Outpatient CDI Wins Big at ACDIS 2017

Las Vegas is best known for its casinos, crowds, and Celine Dion. But now the city can also be recognized for coding and clinical documentation improvement (CDI). Why?

The American Association of Professional Coders (AAPC) and HCPro’s Association of Clinical Documentation Improvement Specialists (ACDIS) both convened in Las Vegas during the second week of May for their annual meetings. Hundreds of attendees met to discuss the latest news, trends, and best practices in clinical coding and physician documentation.   

From CDI program expansion and physician queries to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Merit-Based Incentive Payment System (MIPS), and the Quality Payment Program (QPP), attendees were squarely focused on outpatient care settings. This article provides a brief overview of information shared and discussions conducted during the 10th Annual ACDIS Conference.

CDI Expansion Underway

Every ACDIS attendee recognized that clinical documentation improvement is an evolving practice. But this has never been more obvious as it was at this year’s conference. Inpatient CDI and outpatient CDI must deliver consistency across each care episode. Continuity of care is a unifying goal and will become more important in the years ahead.

CDI reviews of emergency department, physician practice, and outpatient clinic cases were an important topic since outpatient expansion is the logical next step for most organizations. Several sessions focused on the expansion of CDI services into outpatient settings.

Speakers covered the unique challenges associated with CDI expansion, to include documentation reviews in clinics, physician practices, emergency departments (ED), and other outpatient areas. However, some attendees remained unclear as to how CDI programs can be operationalized to address outpatient documentation concerns. Many questions were asked during and after these outpatient sessions.

During three standing-room-only sessions on Wednesday, May 10, speakers suggested the following four initial steps to successfully embrace and implement outpatient CDI:  

1. Identify where to begin: physician offices, clinics, or the ED.
2. Determine the focus of your CDI reviews within each setting.
3. Develop a plan based on the answers to these questions. For example, if physician practices are your first target area, conduct CDI reviews to ensure correct diagnosis capture to the highest level of specificity for accurate HCC assignment and physician reimbursement. If the ED is your primary focus, review documentation to ensure that care and testing is medically justified based on the ED’s clinical documentation.
4. Take outpatient CDI to the next level by breaking down the plan even further into very specific categories, such as ED cases that are admitted versus discharged. These two clinical scenarios spawn completely different clinical documentation concerns in real-world practice.

Role of Pre-bill Reviews Emphasized

Another area of CDI focus during the ACDIS conference was the importance of pre-bill reviews to mitigate denial risk. Most CDI programs began pre-bill reviews with hospital-acquired condition (HAC) and patient safety indicator (PSI) cases. However, now organizations are also reviewing other types of cases before claims submission. One speaker listed 25 separate categories now being reviewed prior to billing.

Payer denials raise red flags for future recovery audits and third-party reviews. Having CDI teams perform a second check of claims before submission to the payer is a practical way to reduce risk. Sessions at ACDIS revalidated the need for pre-bill reviews.

Communication Remains a Concern

Teamwork among clinical coders, CDI specialists, and physicians is a perennial challenge. Every ACDIS annual conference includes vibrant discussions about the need to improve communication among these teams.

While most sessions at this year’s event centered on CDIS-physician collaboration and health information management (HIM), coding professionals in attendance certainly recognized the importance of this topic, having experienced the adverse effects of flawed communication. This is especially true in outpatient settings, where CDI specialists and coders rarely interact.

Breaking Down the Silos

It was clear throughout the conference that CDI can no longer operate as a single silo. Going forward,  CDI, case management, and coding and quality departments all must collaborate and work together as a single team to avoid duplication of efforts and for maximum clinical effectiveness.