Q&A: Data needed to start outpatient

Q: What areas in the facility should be reviewed as part of outpatient CDI reviews (e.g., emergency department, same-day surgery, hospital-owned physician practices, etc.)? Does outpatient CDI include patients in the hospital currently in observation status? Do inpatient CDI specialists review those patients who are in observation status?

A: While all of those areas mentioned are considered outpatient, you can’t boil the ocean, so to speak, so you’ll need to put in the legwork to determine the best use of your time and resources. The best place to start is with your data, such as denial rates, payer information, contracts, etc. For example, contracts with Medicare Advantage payers might offer a bonus opportunity with improved risk adjustment factor scores, which CDI could help with. 

If your organization is part of an accountable care organization (ACO), you should be able to get quality data directly from the ACO. Use that data to find opportunities. One common starting place would be to focus on hierarchical condition category capture in the primary physician practice setting. Another option is to audit the coding department on your ACO payer population, or Medicare Advantage plans. You can also work with your ACO and business office on the education for and auditing of Medicare wellness visits and transition of care visits.

Editor’s note: This question and answer were adapted from a thread on the ACDIS Forum. To learn more about participating on the Forum, click here.