CASE STUDY

Boosting Revenue and Efficiency Through CDI

Maximizing Your Investment with CSI's Healthcare Expertise

The Background

An acute care hospital, located in central Alabama, with multi-specialty clinics, an ambulatory surgery center, an imaging center along with several ambulatory facilities, throughout the region, recognized there was an opportunity to take a deeper look at their Clinical Documentation Improvement/Integrity (CDI) program to possibly make some adjustments to improve the overall approach.

With that, CSI partnered to provide full access to our Revenue Cycle and coding team which comprises of over 1,000 US-based detailed coders. Backed by broad experience in EHR implementation, revenue readiness assessments, and coding advisory services, CSI brought a strong foundation of knowledge to the partnership. CSI understood the need to support our client here specifically with RCM system workflow improvements, automation integration, physician training, and staffing.

The Challenge

Our partner identified the need for a more structured CDI program, including policies, reporting structures, and a knowledgeable leadership team. Their internal CDI team was undersized and operating without a cohesive process, leading to missed revenue opportunities and gaps in education. Additionally, outdated technology and a lack of interdepartmental collaboration further hindered their efficiency and effectiveness. The healthcare organization worked through the challenges but needed to make an investment in overall process improvement.

How CSI Can Help

Our Clinical Documentation Integrity (CDI) solutions help our healthcare clients transform how they use claims data to drive decisions and improve clinical, administrative, and financial outcomes.

CSI had previously partnered with the organization on chart reviews to help with improving inpatient Diagnosis Related Group (DRG) changes, overall knowledge of Value-Based Care (VBC), and improvements in Hierarchical Condition Category (HCC) captured across the hospital. For this new effort, CSI worked closely with leadership to create a proposal to help implement a clinical documentation improvement/integrity program as part of the new financial restructuring initiative.

The Solution

For this new effort, CSI worked closely with the client to align a proposal that would help implement a clinical documentation improvement/integrity program as part of the new financial restructuring initiative. With deep expertise in RCM advisory and healthcare operations consulting, CSI developed a comprehensive six-month action plan tailored to the organization’s clinical and financial focused on:

  • Current State Assessment & Future State Redesign: CSI conducted an in-depth analysis of client’s existing inpatient CDI workflows and designed an optimized future state. CSI process-mapped current and future CDI workflows, focusing on improving HCC capture for risk adjustment, particularly for their outpatient clinic.
  • Education & Training: CSI developed an enhanced education model, with the implementation of leadership requested KPIs and identification of gaps in the current education program for hospital staff. This included specialized HCC education and inpatient Physician Advisor training.
  • Staffing & Support: Through a tailored workforce optimization plan, CSI added four Inpatient Clinical Documentation Integrity Specialists (CDIS) and planned for three outpatient CDIS. A coding professional was also assigned to identify HCC opportunities and educate the CDIS.
  • Technology & Workflow Enhancements: CSI identified workflow gaps, including clinicians bypassing critical prompts, and discovered inaccuracies in financial metrics reported by their CDI tool. CSI also provided advisory on technology improvements, suggesting AI-powered tools and NLP for automated chart reviews and streamlined query processes with standardized templates.
The team fostered cross-department collaboration to encourage close communication between coding and quality teams to ensure accurate documentation, compliance, and quality reporting.
Photo of Cathy Nakhoul, CSI's Director of Revenue and CDI expert.
Cathy Nakhoul
Director of Revenue and Project lead

The Results

CSI’s team, through our partnership, delivered significant improvements to the client’s CDI program. The successful collaboration with various departments resulted in more accurate documentation and better financial reporting.

  • Drastic Efficiency Gains: The initial assessment time by the CDI team was dramatically reduced from five days to just one day. A chart review rate of 23 charts a day and a 35% query rate, with new reviews initiated within 24 hours of hospital arrival. While this initially led to some improper queries, further targeted education addressed this.
  • Enhanced Accuracy & Financial Reporting: Successful collaboration across departments, led by CSI’s advisory team, including Case Management, Quality, and Finance, resulted in more accurate documentation and improved financial reporting.
  • Increased Revenue & Operational Efficiency: The swift onboarding of the right personnel, optimized processes and improved collaboration between departments directly led to increased revenue and operational efficiency.

CSI’s direct consultation with the leadership team has helped to align CDI objectives with broader organizational goals and fostering long-term success through improved documentation accuracy and clinician engagement.

CSI's RCM & CDI Solutions

CSI’s customized solutions in revenue cycle management have included providing audits by the CSI coding and auditing team who identify coding errors, improve documentation, and eliminate potential revenue leakage. CSI offers tailored service experience, with custom education and training targeted at realizing operational opportunities and compliance commitments and presenting ongoing best practices in aspects of patient care, coding, and Clinical Documentation Improvement.

Is your organization seeking opportunities for documentation and coding improvements? Our RCM and coding solutions assure client improvements in accurate and complete documentation, proper coding and billing, CDI education programs, and overall staffing support to help your organization improve overall revenue capture.

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