Revenue Cycle

Reduce RAC vulnerabilities with a quality CDI program

Recovery Auditor Report, June 24, 2010

DRG (diagnosis-related groups) validation issues have been the main target of RACs nationwide in recent months. When unclear documentation results in improperly assigned DRGs, it puts facilities at risk for RAC denials. However, an effective clinical documentation improvement (CDI) program aims to minimize these financial risks by producing the most accurate and comprehensive medical records possible - records that fully support the condition of the patient and the services rendered.

A CDI specialist is trained to identify terms and phrases that a physician uses that may lead to the assignment of imprecise or non-specific codes, according to Lynne Spryszak, RN, CCDS, CPC-A, CDI Education Director for HCPro, Inc.

“The CDI specialist serves as a translator between the physicians and their clinical language, and the coders and ICD-9 coding language, which are not always synonymous,” says Spryszak.

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