Best-in-Class Clinical Documentation Improvement Programs

Blueprint for Maximizing Revenue Capture

Topics: Clinical Documentation, Information Technology, Revenue Capture, Revenue Cycle, Finance, Performance Improvement, Reimbursement, Coding

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Qualitative imperatives for achieving best-in-class performance span program staffing and oversight, program scope, staff accountability, and physician compliance. After reading this study, members will be able to:

  • Size the revenue opportunity of CDI programs
  • Define the role of finance in CDI
  • Access benchmarks for CDI staff productivity and revenue contribution
  • Follow key imperatives for driving CDI financial performance
  • Identify key CDI financial performance metrics to routinely track

Executive Summary

Improved documentation specificity can reveal missed revenue opportunities

Amid a confluence of pressures on operating margins, a small but growing number of hospitals have achieved remarkable success in boosting revenues by launching or revitalizing Clinical Documentation Improvement (CDI) programs. These programs—in which dedicated specialists concurrently review patient charts for completeness and accuracy—are designed to improve specificity of clinical documentation, thereby preventing downstream coding and billing errors that ultimately lead to missed revenue opportunities or denials.

Close involvement on the part of finance is critical to ensure revenue opportunities are consistently identified and pursued, while staff accountability and physician engagement also remain central to the effort.

Eight imperatives for CDI program success

This publication presents eight imperatives for maximizing performance on Clinical Documentation Improvement programs, organized into four main categories: overseeing and staffing a program, defining program objectives, instilling accountability, and improving physician compliance. Each of the below imperatives is designed to help CDI programs bridge the gap between average and best-in-class performance:

  • Make CDI a finance priority
  • Invest in adequate staffing
  • Focus on accurate DRG assignments
  • Prioritize chart reviews for maximum impact
  • Develop robust tracking capabilities
  • Hold staff accountable for productivity and accuracy
  • Emphasize query compliance
  • Leverage EMR

Access the full study to learn more

In addition to exploring the above imperatives, this publication offers benchmarks and implementation tools to support members in maximizing the financial returns of their CDI programs.