EDITOR’S NOTE: The following is part of a series on outpatient clinical documentation integrity (CDI). Part III was published on May 9, 2017 in the ICD10monitor eNews.
Outpatient CDI specialists must first and foremost exhibit the mindset and display characteristics of a businessperson. This individual should be capable of identifying, developing, and tailoring a business plan to effectively execute the goals and objectives of the CDI program.
Each outpatient CDI specialist must recognize that he or she is running a business within a business, entailing constantly maintaining a pulse on business operations; tailoring activities in a just-in-time manner while still meeting the educational needs and desires of physicians; and understanding and practically applying best-practice principles and standards in their daily practice of medicine. A specific CDI initiative or project may require revisions and critical thinking skills in midstream.
Requisite Skill Sets, Core Competencies, and Knowledge Bases
The following represents the requisite skill sets, core competencies, and knowledge bases of a competent outpatient CDI specialist, at a minimum to fulfill the goals, objectives, roles, and responsibilities of an outpatient CDI program:
In addition, the following general skill sets and core competencies are mandatory for the selection and hiring process:
Getting Started: A Reasonable Approach
The selection, interviewing, and hiring process can often be daunting. Resumes may be front-loaded with buzzwords and puffery, and candidates may present themselves well during the interview process but not as well thereafter. After the vetting and hiring process is completed, you may find that the individual is missing several of the critical practical skills necessary to contribute to the success of an outpatient CDI initiative.
What should you do to avoid such a misstep in the hiring process? It is highly recommended that the process include several case studies and clinical scenarios with role plays to afford the opportunity to view the candidate “in action.” Clinical scenarios include providing Health Insurance Portability and Accountability Act (HIPAA) cases in which key documentation elements are missing or incomplete, such as a scenario of a nonspecific diagnosis for a physician-ordered test; an operative report with nonspecific preoperative and postoperative diagnoses; or operative reports without an encompassing indication for a procedure. Other such scenarios could include presenting several business ideas and requesting the candidate to outline how they would research the idea, determine if the idea can be brought to market, develop a sales and marketing plan, and identify a target audience.
Ask them how they would overcome objections and resistance from decision-makers for the product and how they would proceed in the event that the product fell out of favor with customers. How would they deal with an angry, unreasonable customer? By incorporating clinical and business scenarios into the interview process, you will gain a keen perspective of whether the candidate indeed possesses a solid foundation for success in the rollout of an outpatient CDI initiative.
A word of caution is in order: do not overlook the importance of and short-change the selection, interview, and hiring process. After conducting due diligence, planning, organizing, and developing, sell the program to all relevant parties within the hospital. Invest the time and take the lead in the staffing process, keeping an open mind as it pertains to deciding who will make a competent outpatient CDI specialist.
Don’t fall into the limited mindset that the candidate must be a nurse; this is a misnomer and fallacy that must be dispelled in the outpatient CDI arena.
EDITOR’S NOTE: The author of this article used artificial intelligence (AI)-assisted tools in its composition, but all content, analysis, and conclusions were based on the
Creating industry guidance is a challenging task. It is often difficult to remove ambiguity that could lead to unintended interpretations. I think the contributors to
Please log in to your account to comment on this article.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Happy HIP Week! Sign up to win free access to our 2026 Coding Clinic Update Webcast Series! Click here to learn more →
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
