How will CDI impact your payments in 2019As patient care continues to move from inpatient to outpatient settings, hospitals are preparing for change. The March 2016 Medicare Payment Advisory Commission Report to the Congress: Medicare Payment Policy shows:
- Hospital inpatient discharges declined nearly 20% between 2006 and 2014, while outpatient services experienced a cumulative increase of approximately 44%.
- Hospitals are employing higher numbers of physicians and unveiling new strategies focused on outpatient growth.
- The number of hospital-employed physicians jumped 50% from 2010 to 2015, says Bonnie Peters, a managing director at Berkeley Research Group. “Coupled with the fact that value-based reimbursement continues to grow, this is incentivizing hospitals to launch outpatient clinical documentation improvement (CDI) programs,” says Peters.
Physician practices face challenges with identifying resources to lead documentation improvement initiatives on behalf of the organization. They rely on internal coding professionals or other staff to manage Clinical Documentation Improvements (DCI) efforts. Whether a practice elects to use an in-house, outsourced, or hybrid CDI model, there are certain steps that are essential to any outpatient CDI program. The ongoing challenge is that outpatient coders can only assign a code based on physician’s documentation. For example, if the level of specificity for an ICD-10-CM code is not clear, the coder can query the physician, using different recommended processes to update the information in the patient record to accurately reflect the patient encounter.
Outpatient CDI has also received increased support with the Medicare payment changes that impacted physician practices, including the MACRA Quality Payment Program and its two tracks: The Merit-based Incentive Payment system (MIPS) and the advanced Alternative Payment Models. For the first year of MACRA, more than 70% of physicians participated in the MIPS track, says Peters. “Under MIPS, physicians’ documentation this year will affect their 2019 reimbursement.”
Why Should You Attend?
Outpatient CDI efforts reinforce coding to the highest degree of specificity by educating clinicians and staff on evolving documentation requirements. The benefits of outpatient CDI include improved patient risk assessment, reduced claim denials, audit preparedness and improved cash flow. Outpatient CDI programs can also aid in clinical quality measure documentation under reporting programs like the Merit-based Incentive Payment System (MIPS).
CDI programs may focus on a variety of areas including evaluation and management coding, CPT procedure codes, ICD-10 diagnosis codes, hierarchical condition categories or any combination therein.
What You Will Learn
This 60-minute webinar will provide comprehensive steps on how to start a successful CDI program or improve existing benchmarks. Reinforce the importance of understanding the link between documentation, outcomes and reimbursement will be essential to physician practice success under value-based care.
Implementing a formal process for case review, provider queries and staff education can proactively ensure that clinical documentation best practices are in place to best support practice efficiency.
- Identify CDI focus areas related to quality concerns, (i.e., cloning, copy/paste)
- Define the roles and responsibilities of core team members
- Assess productivity expectations and staffing requirements to meet advanced quality review needs
- Proper techniques for physician queries to improve provider/coder/auditor communication
- Share reporting to demonstrate CDI success, opportunities for training or retraining
- Case study with top (5) CDI challenges for outpatient physicians, coders and auditors
- Tips on Corrective Action Plan to achieve and maintain compliance
Who Should Attend?
- CDI managers/directors
- Quality managers/directors
- Revenue cycle integrity managers/directors
- HIM managers/directors
- CDI specialists
- Outpatient medical coders
- Quality assurance professionals
- Case managers