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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 based on health conditions managed in the current year. That means organizations will benefit from both a quality and financial aspect with accurate documentation and capture of patients’ conditions in all settings, not just inpatient.

There is a movement from a quantity-driven system to a quality-driven system in both inpatient and outpatient settings. With a quantity-driven system, or fee for service, services are billed based on current procedural terminology (CPT) codes; diagnosis codes are minimally used, primarily to medically justify CPT services.

As the healthcare industry moves towards a quality-driven system, there is more payment variety to move healthcare toward a quality-driven system.

Initiatives to Increase Quality:

  1. Pay for Performance
  2. Value-Based Purchasing
  3. Bundled Payment
  4. Incentives
  5. Penalties for Hospital Acquired Conditions (HACs)

Outpatient CDI is focused on capturing patients’ chronic conditions that are monitored, evaluated, assessed, or treated to assist in complete documentation, accurate code capture, and ultimately appropriate reimbursement.

To learn more about outpatient CDI, click here to download a PDF of a recent webinar titled “Inpatient to Outpatient CDI: Understanding the Similarities and Differences” by  Staci Josten, Director of CDI at UASI.

Need help with establishing your outpatient CDI program? UASI has helped hospitals across the country establish or maintain quality CDI programs. Contact us now at to get started.