A study performed by Black Book Market Research shows that nearly 90% of hospitals realized a minimum of $1.5 million in improved healthcare revenue and claims reimbursements following a clinical documentation improvement program (CDI program) implementation the year before. “CDI solutions are the critical link in ensuring full and timelier reimbursements from insurers and payers, as well as avoiding costly penalties for non-compliance,” states Doug Brown, Managing Partner at Black Book, “Hence [why] hospital chief financial officers have become the greatest advocates for [CDI].” According to the study, many healthcare organizations challenged by post-ICD-10 effects, including institutions that have outsourced their CDI program, are now considering implementing or switching to a second or third generation CDI vendor.
With a growing number of CDI solution providers, each with a unique methodology and approach, it’s no wonder that hospitals are often at a loss as to what criteria should be used when selecting a CDI program or CDI vendor. While there are many ways to evaluate CDI vendors and technology solutions for streamlining chart reviews and improved reimbursements in their revenue cycle management, most organizations can successfully implement CDI initiatives by using these 3 basic criteria:
1. Compatibility: A computer-assisted CDI program must adapt to an organization’s existing workflows. Although most healthcare providers have migrated to fully electronic medical record systems, there are still many paper-based operations that are challenged by compliance and reimbursement issues. The right solution should help users across the organization to do their job more efficiently, adapt to existing processes, but laying the groundwork for even more efficient workflows
2. Training: Every role in a healthcare organization faces a specific set of challenges. The right CDI vendor is the one that can provide user training and guidance to physicians, internal staff, and remote or outsourced coders. In addition to user education, the ideal CDI vendor also provides the insights that senior administrators and other stakeholders need to better understand program performance, updates, areas for improvement, and plans for future.
3. Reporting: The right CDI tool should assist in increasing transparency as well as efficiency, allowing healthcare revenue cycle managers to analyze the effectiveness of the CDI program in use and gain visibility into the program impact through real-time, on-demand reporting. This will help to keep the program on track and ultimately improve patient outcomes.
Having worked with over 100 hospitals for over 8 years, ChartWise understands how vital CDI is to a hospital’s revenue cycle management. That’s why it’s so important to find a CDI vendor that not only delivers on what’s being promised but also helps an organization be prepared to respond to all types of regulatory complexities. While finding a CDI vendor that meets all an organization’s ever-changing needs may seem daunting, it’s best to start with the basics. Choosing a CDI vendor that address the fundamental challenges of compatibility, training, and reporting will ultimately provide the necessary framework for building and growing a successful CDI program in any organization.