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

Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.

November 21, 2024
Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Comprehensive Outpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.

September 5, 2024
Advanced Outpatient Clinical Documentation Integrity: Mastering Complex Narratives and Compliance

Advanced Outpatient Clinical Documentation Integrity: Mastering Complex Narratives and Compliance

Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.

September 12, 2024

Foundations of Outpatient Clinical Documentation Integrity: Best Practices for Accurate Coding and Compliance

This webcast, presented by Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, a recognized expert with over 30 years of experience, offers essential strategies to improve outpatient clinical documentation integrity. You will learn how to enhance the accuracy and completeness of patient records by adopting best practices in coding and incorporating Social Determinants of Health (SDOH). The session also highlights the role of technology, such as EHRs and CDI software, in improving documentation quality. By attending, you will gain practical insights into ensuring precise and compliant documentation, supporting patient care, and optimizing reimbursement. This webcast is crucial for those looking to address documentation gaps and elevate their coding practices.

September 5, 2024

Trending News

Featured Webcasts

Patient Notifications and Rights: What You Need to Know

Patient Notifications and Rights: What You Need to Know

Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.

December 5, 2024
Navigating the No Surprises Act & Price Transparency: Essential Insights for Compliance

Navigating the No Surprises Act & Price Transparency: Essential Insights for Compliance

Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks.  Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.

November 19, 2024
Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.

October 24, 2024
The OIG Update: Targets and Tools to Stay in Compliance

The OIG Update: Targets and Tools to Stay in Compliance

During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.

September 19, 2024

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!

👻Spooky Sale is Back!👻 Get 31% off all three Medlearn brands, using code SPOOKY24.