What does your facility use to calculate financial impact?   Only queries?  Reconcilliation w/coders?


  • We use reconciliation with coders. We use 3M/360 and there is a process where we select what the DRG would have been without a query and we can run a report of that information.

  • The only way you can judge if an individual  'query' had any financial impact is to use them workflow described above by 'vparent'.

    Paul Evans,RHIA, CCDS

  • 1) Query impact
    2) Reconciliation
    3) Appeals
  • Hi Wendy,
    This is really a complicated question.  The problem with only counting CDI financial impact when a provider responds to a CDI query is the loss of provider education.  In my opinion, the goal of CDI is to change provider documentation behavior by giving them the terms they need to accurately reflect their intent within coded data.  If a CDI department is successful, then they should be querying less frequently as providers change their behavior.  Consequently, CDI is still making an impact.  I would argue that CDI is making a bigger impact because the number of records impacted by changing the documentation of one provider is much greater than what can occur one query at a time.  

    Yes, many organizations use the methods described above, but the real question should be what is the purpose of this information?  Is it a metric required by administration?  Is it a way to evaluate the individual CDI - I hope not since query opportunities vary by provider and service line?  Once you know what needs to be measured then the organization might be able to develop a better, more accurate way to measure CDI impact.  

    Hope this helps. Cheryl Ericson 
  • We use query impact and reconciliation impact via the 3M360 reconciliation process.

  • Now that clinical validity is on our radar, more than ever before, more time is required in the medical record validating documented diagnosis to ensure clinical indicators support and when not, sending queries.

    Our current productivity measure is 10-12 new cases a day. I wanted to get feedback from other programs as it relates to their productivity measures. Has your goal changed since CV is requiring so much more time in the medical record?

    Thank you for sharing.


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