Q&A: Accuracy thresholds for CDI audits to require education

Q: We perform CDI audits on a quarterly basis, which are calculated for a final score. Is there a threshold for audits for which those CDI specialists below the threshold are audited more frequently or provided additional education? What is a good threshold?

A: With quarterly audits on all CDI specialists, you can audit for context, missed opportunities, leading, validity, quality, query follow-up, etc. A standard number to audit would be five random cases per each specialist. Here is an example of accuracy rates to go by: 

• Less than 95% - Does not meet expectations
• 95-96% - Meets expectations
• 97-98% - Exceeds expectations
• 99-100% - Exceptional

Many organizations have set the goal for 100% query compliance, while still understanding that we all can make errors. If less than 100% is trended for multiple months for any CDI specialist, however, then it may be time to dig a little deeper into queries and provide education.

Review the audit with each specialist quarterly and provide them with feedback not only on their score but also any other recommendations or compliments. If you see a trend or consistent accuracy issues with an individual CDI specialist, initiate corrective action and education, and monitor that individual to ensure improvement. It’s recommended that the monitoring be continuous (usually about 30 days). If no improvement is seen, then follow HR policies for next steps.

In addition to the quality audits done by the CDI director, regular peer audits are also helpful. It’s recommended that a CDI specialist begin doing peer audits only once they have been in the role for one year. The CDI specialist can look at five cases of a peer for any missed opportunity, which can include missed queries or coding discrepancies. The peer audits should then be sent to the CDI managers for review once complete.

Any missed query opportunity by the audited CDI specialist is discussed with the individual for educational purposes, and findings from both the quality audits and the peer audits can then be utilized by the CDI staff for personal goals in future evaluations. Also, if the CDI managers identify any specific trends, such as condition-specific difficulties with query construction, they can then do a “deeper dive” and provide education to all staff. 

Editor’s Note: This question was answered by members of the ACDIS Leadership Council.