Outpatient CDI and Risk Adjustment

“Outpatient CDI” can mean a myriad of things. From outpatient clinics and physician practices to hospital-based outpatient services, CDI leaders looking to expand their program’s footprint have many avenues to explore. Leaders need to determine the top opportunities for their outpatient CDI program, how they’ll realize a return on investment (ROI), and how to track the program’s impact. Though some CDI programs have been reviewing outpatient records for years, no one approach applies to all settings and organizations, making the task even trickier.

In partnership with 3M, the Association of Clinical Documentation Integrity Specialists (ACDIS) CDI Leadership Council asked several of its members to evaluate the results of a nationwide survey detailing the most common outpatient expansion areas and the ways leaders are showing a positive impact for their fledgling programs. The Council members were then asked to discuss their organizational approach to outpatient CDI. In this industry report, readers get a full inside look at the ways CDI teams are branching out into outpatient reviews, choosing their focal points, and showing their ROI!

Three key takewaways: 

• Outpatient areas with the most growth potential are the emergency department and observation stays
• The most common outpatient review focuses, according to respondents, are evaluation and management coding and Hierarchical Condition Category capture
• Few respondents have technology resources specifically for their outpatient efforts. More commonly, CDI programs share technology for their inpatient and outpatient reviews