Is a program established to improve the services provided at the outpatient setting, primarily to focus on determining a variety of opportunities exist regarding the review of provider documentation entered during an outpatient or provider encounter

“Outpatient CDI reviews occur at a much faster pace, it is becoming more critical to accurately capture ICD-10-CM diagnosis codes in the outpatient environment, as physicians’ reimbursement is predicated on quality over volume. In the outpatient arena, the organization may focus more on revenue protection and preventing denials.

Medicare payment changes impacting physician practices, including the MACRA Quality Payment Program and its two tracks: The Merit-based Incentive Payment system (MIPS) and the advanced Alternative Payment Models. More than 70% of physicians will participate in the MIPS track. “Under MIPS, physicians’ documentation will affect their reimbursement.”

The physicians need to provide quality care and manage costs simultaneously in the outpatient setting, just as they do in the inpatient setting. The only way they can achieve this is if their documentation is accurate and complete.”

It is important to capture additional specificity, accurately document the Severity of Illness (SOI), and link those conditions as appropriate.

If the physicians do not capture the true SOI and the Risk of Mortality (ROM) for their patients, they will not be reimbursed appropriately for the level of care they are providing under a risk-adjusted model.”

We start with data analysis and review outpatient charges and denials related to coding for the previous 12 months.

 Interview the coding and accounts receivable staff to learn about denial activity.

Review the medical and operational information to assess to make sure are properly documented.

Review workflow and charge capture entry on encounter forms.

perform a charge capture audit to determine which charges are being billed inappropriately;

provide physicians by training, including a corrective action plan; to establish best practices

Ultimately, develop a detailed outpatient CDI strategy for capturing accurate documentation that supports better reimbursement and the high quality of care provided.”