Current CDI programs potentially increase compliance risk as well risks of financial recoupments and takebacks associated with attempts to improve documentation through the query process.
Overemphasis is placed upon the query process as the primary means of improving clinical documentation with increasing use of software to prioritize and enhance efficiency in CDI specialist chart review.
Reviewing more charts and issuing more queries exponentially increases compliance risk and significantly detracts from the integrity and performance of the revenue cycle through exposure to prepayment and postpayment third party payer reviews and denials.
By attending this highly informative session, attendees will learn how to complete an assessment of their facility's current CDI processes, identify strengths, weaknesses, threats and opportunities to be used as the basis for reformulating, rebranding, reengineering and repositioning CDI foundations and processes to best support achievement and reporting of quality of care outcomes while aligning, integrating, strengthening and supporting the hospital's revenue cycle performance.
Why should you Attend: CDI programs in their present format have the real potential to significantly increase compliance concerns and be a real drag on the revenue cycle by increasing outlier risk, financial recoupments and denials.
Cost to collect in the revenue cycle rises in tandem with increasing number of queries issued as third-party payers refute billed claims on the basis of medical necessity and clinical validation.
CDI programs also heighten compliance risk through potentially aberrant coding and billing patters identified by the OIG, Recovery Auditors, Medicare Administrative Contractors, CERT Contractors, PEPPER reports as well as commercial payers and their cost containment contractors. CDI programs if not positioned properly can accomplish serious disservice to the hospital's financial position causing undisputable financial harm and repercussions.
Hospitals and health systems must take a close look and rebrand, redesign and repurpose current CDI programs to address known shortcomings and shore up alignment and integration with the revenue cycle and the accurate reflection, capture and reporting of patient care provided and true achieved quality.
Areas Covered in the Session: