Note from the ACDIS Director: Notes from the ACDIS Symposium

November 8, 2018

CDI Strategies - Volume 12, Issue 53

By Brian Murphy

Outpatient CDI has been compared to the “wild west,” and with good reason. It reminds me very much of what the old days of this country were like, when there were wide open frontiers to be explored, gold to be mined, land to be claimed, and a mad rush to get started.

But in the wild west there were hazards and pitfalls, too: Starvation, exposure to the elements, clashes with native Americans, and encounters with dangerous animals. Outpatient CDI might not be as hazardous as California in the days of the gold rush, but it too is fraught with difficulties. These include a lack of focus (what are your metrics for success?), a lack of a coherent workflow, and CDI specialists being asked to do more with the same, limited resources.

And we’re also starting to see the first heavy audit pushbacks. CMS last week issued a Medicare Advantage proposed rule in which it plans to use extrapolation on denials from its Risk Adjustment Data Validation (RADV) audits.

This is why we started the ACDIS Symposium: Outpatient CDI. A symposium is an intimate gathering on a focused topic, in which participants are experts in their fields. This is why we chose the name “symposium” for this one of a kind event, focused on this new, growing discipline.

Outpatient CDI is not just CDI in an emergency department or clinic. It requires a different skill-set and a different mind-set. You’re not going to be reviewing the record a patient while he or she is being seen during a 15-minute clinic visit—if you’re like many other programs, you’re reviewing them pre-visit. Or post-visit. Or, in some cases, not at all, but spending your time with increased education to networks of physicians dispersed throughout your organization.

Our attendees at the Symposium this week are hearing case studies of organizations that have, through the process of trial and error, implemented outpatient CDI programs. How they developed their review targets and benchmarks. How they staffed their programs and onboarded new CDI professionals. And how they are measuring their success along the way. It includes sessions on compliance, with the CMS RADV program and with official outpatient coding guidelines. And we’re also planning on having some fun down here in Orlando!

If you weren’t able to attend, I recommend you check out some of our other helpful outpatient CDI resources:

Queries in outpatient CDI: Developing a compliant, effective process, a position paper which provides an ACDIS-endorsed policy and procedure for compliant physician queries in the outpatient setting.
Outpatient Clinical Documentation Improvement (CDI): An Introduction, a white paper that explains what typically constitutes outpatient CDI, and ways in which CDI specialists can be leveraged to improve documentation associated with outpatient facility and/or provider encounters.
The 2019 Outpatient CDI Pocket Guide, which explains how Hierarchical Condition Categories (HCCs) effect both providers and payers and clarifies the chief considerations in outpatient reimbursement, documentation, and coding guidelines.
The Outpatient CDI Specialist’s Complete Training Guide, which walks readers through all the basics of effectively onboarding new outpatient CDI staff.
ACDIS Live! Outpatient CDI at Ochsner: A Case Study Approach, a three-hour on-demand webinar in which members of the Ochsner CDI team discuss how they implemented and built a strong outpatient CDI program.