AHIMA ADVANTAGE 4
In Wieczorek’s view, both inpatient and outpatient clinicians are beginning to
recognize the importance of diagnoses, particularly for chronic conditions, that
affect not only payment but also quality metrics. For this reason, CDI specialists can
bring even greater value to their organizations by collaborating with their quality
teams to identify opportunities to improve performance.
Another way for CDI specialists to enhance their value is to boost their coding
skills. “This is a core competency, particularly in the inpatient setting,” Wieczorek
says. She suggests reading white papers (such as those available in the AHIMA
Body of Knowledge) on how coding affects the middle revenue cycle and influences
physician and hospital performance. “When I look at what qualities CFOs and CEOs
value in an HIM director, it is middle revenue cycle experience and the ability to
understand coding data and coding guidelines in a myriad of different use cases,”
Shift to a Population Health Focus
New payment methodologies are elevating the value of comprehensive CDI programs
while driving the need for collaboration across providers in a variety settings, says
Cheryl Ericson, RN, MS, CCDS, CDIP, manager of CDI services at DHG Healthcare.
As a result, CDI is developing even more of a population health focus.
With an eye toward population health, CDI specialists can shift their attention
from less meaningful metrics, such as case-mix index and CC/MCC capture
rate, to more valuable metrics like HCCs. Yet this can be a complex area, as
HCC definitions often differ by payment model, creating opportunities for CDI
professionals to become experts in bundles and other models. “We are going to see
more specialization and depth of understanding in those areas,” says Ericson, a
member of the CDI Practice Council.
To prepare for the changes ahead, Ericson recommends that HIM professionals “go
back to the basics” and brush up on their critical thinking skills, which may have
lapsed somewhat as a result of computer-assisted coding. “It is really about looking
at the totality of the record and clinical scenario,” she says.
Stay Ahead of Outpatient CDI
Anny P. Yuen, RHIA, CCS, CCDS, CDIP, principal, AP Consulting Associates, LLC,
Philadelphia, PA, believes that the dynamic nature of CDI is creating a learning
curve for HIM professionals, even those who have coded outpatient services for
many years. For example, HIM and CDI professionals have had to keep pace
with different outpatient visit documentation guidelines (from 1995 and 1997),
along with the Centers for Medicare and Medicaid Services (CMS) evaluation
and management (E/M) documentation guideline (published November 1, 2018)
addressing the recording of redundant data for outpatient visits. What is more, Yuen
expects that CMS will issue additional guidance in the next two years that may
change how providers document E/M visits due to changes in leveling.
“Everyone needs to stay nimble,” she says. To keep their skills sharp, Yuen
recommends that HIM and CDI professionals leverage resources available from
their workplaces, the CMS website, and the AHIMA Body of Knowledge, such as
practice briefs and toolkits. As a member of the CDI Practice Council, Yuen is part
of a committee developing an outpatient query toolkit that will be published later
As Yuen puts it, continued learning “helps you to put the puzzle together and
think critically, because each case you review is going to be different.” HIM and
CDI professionals also need to have confidence in their abilities. “You don’t have
the luxury of coming back to review the case on Day 2 to see if there is more
information,” she says. “You have to be 10 steps ahead, especially when you are
targeting outpatient CDI.”
s COVER STORY CONTINUED
Preparing for the New Brand of CDI
Access tools in the AHIMA Body of
Knowledge, the AHIMA Store, and online
at ahima.org. (Use your AHIMA login and
password; some resources are free, while
others are available for purchase.)
CDI Summit—Held July 14–15 in
Chicago, IL, this premier event includes
expert speakers on hot CDI topics.
CDI Trainer—This workshop, held
July 16–18 in Chicago after the CDI
Summit, helps HIM professionals
become AHIMA-approved CDI trainers.
CDI Academy—The next live academy
is November 13–15 in Long Beach, CA.
Self-paced versions are also available for
inpatient and outpatient CDI.
AHIMA Health Data and Information
Conference—This event, held in Chicago
from September 14–18, includes sessions
CDI Textbooks—The AHIMA Store offers
a new book on “Clinical Documentation
Improvement for Outpatient Care,” as well
as other topics.
CDI Portal—Find courses, publications,
and other resources on this portal.
“Diving into Documentation”—Webinars
available on Feb. 13 and March 13 will
cover updates to the “Guidelines for
Achieving a Compliant Query Practice”
practice brief. In April, a webinar will
discuss the “Clinical Validation: The
Next Level of CDI” practice brief.
Certified Documentation Improvement
Practitioner (CDIP®) Credential—Earn
this credential and gain recognition for
CDI expertise. CDIP: Advancing the Practice
webinars are available on demand, and live
chats are held throughout the year.
Advanced CDI Courses—More than 20
prerecorded webinars are organized by body
system and available for purchase in the
AHIMA Store individually or as a bundle. v