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Insights & Education

The Importance of Calculating Accurate RAF Scores

By Staff / February 17, 2021

The risk adjustment factor (RAF) score is the risk score assigned to each patient in a risk adjustment payment model. Risk Adjustment Models account for multiple factors to calculate a RAF score which is the combination of both the demographic risk score and the disease risk score. Demographic Risk Score: The patient’s age and whether… Read More »The Importance of Calculating Accurate RAF Scores

Risk Adjustment Factor Basics

By Staff / February 17, 2021

Risk adjustment provides a way for the Centers for Medicare & Medicaid Services (CMS) to pay health plans for the risk of the beneficiaries they enroll. By risk adjusting payments, CMS can make different payments for patients based on expected costs. Risk Adjustment Models are predictive, based on actuarial data that forecasts the cost of… Read More »Risk Adjustment Factor Basics

UASI Solutions

Monthly CDI Scenario Discussion – February 2021

By Tara Bell / February 9, 2021

Topic: Outpatient CDI: Diabetes with Chronic Complication Office Visit 6/8/2020: 87-year old Caucasian female who lives with her son being evaluated today for diabetes. Her son reports elevated blood sugars in the past 4 weeks. Starting from yesterday the readings are 272, 172, 202, 242, and 198. These are on a daily basis in the morning.… Read More »Monthly CDI Scenario Discussion – February 2021

The Top 3 Challenges in Outpatient CDI

By Staff / February 8, 2021

Outpatient clinical documentation improvement (CDI) is in its infancy. As our experience grows in this arena, we gain new insights and move closer to nationally recognized best practices. But meanwhile, we face some challenges. The Top 3 Challenges in Outpatient CDI: Industry Standards are Not Yet Formed – In the coming years, processes and metrics… Read More »The Top 3 Challenges in Outpatient CDI

UASI Solutions

Outpatient CDI Basics

By Staff / February 2, 2021

Healthcare in the United States continues to evolve. Risk adjusted reimbursement methodologies assign payments for patients based on risk, determined by chronic and co-existing conditions. Accurate diagnosis codes with higher specificity better define future financial risk. Additionally, the Center for Medicare and Medicaid Services (CMS) risk adjusted plans determine the reimbursement amount for next year… Read More »Outpatient CDI Basics

UASI Solutions

The 3 Main Differences between Inpatient and Outpatient CDI

By Staff / January 25, 2021

Inpatient and outpatient clinical documentation improvement (CDI) share a common goal: to ensure accurate and complete documentation that reflects the care given to the patient. Inpatient and outpatient CDI also have individual goals such as: Inpatient- Accurate and appropriate diagnosis-related group (DRG) assignment by capturing comorbidities (CC) or major comorbidities (MCC) and quality metrics like… Read More »The 3 Main Differences between Inpatient and Outpatient CDI

UASI Solutions

Inpatient to Outpatient CDI: Understanding the Similarities and Differences – UASI Lunch and Learn: CDI Program Management Series

By Staci Josten / January 19, 2021
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Click the button below to download a PDF copy of Staci Josten’s Lunch and Learn, “Inpatient to Outpatient CDI: Understanding the Similarities and Differences.”

UASI Solutions

Monthly CDI Scenario Discussion – January 2021

By Staff / January 11, 2021

Topic: Obesity severity/specificity in a pediatric case H&P:  8 y/o otherwise healthy male presents with fever, poor intake, and rash that progressively worsened over the last 7 days. Patient had throat pain and fever a week ago and was given a 10-day course of amoxicillin. Following the initiation of the amoxicillin, patient developed a rash… Read More »Monthly CDI Scenario Discussion – January 2021

UASI Solutions

Creating and Maintaining the Best CDI Team – UASI Lunch and Learn: CDI Program Management Series

By Staci Josten / December 9, 2020
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Click the button below to download a PDF copy of Staci Josten’s Lunch and Learn, “Creating and Maintaining the Best CDI Team.”

UASI Solutions

Monthly CDI Scenario Discussion – December 2020

By Tara Bell / November 30, 2020

Topic: Cerebral Palsy Scenario: 12-year-old male presents with fever, loud breathing and cough PMH: Premature birth at 28 weeks gestation weighed 680g due to PRM; NICU for 4 mouths; on mechanical vent 7 days then on/off NCPAP then Vapotherm for respiratory distress. Received Surfactant, steroids, vaccines and antibiotics at appropriate times.  NICU diagnoses included: Grade II… Read More »Monthly CDI Scenario Discussion – December 2020