How AI-driven CDI Programs Give Us More of What We Need Most

Artificial intelligence (AI) solutions are designed to support CDI teams in their quests for efficiency.

The concept of “doing more with less” is far from uncommon. You hear it every day in nearly every aspect of life: at home, we strive to live simply; in the community, we build resiliency; and at work, we are asked to boost productivity while improving effectiveness.

The transition to value-based healthcare has made doing more with less increasingly important. That is to say, clinical documentation is a core function across healthcare business management, as documentation must accurately reflect not only the patient population’s health and history but also the level of care required to appropriately care for patients. Documentation that is either inaccurate or lacking in appropriate specificity (or both) can have a negative impact on reimbursements, quality ratings, denials, and, most importantly, patient health and well-being. On the other hand, we know from extensive available research that healthcare organizations with robust clinical documentation improvement (CDI) programs consistently rank high in terms of quality, especially with observed-to-expected mortality ratings, an area that is most directly affected by the quality of documentation.

For example, if a patient’s documentation reflects a urinary tract infection, but that patient died, the documentation was clearly wrong. There was a missed diagnosis within the record, which not only affects reimbursements but also means that it will be publicly reported that healthy patients may die while in the care of that organization.

In short, we need to do more, to work smarter and more efficiently. Through the focus on CDI, a great responsibility falls to coders and CDI specialists, as they’re charged with applying their skills and experience in new ways. Not only must these professionals possess the appropriate knowledge to help ensure excellent clinical documentation, but they also must have the finesse to collaborate with physicians and executives along the way. In other words, their responsibilities have expanded, but they have no more time in the day.

Today’s technologies and artificial intelligence (AI) solutions are designed to support CDI teams in their quests for efficiency. Consider a CDI specialist (CDIS) who has 100 patient charts in their workflow. Research suggests that only 30 of those charts will require follow-up or clarifications – but which 30 should time be spent on? In the past, each record would need to be manually reviewed to uncover only those charts that represent quality improvement opportunities. Today, however, the right technology can help CDISs hone in on those more complex cases automatically, allowing them to apply and use their skills more effectively and spend their time in ways that can make the most impact.

Similarly, AI can be applied to the front end of the documentation process, supporting providers and physicians as they add specificity where it matters most. A healthcare virtual assistant, for example, is one AI-powered platform that augments providers’ knowledge, recognizing natural language to make chart searches, electronic health record (EHR) navigation, and computerized physician order entry (CPOE) more intelligent, simpler, and voice-powered. By helping providers create more complete and compliant documentation upfront, these technologies are creating efficiencies on the back end, giving even more time back to CDI specialists and coders. Now, they’re able to dive deeper into patient records, freed from the weight of retrospective queries and rework.

Engaging the entire organization in denials prevention
Denials remain a costly burden for healthcare organizations, both in terms of financial impact as well as the amount of time coding and CDI specialists must dedicate to addressing denials as they arise. The rules governing denials are fluid, and it can be difficult to keep up with them; this is complicated by the fact that once a claim has been denied, there is typically a short time frame in which to address it. The process chews up time and other resources and requires extensive knowledge of the appeals process.

It is in this area that today’s clinical documentation technologies are well-positioned to support organizations’ denial prevention strategies. CDI and coding specialists can rely on tools that capture greater specificity in clinical documentation, mitigating the risk of denials upfront. On the back end, the right technologies will also include appeals templates to help CDI teams effectively and efficiently address denials as needed.

While the technologies themselves are designed to support any organization’s denial prevention strategy, adding a guidance and educational program will optimize the impact of these investments. These programs can drive progress toward achieving organizational goals by keeping all clinicians and specialists on top of changing payor requirements and processes, helping continuously improve the quality of documentation and engaging the entire organization in quality improvements.

In other words, the combination of educational programs and technology solutions help improve the quality of documentation upfront, which alleviates the burden of rework while also helping to prevent denied claims going forward.

The future of CDI: education, process changes, and AI-powered improvements
In December 2018, McKinsey published its research on the “promising” effects of natural language processing (NLP) in healthcare. Indeed, from the ability to identify appropriate and accurate ICD-10 diagnosis codes to the creation of time-savings opportunities, the influence of NLP (itself a subset of AI) can have a significant and positive impact on CDI teams’ ability to expand case coverage while maintaining resources.

This progress, of course, is made more powerful by the advanced analytics only available through innovative technologies that can aggregate and process large amounts of data. We hear consistently that one of the most challenging aspects of healthcare leadership is benchmarking: how are we doing? How are we doing relative to our own performance, or that of other organizations like ours? Where are our problem areas? Has our patient population changed, and affected the case-mix?

Getting answers to these questions used to be incredibly difficult. Today, however, with real-time intelligence that’s available within advanced CDI technologies, it has never been easier to uncover areas where education, process changes, and other interventions can have a positive impact and give all of us more of what we need most: time.

Programming Note: Listen to Mel Tully report this story live today during Talk Ten Tuesdays, 10-10:30 a.m. EST.

Facebook
Twitter
LinkedIn

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

2026 IPPS Masterclass 3: Master MS-DRG Shifts and NTAPs

2026 IPPS Masterclass Day 3: MS-DRG Shifts and NTAPs

This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 14, 2025
2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 13, 2025
2026 IPPS Masterclass 1: Master ICD-10-CM Changes

2026 IPPS Masterclass Day 1: Master ICD-10-CM Changes

This first session in our 2026 IPPS Masterclass will feature an in-depth explanation of FY26 changes to ICD-10-CM codes and guidelines, CCs/MCCs, and revisions to the MCE, presented by presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 12, 2025

Trending News

Featured Webcasts

The Two-Midnight Rule: New Challenges, Proven Strategies

The Two-Midnight Rule: New Challenges, Proven Strategies

RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.

June 19, 2025
Open Door Forum Webcast Series

Open Door Forum Webcast Series

Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.

June 11, 2025
Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025.  Register today and be a part of the conversation!

July 16, 2025

Trending News

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. 2 with code CYBER24