In a previous blog post, More Than Just HCC's: 6 Best Practices for Outpatient CDI, we discussed the areas that need to be addressed in a comprehensive outpatient clinical documentation improvement (CDI) program. While we recommend going beyond just focusing on Hierarchical Condition Categories (HCC’s), taking a closer look at documentation related to HCC’s is a good place to start. Here are four areas where an HCC-focused CDI program can help you optimize revenue, reduce denials, and improve quality.
1. Emergency Department
CDI efforts can be challenging in an emergency department due to the short time available to treat patients. But implementing CDI in the emergency department can help to improve patient care, core measures, quality scores, and mortality rates and reduce HAC and readmission rates – not to mention the benefit of aligning your organization with Centers for Medicare and Medicaid Services (CMS) bonuses and incentives. Check out this CDI Quick Tip for an example of the value of CDI in the emergency department.
2. Physician Practice
CDI efforts in physician practices provide numerous benefits – CDI aids in the creation of audit defense documentation, it ensures accurate reflection of the health of the practice’s population, which is used for profiling and quality, and it helps to reduce denials and the extra work that comes with denials management.
3. Evaluation and Management (E/M) Services
According to the CMS Comprehensive Error Rate Testing (CERT), $830 million of revenue is lost due to inaccurate E/M level of service assignment. $830 million. Documentation is critical – insufficient documentation in the medical record and missing documentation elements could lead to lower E/M service assignment, resulting in lower reimbursement and lost revenue.
Bringing CDI efforts to your observations and extended post-operative observation cases can help to improve your bottom line. By utilizing CDI in your observation cases, your organization can reduce denials, meet medical necessity requirements, and generate additional revenue.
So where do you start and how do you build a successful CDI program?
Start with an assessment specific to your organization. Identify the areas that will have the greatest impact on revenue and quality and focus your CDI efforts there. Once you know where the opportunities for improvement are, build an education program for your coders, CDI staff, and physicians and make sure everyone understands the key concepts and techniques that make up a robust, effective CDI program – as well as the benefits of maintaining high quality documentation.
Education goes hand-in-hand with an ongoing quality assurance plan. A one-time assessment and education project is not enough to sustain quality. It’s important to build a continuous process of reviewing documentation quality, identifying areas for improvement (remember, these could change over time if you add service or have new staff), providing education, and measuring results.
Due to the increase in patients covered under risk-based payment, clinical documentation improvement programs are moving quickly into the outpatient and professional fee environments. And because the HCC methodology is used in all risk-adjusted health plans, taking a closer look at CDI as it relates to HCC’s is a good first step.
Have you implemented an HCC-focused CDI program? What results have you seen? What tips can you share? Share your experience in the comments below.