2018 Exchange Insights Report - CDI Department Expansion: Growing Smarter to Meet New Demands

Download our December 2018 Insights Report to gain a better understanding of CDI expansion from its traditional role/responsibility—concurrent chart review in the inpatient acute care setting—to include new roles and responsibilities, principally outpatient CDI and denials management. New metrics are required for success, a new mindset for CDI managers and leaders, and new skillsets for CDI professionals at the front lines of these initiatives.

But in exchange for willingness to take on new roles and responsibilities, organizations can expect improved outpatient reimbursement and a decrease in denials.

Key takeaways:

• Great opportunity exists in outpatient CDI, including improvements in Medicare Risk Adjustment Factor (RAF) scores, star ratings, physician E/M billing, outpatient quality scores, and helping to ensure medical necessity of high-cost drugs and procedures.
• CDI departments can get into outpatient CDI through a pilot program, such as the example pioneered by Yale New Haven Health System, or by pulling historical RAF scores and ROI potential after appropriate diagnosis capture and improvements to Hierarchical Condition Category (HCC) capture.
• CDI staff are a natural fit for proactive denials prevention, and appeals of denied claims, due to their clinical acumen and working relationships with providers.