EDITOR’S NOTE: This the final installment in a two-part series on the clinical documentation integrity department at Essentia Health, a health system that serves Minnesota, Wisconsin, North Dakota, and Idaho.
Becker’s Hospital Review recently named Essentia Health one of the top Accountable Care Organizations (ACOs) in the country. To validate that honor, we must ask ourselves if we are providing the very best healthcare and track our quality of care through risk score data.
Essentia has worked hard in a short period of time to implement an outpatient clinical documentation improvement (CDI) program touching more than 60 clinics in its four-state healthcare network. The initiative has shown how coded data translates to reportable outcomes. Part II of this series takes a deeper dive into implementing an effective CDI program within physician practices. Readers should gain a sense of the importance of data mining and how to approach hiring, policies and procedures, query examples, and much more.
The next level of implementation is taking notes. Record what is going well and what is not. We found that the types of visits populating within the work queues were not an efficient use of CDI coders’ time. Many visits were single-focus encounters that did not warrant a holistic view of the patient’s entire health picture, such as a visit for strep throat for example. Be mindful of what visits will allow a close look into the integrity of the patient’s clinical picture and offer true severity of illness and mortality metrics.
Do you have any expectations regarding how many reviews each CDI coder should complete in a day, week, or month? Are you focusing on total reviews or total coverage of a patient population? Essentia’s practice is looking at patient populations within payor groups. Each CDI coder has an “alpha split” of patients to follow for the entire calendar year. Essentia has an average number of reviews established; however the number today may not be the same number at the beginning of the calendar year.
What do you think the most common query will be? Look back at gap analysis; did you perform one? Essential prepared a list of the top 10 most common queries based on the original gap analysis done prior to implementation of the program. From this list, Essentia developed compliant queries to be housed in the electronic medical record (EMR) and a hard copy saved on a shared drive.
Are your queries compliant? Does your outpatient CDI team know how to craft a compliant query? Chances are, if they are traditional coders, they may need support in crafting a compliant query, including pertinent clinical criteria, appropriate choices, etc. Currently, Essentia Health has more than 30 queries templated for each team to utilize.
At the end of the day, as outpatient CDI specialists, reviews can be done and queries can be crafted and answered. But how are you delivering the education messages to the entire health facility? Essentia Health partners with an established coding and education team. The team has boots on the ground and works closely with the physician advisor to deliver clear, consistent messaging across the entire healthcare organization. Education is key to a successful outpatient clinical documentation program, no matter where the focus is.
Physician advisors: Do you have one? Essentia utilizes the same physician advisor (PA) as the inpatient CDI team. The PA works within an already comfortable relationship with the medical team to share new concepts regarding outpatient clinical documentation and why it matters to the medical practitioner. If your CDI program is well-established with a dedicated PA, look to expand his or her experience to the outpatient arena.
How can inpatient CDI teams help? Perform a time study centering on actual time spent reviewing records. The Essentia CDI team has embraced the outpatient team, developing four inpatient/outpatient teams within the inpatient team to include the four coders. The team atmosphere offers a great approach and support to a new and challenging program.
To date the outpatient CDI program has reviewed nearly 5,500 visits, educated more than 25 clinics with several one-on-one education sessions, and sent and received compliant queries. The program not only recognizes the great care delivered by Essentia medical practitioners, it also portrays the integrity of each patient’s overall health.
PROGRAM NOTE: Listen to Tracy Boldt describe the outpatient CDI operation at Essentia Health today on Talk Ten Tuesdays, 10-10:30 a.m. ET. Register to listen.
EDITOR’S NOTE: Artificial intelligence was utilized for structural refinement and grammatical editing. All analyses, interpretations, and opinions expressed in this article are solely those of
Having worked in clinical documentation integrity (CDI) in a variety of roles, I have heard a lot of advice when it comes to the timing
Please log in to your account to comment on this article.
Sepsis sequencing continues to challenge even experienced coding and CDI professionals, with evolving guidelines, documentation gaps, and payer scrutiny driving denials and data inconsistencies. In this webcast, Payal Sinha, MBA, RHIA, CCDS, CDIP, CCS, CCS-P, CCDS-O, CRC, CRCR, provides clear guideline-based strategies to accurately code sepsis, severe sepsis, and septic shock, assign POA indicators, clarify the relationship between infection and organ dysfunction, and align documentation across teams. Attendees will gain practical tools to strengthen audit defensibility, improve first-pass accuracy, support appeal success, reduce denials, and ensure accurate quality reporting, empowering organizations to achieve consistent, compliant sepsis coding outcomes.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
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.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
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
