Physician Practice

Expanding the CDI focus to the outpatient arena

Physician Practice Insider, February 21, 2017

The focus for clinical documentation improvement (CDI) specialists has historically been on the inpatient hospital stay. Review of the chart for conditions that are not fully documented and/or evidence of conditions not documented at all has been standard practice.

However, with so many changes in the industry facing providers in their outpatient practices, the importance of CDI in places of service such as physician offices, ambulatory clinics, and urgent care clinics is even more vital.

As mentioned, the healthcare industry has undergone a change of focus, and this focus is still evolving. Each year, CMS offers regulations that change inpatient surgeries to those covered only in outpatient settings. Inpatient stays are down, and more patients are being admitted to observation status.

With the new MACRA and MIPS/APM regulations for physician practices, quality over quantity is in effect. Hierarchical condition categories (HCC) are more in focus, with Medicare Advantage plans and other insurers offering risk-adjusted reimbursement for providers caring for patients with long-term chronic conditions. Finally, with the specificity requirements of ICD-10-CM, documentation needs to be even more robust to ensure correct capture of the most appropriate diagnosis code.

At the heart of each of these changes is documentation. Providers are beginning to understand the importance of having a CDI specialist in their practice to ensure the documentation is appropriate to fulfill reporting regulations for MIPS, HCCs, and overall quality of the patient’s care across the healthcare continuum. Of course, appropriate documentation has a direct tie to reimbursement as well, and providers want to ensure their documentation is meeting the necessary requirements for positive payment adjustments as they move into a system where reimbursement is for quality over quantity.

This article originally appeared in Briefings on APCs. Log in to read the complete, detailed article here.

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