Clinical documentation integrity programs sit at the intersection of patient care, quality reporting and revenue capture but too many remain siloed and disconnected from the workflows around them.
During a recent webinar hosted by Becker’s Healthcare and Solventum, Dan Bray, RN, corporate clinical documentation integrity manager at Cape Fear Valley Health and Josh Amrhein, business manager of revenue integrity at Solventum, shared how Cape Fear paired AI-enabled workflows with a clinical partnership to lift case mix index, improve mortality scores and reach all-payer review.
Here are four key takeaways from the conversation:
1. The starting point
When Mr. Bray arrived nearly a decade ago, the CDI function consisted of five homegrown reviewers with limited oversight, minimal education and almost no interaction with coding, utilization review or quality. Reviews covered only about 75% of Medicare patients, and CDIs worked in a hybrid paper-electronic environment that often had them chasing records around the hospital.
Engaging Solventum under an at-risk model gave the team the leadership, education and technology to break those silos and rebuild around all-payer review.
2. Prioritizing workflows
Mr. Amrhein cautioned that AI alone is not a strategy, particularly in a CDI market saturated with vendors offering similar capabilities. What matters is whether the partner brings clinical depth and a workflow that holds up in the real world.
“It is a little bit easy to get distracted with the next shiny object,” Mr. Amrhein said, “but the next shiny object is not going to drive the best solid results.”
At Cape Fear, AI now powers prioritization across the full encounter — pulling in labs, radiology, medications and provider documentation to surface the highest-impact cases in real time.
Auto-suggested DRGs, evidence sheets and computer-assisted physician documentation nudge providers in the moment, and denial-risk signals shift work from retrospective rework to concurrent fixes.
3. Enterprise-wide results
The partnership produced measurable gains across CMI, mortality and review coverage. The CDI team grew from five reviewers to 22, expanded from Medicare-only to all-payer review, and now reaches roughly 90% of cases with a 65% query rate, a 100% provider response rate and a 94% agree rate. CMI at the main campus climbed from 1.58 to 1.82, with mortality observed-to-expected ratios improving across multiple facilities.
“We started off with five CDIs and we’re now up to 22,” Mr. Bray said. “Now we review all payers rather than just focusing on our government payers.”
The 100% response rate is no accident. Cape Fear built an escalation process that loops in leadership at 48 hours and converts unanswered concurrent queries into retrospective coding deficiencies that can result in provider suspension. Peer-to-peer education from Solventum physicians, sustained through monthly case-study sessions, gave providers a reason to engage rather than resist.
“At first, there was some resistance from our providers,” Mr. Bray said, “but once we’ve shown them that data, they have actually been more engaged and are seeking more data to say, ‘Okay, how can I improve?'”
4. Revenue integrity belongs upstream
Revenue integrity workflows are increasingly being pulled out of the back-office denials queue and into the concurrent CDI workflow, Mr. Amrhein said. Predictive models flag encounters where the same clinical and code patterns previously triggered denials or DRG downgrades, and route an action to the CDI, coder or clinician while the patient is in house.
Cape Fear’s mid-cycle denial data showed where that pays off: select DRGs ran at twice the overall denial rate, short-stay encounters carried disproportionate denial dollars and cases that bypassed CDI review had higher denial dollar rates than those that were reviewed.
Strong results, Mr. Amrhein said, still rest on the fundamentals including motivated staff, engaged provider leadership, responsive executives and collaboration across the organization.
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