Outpatient CDI efforts offer documentation opportunities: High-cost procedures, medical necessity represent best potential

With the advent of Medicare Administrative Contractors (MAC), which review both Part A (hospital) and Part B (physician) billing, payers are now looking to ensure that physician and facility billing match, says Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDIS, CCDS, an ACDIS Advisory Board member and independent consultant based in Madison, WI. This combined review could mean new vulnerabilities for hospital and physician reimbursement, but it also represents a new opportunity for CDI specialists: outpatient record review.