News: Outpatient CDI efforts on the rise

In 2008, only 11% of poll respondents indicated their CDI program either reviewed outpatient records for documentation improvement opportunities or were looking to expand into outpatient (8% and 3% respectively). How has the climate changed?

According to more than 400 respondents to the question this past month on the ACDIS website poll, 35% now say they conduct outpatient reviews and  61% do not (1% say they only review emergency department records, and 2% plan to start outpatient reviews within the next year).

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, a previous ACDIS Advisory Board member and independent consultant based in Madison, Wisc., in a previous edition of the CDI Journal. This combined review could mean new vulnerabilities for hospital and physician reimbursement, but it also represents a new opportunity for CDI specialists.

“We [as CDI specialists] are trying to get buy-in, support, from physicians,” Krauss says. “But we don’t explain how documentation affects their business. Outpatient documentation review is a good segue for helping physicians understand the importance of documentation in the medical record.”

Although the majority of those participating in the recent ACDIS poll remain focused on inpatient record reviews, outpatient CDI is clearly gaining traction. As more government initiatives roll out, no doubt CDI will continue to advance into the outpatient arena.