Services
Clinical Documentation Integrity Services
Overview
Healthcare providers face difficult challenges with the documentation of services in patient medical records. This documentation is used across the organization for reimbursement, compliance, patient and care management, quality measures, and more. Proper coding requires meaningful documentation that is complete, accurate, and consistent. A correctly configured clinical documentation integrity (CDI) program can help achieve this goal and drive greater revenue outcomes for your organization.
Our comprehensive CDI services are tailored for both inpatient and outpatient settings. Through a combination of retrospective, prospective, and concurrent reviews, we offer precision and specificity in clinical documentation. Our solutions focus on key data points such as diagnosis-related group (DRG) validation, resolving case mix index (CMI) inconsistencies, accurate diagnosis and procedure coding, and present-on-admission (POA) reporting to reflect the complete clinical picture. We meticulously capture comorbid conditions (CCs) and major comorbid conditions (MCCs) while ensuring thorough documentation of severity of illness (SOI) and risk of mortality (ROM) values. Additionally, we focus on the documentation of patient safety indicators (PSIs), and hospital-acquired conditions (HACs) to ensure a comprehensive clinical picture. Our outpatient CDI specialists are focused on accurate documentation of infusions, procedures, and observation services in ambulatory settings, optimizing Ambulatory Payment Classification (APC) for appropriate reimbursement.
SERVICES PROVIDED
Retrospective, concurrent, and prospective review of clinical documentation to identify missing information, query physicians, and recommend improvement opportunities to ensure your documentation is ready for final coding. Our clinical documentation integrity (CDI) services include:
- Concurrent reviews of medical records ensure timely filings.
- Timely physician queries to obtain the necessary clarifications or corrections for accurate coding.
- Follow up on previously unanswered queries or delayed answers.
- Validate and resolve DRG discrepancies and questionable diagnoses POA values.
- Education on documentation best practices and requirements for physicians.
BENEFITS
Unlocking the benefits of clinical documentation integrity
Deliver Precise Documentation
Increase accuracy and efficiency of the documentation and reporting process while reducing disruptive retrospective queries, minimizing query response times, alleviating administrative burdens, and improving communication.
Ensure Appropriate Reimbursement
Accelerate and streamline clinical workflows for accurate diagnoses and procedures to maximize reimbursements, reduce denials, and eliminate re-work and resubmission of claims.
Achieve Regulatory Compliance
Ensure adherence to legal and regulatory requirements with advanced automation technologies and analytics-based CDI management solutions that leverage artificial intelligence (AI), natural language processing (NLP), machine learning (ML), and clinical decision support.
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Additional Clinical Administrative Services to streamline your revenue cycle
Clinical Prior Authorization Services
Secure clinical authorizations for complex medical cases, including prior authorizations (prospective) and concurrent authorizations, to ensure proper reimbursement and timely delivery of care aligned to payer contracts.
Utilization Management Services
Provide appropriate, efficient, and cost-effective care consistent with current medical standards, preventing unnecessary procedures and optimizing treatment plans to enhance patient outcomes, streamline resource utilization, and drive healthcare excellence.
Clinical Denials and Appeals
Review denied claims to identify root causes, and craft compelling appeals supported by comprehensive clinical evidence to maximize revenue and minimize financial losses.
Physician Advisory Services
Skilled physicians and healthcare professionals provide customized solutions to optimize clinical documentation, coding accuracy, and revenue integrity.
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