Outpatient CDI HCC Clinical Concepts – UASI Lunch and Learn: CDI Program Management Series
Click the button below to download a PDF copy of Tara Bell’s Lunch and Learn, “Outpatient CDI HCC Clinical Concepts.”
3 Keys to Implementing Outpatient CDI in a Physician Practice
When implementing outpatient CDI in a physician practice, there are 10 steps you must follow to be successful. Assess Current State Define and Align Set Program Goals Determine Return on Investment Staffing Infrastructure Define Workflow Communicate and Educate Performance Expectations Monitor and Track Ongoing Evaluation However, the following steps are considered keys to an effective…
Pancreatitis CDI Scenario – March 2021
Topic: Pancreatitis H&P: 68-year-old male presents with a history of a sudden onset of acute upper central abdominal pain radiating to his back. The pain began two days prior with intermittent vomiting, without relief of his pain PMH: Appendectomy, Tonsillectomy, Hypertension, Pre-diabetic Pertinent Family History: Cholelithiasis and cholecystectomy in multiple family members Pertinent Social History:…
Key Steps to Successfully Implement Outpatient CDI in a Physician Practice – UASI Lunch and Learn: CDI Program Management Series
Click the button below to download a PDF copy of Staci Josten’s Lunch and Learn, “Key Steps to Successfully Implement Outpatient CDI in a Physician Practice.”
The Importance of Calculating Accurate RAF Scores
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…
Risk Adjustment Factor Basics
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…
Monthly CDI Scenario Discussion – February 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….
The Top 3 Challenges in Outpatient CDI
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…
Outpatient CDI Basics
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…
The 3 Main Differences between Inpatient and Outpatient CDI
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…
Inpatient to Outpatient CDI: Understanding the Similarities and Differences – UASI Lunch and Learn: CDI Program Management Series
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.”
Monthly CDI Scenario Discussion – January 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…