Dr. Erica Remer and I had the pleasure of co-presenting at the Healthcare Financial Management Association (HFMA) Region 6 Conference this past week in Columbus, Ohio. Our topic was the intersection of utilization review (UR) and clinical documentation improvement (CDI), examining the current state of these disciplines and offering predictions about their future directions.
Our presentation aimed to provide clinical relevance to a healthcare financial and revenue cycle audience.
In previous articles, I have explored why these two disciplines have historically been separate. Key reasons include differences in technology and the distinct roles UR and CDI play; UR traditionally aligns with case management, and CDI with coding. However, the landscape is evolving. Technology firms such as Iodine are making significant strides in bridging UR and CDI, enhancing transparency and efficiency in collaborative learning.
Other technology platforms are also recognizing the importance of uniting these two areas to form a cohesive clinical revenue cycle.
While the partnership between case management and utilization review remains essential, the increasing focus on the social determinants of health (SDoH) and transitional care across the care continuum is continuing to shift case management’s role. It is becoming more integrated with population health, creating new opportunities for collaboration with outpatient services.
To foster greater collaboration between UR and CDI, and to improve efficiency, I recommend the following steps for consideration today:
The convergence of UR and CDI is essential as we move towards a more integrated healthcare model. Technology is playing a pivotal role in bringing these traditionally separate disciplines together, allowing for better communication, efficiency, and financial outcomes. By fostering collaboration through shared learning, data transparency, and unified communication efforts, healthcare organizations can enhance their clinical revenue cycle while delivering high-quality patient care.
The future of UR and CDI lies in breaking down silos and working cohesively to adapt to the rapidly changing demands of healthcare.
Programming note:
Listen to senior healthcare executive Tiffany Ferguson report this story live today during Talk Ten Tuesday with Chuck Buck at 10 Eastern.
I receive a lot of newsletters every morning to help me stay abreast of what is happening in the healthcare industry. A troubling recent trend
In the CY 2026 OPPS/ASC Final Rule, the Centers for Medicare & Medicaid Services (CMS) formally finalized the removal of the Screening for Social Drivers
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