that these measures of CDI success are what is preventing the CDI profession from operating at the top of its game. Notice in this infomercial that there is no mention of actual achievement of physician documentation improvement/integrity. Instead, the focus is upon task based CDI activities that generate outcomes of reimbursement without addressing opportunities for addressing true documentation insufficiencies that detract from communication of fully informed, coordinated, quality focused, outcomes based patient care, all necessary to support optimal net patient revenue less prone to payer denials and financial takebacks.
Witness the increase in payer medical necessity and clinical validation denials as well as level of care and DRG downgrades. A good number of these costly denials are attributable to poor/insufficient physician documentation, the same documentation that the CDI specialists who reviewed the record and took credit for capturing a CC/MCC, one of the key results listed in this informercial along with 15% more complication or comorbidity (CCs) added. The question to ask is how many of these CCs/MCCs were challenged by the payer and ultimately not reimbursed at the higher weighted DRG. A related question is does the 15% financial impact increase take into account payer denials associated with diagnoses secured by the query process that were eventually denied by the payer.
Given the potential that the CDI profession can contribute in achieving complete and accurate physician documentation, the measures as pointed out above do not reflect a CDI victory. It is my hope the CDI profession will take note with ACDIS week coming up this month. More of the same is not acceptable, our physicians and CFOs deserve better from the CDI profession.
#cdibetterway, #CDIvictory, #CDIdenials, ERNIE DE LOS SANTOS, Keith Stokes, MD, #moredenialsfromCDI
https://lnkd.in/dVnTnMSr
Charge Nurse at Luling LTAC
3moI would love to be a part of your team, I've been certified for picc and midlines. Min hands on experience