Achieving Optimal CDI ROI—Proper Alignment & Integration with Revenue Cycle

13 Dec 2016 10:00 AM | Ronald Gallagher (Administrator)
Speaker: Glenn Krauss

Clinical documentation improvement programs have existed for sometime and in fact are mature programs at most hospital facilities. A recent Black Book survey of 907 healthcare leaders found that a majority of CFOs and other financial staff (87 percent) that case mix index improvement was the largest motivator for CDI adoption because of its potential to increase healthcare revenue and optimize high-value specialist utilization.

The survey goes on to indicate healthcare leaders found that hospitals enhanced quality of care and the organization’s bottom line by choosing to use CDI programs after the ICD-10 transition. Approximately 85 percent of hospitals experienced quality improvements and case mix index increases after CDI implementation. This overwhelming support and embracement of CDI initiatives by healthcare leaders fails to acknowledge and take into account the increasing number of medical necessity denials, DRG downcodes and clinical validation denials directly attributable to these programs amounting to revenue leakage. Revenue leakage attributable to CDI, easily avoidable with process improvement in the current widespread framework in which CDI operates, perpetuates misalignment and close integration with established goals and objectives of the revenue cycle.

Learning Objectives:
  • List the 5Rs associated with changing the framework of CDI
  • Be able to discuss the pitfalls of traditional CDI programs and identify opportunities to engage physicians in true CDI efforts that support the overall revenue-cycle process

Take Away:
Learn the significant limitations and after effects of current CDI programs that negatively impact the revenue cycle.

Speaker Biography:
Glenn Krauss is ZirMed’s Regional Director of Enterprise Solutions. Glenn brings more than 20 years as a professional in the Health Information Management field to his work at ZirMed; previously, he held executive and consulting positions including Revenue Systems Manager, CDI Director of both inpatient and outpatient programs, Director of Case Management and Revenue Enhancement, Director of Health Information Management, Corporate Director of Clinical Coding, and Data Quality Manager with major US hospital and health systems nationwide. He has successfully implemented numerous outpatient CDI programs at multi-hospital systems throughout the country with notable recognized returns while engaging physicians in achieving true documentation excellence through consistent adherence to best practice standards of clinical documentation.

Field of Study: Specialized Knowledge
Delivery Method: Group Internet Based
Program Level: Intermediate
Prerequisite(s): None
Advanced Preparation: None
Cost: Free
CPE Hours: 1.0 Hours CPE
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