Q:I have come across an ethical dilemma. We have a small CDI program and a “home grown” application we use to report metrics to the chief financial officer (CFO). In this, we track whether a CDI specialist’s query captured a CC/MCC. If it is the first and/or only CC/MCC...Read More »
It has been three years since ACDIS last surveyed its membership about physician query practices. In 2010, 382 CDI professionals participated. This year’s survey garnered 517 respondents, primarily CDI specialists.
“That’s really a tremendous response rate,” says Drew K. Siegel,...Read More »
Auditors have been reviewing medical necessity for inpatient services for years and Recovery Auditors (RA) have recouped millions of dollars in overpayments. Now outpatient providers are beginning to see more and more medical necessity audits, especially in the ED and for evaluation and...Read More »
CDI specialists should review the overall quality of medical record documentation from the day a patient comes into the ER—regardless of whether that patient ultimately ends up in observation, as an inpatient, or elsewhere.
“Quality of care is not segregated into buckets,” says Glenn...Read More »
This month’s question was submitted on February 26, 2024, and focuses on templates for CDI review notes and how to add findings. Please note that questions and answers have been de-identified for the purposes of this article.
Q: We are currently seeking out best practices for...Read More »
Q:Our CDI program is three years old and our administration still questions our productivity goals. Initially we set benchmarks at 90-95% coverage rate of Medicare/Managed Medicare; 20-25% query rate; 90% response rate and 80% agree rate. Since census varies, we also...Read More »
Many CDI managers use case-mix index (CMI) as the primary metric for determining the success or failure of their program. If the CMI rises in a given month, the CDI staff is doing its job, appropriately querying physicians for the correct principal diagnosis and...Read More »
Q: For a newly trained CDI specialist, what is the approximate number of reviews (both concurrent and follow up) one should expect him/her to be able to handle per day? I recall from the CDI Boot Camp that the starting number was about 10, but I can’t remember how many new versus follow-...Read More »