Blog by David Reece, BSN, RN, CCDS, Consulting Director, Outpatient CDI Solutions, MedPartners University
Starting an Outpatient Clinical Documentation Improvement (CDI) program can be a daunting task, but deciding who the best fit for staffing the program is can be challenging as well. Traditional Inpatient CDI programs have relied heavily on clinician based staff, such as Registered Nurses (RNs) because of their clinical backgrounds, but Outpatient CDI encompasses multiple aspects and requires a greater knowledge base. In the outpatient setting, a Clinical Documentation Specialist (CDS) will need to know not only the clinical documentation aspect, but may be involved in reviews related to Evaluation and Management (E/M) components, Current Procedural Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, Risk Adjustment methodology, Denials Management, and Observation status versus Inpatient admission criteria.
So you may be asking yourself, is it even possible to find one person that has an in-depth knowledge base for all those aspects? At MedPartners, we identify that person as a “Purple Squirrel” because they are very rare. Instead of focusing on credentials (RN, LPN, HIM professional/Coder, NP, PA, and Physician), MedPartners focuses on the background, knowledge, and skill set of the individual and evaluates all potential Outpatient CDI consultants the same way through an Outpatient CDI Onboarding Assessment to assure a “best fit” with program objectives. The important attributes of a CDI professional regardless of certifications or credentials should include critical thinking skills, ability to communicate effectively and efficiently, and a desire to learn new skill sets and expand their knowledge base.
In addition to finding the person with the right knowledge and skill set, the setting and opportunities play an important role. In the physician practice arena, RNs, LPNs, or HIM professionals/Coders are often a good fit when the opportunities are centered on Hierarchical Condition Category (HCC) capture, CPT codes, and E/M levels. In the Emergency Department, a physician may be a good fit if the focus is patient status (Observation versus Inpatient). Knowing medical necessity criteria for inpatient status and how the Medicare Two-Midnight Rule should be applied is critical. Physician to physician dialog in this setting may be accepted better due Emergency Department culture and peer credibility.
Finding experienced Outpatient Clinical Documentation Specialists can be challenging for many reasons. Due to the rapidly evolving focus of Outpatient CDI, the qualified candidate pool is somewhat limited. This can be further exacerbated when limiting your program to only one type of person or credential. A hybrid model approach is an excellent way to staff your program and have a variety of skill sets available to find multiple areas of impact. The opportunities found in Outpatient CDI often overlap between settings allowing cross coverage by different disciplines.
Do you already have an Outpatient CDI program or are you looking to expand your focus or settings? Cross training and obtaining additional certifications allows current staff to expand their knowledge base and skill sets while providing additional credibility to your program. Outpatient CDI certifications are available through industry leading organizations such as AHIMA, ACDIS, and AAPC.
MedPartners has the qualified and experienced staff available to start an Outpatient CDI program or augment an existing program. In addition, MedPartners offers training either onsite or online to develop your internal candidates and ensure a successful journey into Outpatient CDI.