Achieving Outpatient CDI: Part III

EDITOR’S NOTE: The following a part of a series on outpatient clinical documentation integrity (CDI). Part II was published on April 25, 2017 in the ICD10monitor eNews.

Critical to the successful rollout of an outpatient clinical documentation improvement (CDI) program is the selection and hiring of employees to staff the program. Identifying the right people for the position cannot be overemphasized, given the nature of the work and the need to establish a solid foundation for growth and development of the program right from the very start.

Ample time must be devoted to the hiring process after the initial preparation for the rollout to ensure that the program is staffed with people in the right roles and with the right fit.

Inpatient versus Outpatient CDI

As I mentioned in my previous articles, the essential skill sets, core competencies, and knowledge bases of proficient outpatient CDI specialists are strikingly dissimilar and notably different from those of inpatient CDI specialists. Generally speaking, one cannot simply place an inpatient CDI specialist into the role of the outpatient CDI specialist and expect a smooth transition with impressive performance.

Why is this? The role, duties, responsibilities, and expectations of an inpatient CDI specialist are for the most part divergent from that of an outpatient CDI specialist. In the inpatient arena, the established framework is much more structured, rigid, predictable, and defined. While there exists some variation in the stated framework of inpatient CDI, the daily work duties and responsibilities are for the most part stable, with pre-established parameters and expectations such as the number of queries issued, number of charts to review, and number of follow-up reviews, to name just a few metrics.

The focus of an inpatient CDI is primarily upon seeking clarification and securement of diagnoses, clarifying hospital-acquired conditions and present-on-admission indicators, and assigning and reconciling working MS-DRG listings. On occasion, CDI specialists are tasked with working with core measures and other added assignments. Querying is the mainstay of inpatient CDI, serving as the heart of most programs.

Outpatient CDI offers a totally unique working environment, again, requiring diverse skills sets, core competencies, knowledge bases, and thought processes. There is less emphasis upon diagnoses and more focus devoted to various process improvement goals, objectives, and responsibilities.

An outpatient CDI specialist’s vision and outlook must embrace role-based thought processes and actionable knowledge sharing with physicians as a major provision of their duties. This requires a business leader exhibiting strong thought leadership capabilities, with recognition that outpatient CDI is not just a job that allows one to collect a paycheck.

Instead, outpatient CDI is a role that must be treated as being critically important. Having said that, an outpatient CDI specialist views the role as a career, with the willingness and commitment to ongoing learning, clinical expertise, and commitment to maintaining relevancy. Ideally, this individual will have earned a business degree with real-life, hands-on business experience and demonstrated accomplishments in the business world.

Clinical knowledge is an essential component of the position, yet equally as important is the business mindset component, serving as the foundation for fulfillment of the widely expanded role outpatient CDI plays in affecting measurable, valid, and sustainable improvement in the communication of patient care.

Operationally, outpatient CDIs are fluent and variable in nature, ever-changing with the transitional healthcare landscape and the ongoing advances in clinical medicine. Adaptability and constant readiness with a proactive approach and outlook, incorporating the ability to predict trends in a business environment, is a prerequisite for successfully fulfilling the role.

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

HIM coding expert, Kay Piper, RHIA, CDIP, CCS, reviews the guidance and updates coders and CDIs on important information in each of the AHA’s 2024 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 15, 2024

Trending News

SPRING INTO SAVINGS! Get 21% OFF during our exclusive two-day sale starting 3/21/2024. Use SPRING24 at checkout to claim this offer. Click here to learn more →