Revenue Integrity 101

“Revenue Integrity” within a healthcare system means many different things depending on who you ask, the size of the institution, and if the OIG (Office of Inspector General) has paid a visit or not. I believe Revenue Integrity (RI) is a culture that lives within an organization and is part of each component of the […]

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ICD-10 Readiness Checklist

67, 66, 65, 64 days and counting…. We are officially on the FINAL countdown to ICD-10 implementation. Health systems, providers, payors, etc., are working diligently to review that “Master Task List” we all created, what seems to be, a decade ago by now. At this point, time is short and some in the healthcare industry […]

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Code Integration

Most organizations produce 1,000s of claims a day with hopes they’re compliant and will ensure proper reimbursement. Within those UBs/837Is are claim lines, which are primarily comprised of charging and coding data. The process responsible for creating those claim lines is “Code Integration.” At most organizations, this process is a black box. It happens behind […]

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Well-defined and understood processes and policies are key to an efficient and effective CDI program

We all want to have efficient and effective Clinical Documentation Integrity programs. Well defined workflow processes are a key to achieving this goal. The time spent to do a review of current CDI program and/or map (Value Stream Mapping) out your current and/or future state will prove to be time well spent. No detail is too obvious and […]

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New CDI Chart Reviews

A recent Q&A around how to review a chart by a CDI reminded me that so much has changed since 2005 when I began my adventure into the world of Clinical Documentation Improvement (CDI). The move from reimbursement first and foremost to accurate documentation has been such a turning point. The introduction of the Electronic Medical Record […]

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DRG Mismatch

DRG Mismatch: the buzz word for how well the Clinical Documentation Improvement department and the Inpatient Coding department are coming to the same conclusion on the appropriate codes applied to the medical record. It has been discussed amongst many in the industry that an appropriate benchmark of program success is based on the percentage of […]

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Query Appropriateness

A recent Q&A featured in ‘CDI Strategies’ April 16, 2015, caught my eye as it was about the appropriateness of putting certain information in a query. They talked about the rationale behind including mentions of Severity of Illness (SOI) and Risk of Mortality (ROM), as well as support for the level of care for the patient. I agreed […]

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