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Prioritizing CDI on the Ambulatory Side of Healthcare Facilities

By AGS Health

July 28, 2022

Prioritizing ambulatory clinical documentation information (CDI) solutions

Most medical procedures are moving to outpatient facilities, thanks to technological advancements and minimally invasive surgical procedures. Outpatient services in lower-cost settings have also benefited from financial incentives, patient preferences, government support, and other policies. But value-based care incentives have been the driving force behind this trend. Value-based payment models encourage patients to use outpatient care facilities. According to a study by Deloitte, the aggregate share of outpatient services in total hospital revenue increased from 28 percent in 1994 to nearly half (48 percent) by 2018. Patient preferences and clinical advancements that reduce complications and allow patients to return home sooner are driving much of this growth. Because of this growth, a robust outpatient clinical documentation information (CDI) system is necessary to manage the increase in outpatient services.

Significance of Outpatient CDI

As technologies have advanced and costs have skyrocketed, a larger share of medical services are able to be performed as outpatient – driving the need for improved outpatient clinical documentation (CDI) programs. CDI processes should be performed during a patient encounter, which is why CDI technology is so important. The main benefits of outpatient CDI include:

  • Diagnosis specificity is as vital in the outpatient world as in the inpatient world. Because it will affect the hierarchical condition category (HCC) assignment, each diagnosis must be documented to the highest level of specificity possible.
  • More detailed note capture procedure, which allows for accurate CPT code assignment.
  • Accurate Ambulatory Payment Classification (APC) reflects the prospective outpatient payment system. Outpatient documentation support for appropriate APC assignments is as crucial as inpatient documentation support for DRG assignments.
  • CDI offers high-quality clinical documentation for reimbursement, which is essential for getting accurate outpatient services reimbursement.
  • CDI ensures that outpatient services are documented to the same high standard as inpatient services to capture accurate quality scores.
  • Accurate and updated outpatient CDI reduces the scope of payment denials due to missing documentation of the medical necessity. 
  • Accuracy of HCCs and risk scores for the patient population can be maintained.
  • Improved documentation of infusions, procedures, and support for observation services.
  • Outpatient CDI facilitated better coordination between the provider documentation and coded data.
  • Comprehensive health records for improved patient safety and satisfaction.

Measures to prioritize CDI for Ambulatory CDI

Once a solid outpatient CDI has been established, it can be extended to the ambulatory setting. The following issues must be addressed to achieve this:

  • Identify areas where ambulatory CDI will be helpful. A shift in focus from acute to chronic medical conditions is necessary.
  • Recognize many issues that may not be directly related to CDI, such as physician evaluation, coverage determination, management coding, and so on.
  • Determine a clear definition of what you wish to accomplish and what obstacles you are looking to overcome through Ambulatory CDI. Decide which ambulatory CDI clinics will be implemented and in what order.
  • Define metrics that need to be used in the process of ambulatory CDI. Appropriate KPIs must be established because they demonstrate the effectiveness of an organization in achieving business objectives. The Risk Adjustment Factor (RAF) is an excellent metric for assessing Ambulatory CDI's impact.
  • Identify the staffing requirements for Ambulatory CDI, as some programs can be quite labor-intensive as software and technology evolve.
  • Coordination between several programs is mandatory for a successful ambulatory CDI program. Healthcare systems need to look beyond their four walls to understand outpatient CDI requirements. The ideas must be floated from the top levels, and CDI managers must address issues regarding administration, ROI, staffing, quality of patient care, physician engagement, and so on.
  • Accurately identify the patient population in the ambulatory clinical setting. Outpatient CDI satisfies the needs of a variety of people. Aside from determining the patient population, the organization must have clarity on the intended goals before moving forward with its CDI program.
  • Compliance checks must be performed before any program is implemented and relevant documentation submitted to the ACDIS. Finding resources for outpatient CDI can be difficult. It is key to network with peers outside the organization.
  • A team effort is required for an ambulatory CDI program to be successful. First, the operational staff will check the impact of the CDI process on patient care. The CDI team must be familiar with all the staff members’ processes. Physicians must interact with the IT department and CDI staff to manage the EHR records effectively.  
  • Hire and train CDI specialists. Since the main goal for CDI is accurate documentation and coding, the ambulatory and the inpatient teams report to the same leader.  Weekly staff meetings must be scheduled to promote idea sharing and collaboration. 

It's imperative to understand organizational objectives and develop an ambulatory program that supports them. The success of any ambulatory CDI program depends on strong leadership and the ability to adapt to change.

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AGS Health is more than a revenue cycle management company–we’re a strategic partner for growth. By blending technologies, services, and expert support, AGS Health partners with leading healthcare organizations across the US to deliver tailored solutions that solve the unique needs and challenges of each provider’s revenue cycle operations. The company leverages the latest advancements in automation, process excellence, security, and problem-solving through the use of technology and analytics–all made possible with college-educated, trained RCM experts. AGS Health employs more than 10,000 team members globally and partners with more than 100 clients across a variety of care settings, specialties, and billing systems.

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