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Focus on CDI: Prep for ICD-10 AND Raise Documentation Quality-White Paper

April 1, 2021
April 1, 2021

By Lee Ann Bryant, Associate Product Manager, HealthStream

Many think ICD-10 is only a coding problem, but the true challenge of ICD-10 is the need for increasing specificity and granularity in documentation in order to receive optimal reimbursement, meet all reporting requirements and most accurately reflect the level of care provided.

The term “Clinical Documentation Improvement (CDI)” has been used in the healthcare information management (HIM) industry for decades, yet never has it played a more crucial role than it does right now or that it will in years to come. The speed with which physicians adapt to reimbursement documentation requirements and guidelines has a direct impact on the rate of improvement of an organization’s overall workflow quality and productivity and also its ability to enhance cash flow and receive appropriate revenues for work performed. The upcoming conversion to ICD-10 makes this even more important. Improving CDI workflow processes to advance documentation quality and accuracy is of paramount importance as organizations prepare for the ICD-10 environment and the other challenges that lie ahead in the near future.

Documentation has always been necessary for the communication between the providers caring for a patient. But the need for increasing specificity has evolved along with industry trends.

Current Challenges and Trends

As the healthcare industry continues to evolve, there are global drivers and industry trends that are creating ongoing challenges:

  • Increased government reform: With initiatives like the Accountable Care Act, Meaningful Use, Pay for Performance and National Agency Reporting, never before have healthcare providers been so exposed to the public on the quality of care they provide.
  • Globalization: Travel and migration, prevention of epidemics and medical tourism are creating new challenges to the healthcare industry.
  • Aging population: People are living longer and, as a result, more complex healthcare is needed, coupled with shrinking reimbursement.
  • Economic recession: The healthcare industry is being asked to provide better quality but with less resources; facilities have less money to spend on innovation and providers continue to consolidate.
  • Growth of data: The healthcare industry is rich in data but information poor; as medical knowledge grows, there is an increased need for comparative data, however EMRs are not built to analyze data. 

As a result of these trends, the challenge is to reduce costs while enhancing the quality of care. Specific challenges include: 

  • Quality: Provide consistent and accurate documentation that provides the specificity necessary for ICD-10and reduces exposures for fraud and abuse.
  • Financial: Reduce labor costs, denials and DNFB while optimizing reimbursements.
  • Strategic: Create clinical data integration to support IT, HIM and financial goals.
  • Human Resources: Resource management monitoring, outsourcing and role consolidation all create unique challenges, in addition to the need to educate employees not only on ICD-10 but on other initiatives like MU, value-based purchasing, etc. 

This white paper includes:

  • The Evolution of CDI
  • Current Healthcare Challenges and Trends
  • The Need for Increased Specificity and Granularity in Documentation
  • The 3 Main Groups affected by ICD-10: Physicians/Providers, CDI Specialists and Coders
  • Key Processes Related to CDI
  • The role Technology will play in supporting a successful CDI program of the future