Clinical Documentation Improvement (CDI) Specialists play an important role in the revenue cycle process and the healthcare industry overall. CDI closes the gap between clinical validation and the complexity of coding guidelines. There are many moving parts and multiple departments involved from the time a patient is admitted to the hospital to the time the patient is discharged. It’s key to have strong interdepartmental collaboration with multiple departments to achieve the best quality healthcare for patients.
The various departments and/or stakeholders may vary depending on the size, goals and priorities of each organization. Below are examples of the various departments that may impact and contribute to the CDI department’s success toward documentation integrity and quality patient care.
- Health Information / Coding = Health Information Management (HIM) and Health Information Technology (HIT) are often used interchangeably. Coding professionals are responsible for assigning accurate ICD-10-CM/PCS and CPT4 codes in all patient settings. CDI and coding may partner in identifying common errors and trends and provide ongoing education to coding, CDI, clinicians and leadership.
- Physician Liaison / Physician Champion = Physician liaisons may serve as an advisor and communicate findings and best practices to medical staff. It would be ideal for the physician liaison to have strong knowledge in coding, auditing and denials.
- Quality = Quality assurance departments oversee the organization’s quality initiatives such as patient safety indicators and hospital acquired conditions that may impact quality health outcomes. Their collaboration with CDI is integral to complete documentation and reporting of quality measures.
- Utilization Management (UM) = Utilization management involves evaluating the efficiency, appropriateness and medical necessity of the treatments, procedures and services provided to the patients. Lack of medical necessity would result in government agency audits, so collaboration with utilization management and CDI would be beneficial in preventing external audits and potential fines.
- Compliance = Legal, ethical and professional standards must be met or exceeded in every healthcare organization. One of the goals is to prevent fraud, waste or abuse within a healthcare entity.
- Billing = The billing process involves managing insurance claims, rebills and denials. Lack of supporting documentation, medical necessity and coding errors would result in denials which is why CDI and coding collaboration with billing is vital in the billing payment process and claim cycle.
- Case Management = Case managers assess the patient’s insurance plan and ensures the best healthcare delivery reflecting the patient’s severity of illness through effective resource coordination.
- Information Technology (IT) = The advancement in technology in today’s digital era requires the expertise of the Information Technology team. IT may also provide support in various types of health information technology such as coding software, auditing tools, artificial intelligence (AI) and telehealth.
Every department should have updated policies and procedures aligned with governmental healthcare laws and regulations. Although it’s beneficial to have a multidisciplinary team approach, the key stakeholders may vary depending on each organization’s needs in achieving the best results in improving review prioritization, quality documentation, code assignment and overall patient care.
Learn more about the Collaboration Between CDI Specialists and Other Stakeholders in our On-Demand Webinar: The Role of CDI. Learn more and/or register to watch.
