“I want my CDI:” Five real risks without clinical documentation improvement

Without CDI, health care providers could find themselves in dire straits.

Many other health care initiatives, especially those tied to government agencies, may come and go, but CDI remains a cornerstone for data quality and accurate reporting, streamlined claims reimbursement and robust public health information tracking. To physicians, though, CDI can feel a lot like Big Brother is always watching.

Consider this: the bigger concern is what would happen with no CDI. The risks are real, especially with the availability of data due to the advancement of electronic medical records. Most, or maybe all, scenarios that remove CDI from the picture lead to negative quality, financial and patient impacts.

Risk #1: Inaccurate Coding. ICD-10 has exponentially increased the level of documentation specificity; the details must be captured by clinicians, and coded by coders. Details not documented correctly the first time may result in denials or incomplete reimbursement, impacting the organization’s and physician’s bottom lines.

Risk #2: Compromised Patient Care. As patients transition from one care provider or facility to another to another, well documented communication between care providers is critical to ensure that the quality of care does not diminish, especially if the care providers are not members of the same care team. Poor documentation can lead to poor patient care.

Risk #3: Poor Provider Reputation. The reputation of the health care organization is also at risk. Much of public reporting, including mortality rates, is now accessible to consumers. Inaccurate documentation results in inaccurate reporting, which can negatively impact a consumer’s decision when “surfing” for health care.

Risk #4: Reduced Reimbursement and Overburdened Patients. Denials or long delays in payment most certainly increase with a strong CDI program, but they aren’t the only consequences of a weak system. Patients stand to be burdened with higher costs from unnecessary or repeat tests as a result of inaccurate care documentation.

Risk #5: Fraud Risk. Unintended fraudulent behavior can result from inaccurate patient care documentation. EHRs offer customizable documentation applications that offer templates and smart phrases to support documentation. Careful though, if these tools are used incorrectly, the quality of the documentation could be inaccurate and the provider could be accused of fraudulent activity. CDI provides the safeguards to assure accurate patient condition representation.

To some clinicians, CDI may seem like having someone checking over your shoulder, but consider the impact to health care without it. You should have someone who is on your side. Thriving CDI programs integrate quality CDI technology and services to achieve accurate coding, increased reimbursements, quality patient care, higher provider ratings, managed patient responsibility and mitigated risk. CDI’s got your back.

Andrew Woughter Bio:
As Senior Vice President for Product Strategy, Andrew Woughter leads innovation and future direction for nThrive’s technology portfolio. Andrew is a proven revenue cycle executive with 15+ years of experience in healthcare organizations and governmental regulation of health insurance. He has led revenue cycle teams for a broad variety of provider types, and has significant experience working with software and services vendors to improve revenue cycle processes and solutions. He has demonstrated success through strategic vision and innovation and development of custom tools to enhance revenue cycle solutions.

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