Outpatient CDI information

Would anyone have information about their outpatient CDI program they would be willing to share?  

For instance, what areas in the facility are you reviewing as part of you outpatient CDI (ED, Same day surgery, hospital owned physician practices)??  

Does outpatient CDI include those patient in the hospital who are currently observation status (occupying a bed)?  

If your facility does not have outpatient CDI, do your inpatient CDI's review those patient who are in observation status? 

We currently only review inpatients (all payers, self pay).

Thanks in advance

LeeAnn

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Comments

  • Hi LeeAnn,

    I started down the OP path about two years ago. All of these areas, as you know, are considered OP but I had to determine where to start. I did that by looking at a lot of data (denial, payor contracts, etc.). Our facility owned physician group had contracts with Medicare Advantage payers, and there was a bonus opportunity there if we improved our RAF score. This is where we found our biggest opportunity right off the bat. We are now part of an ACO and participate in a MSSP. So there is significant opportunity. Our OP CDI program is expanding to the larger medical group this summer. We started out small in one region with just family medicine and internal medicine physicians and then expanded it to Cardiology and plan on expanding further to endo and neuro. We have shifted from reviewing MA patients to Straight Medicare, and our other ACO products.

  • Thanks for your info...  Does your inpatient CDI review the observation patients in house?  We currently employ a CT surgeon and soon adding pulmonologists..


  • I am very interested in learning about OP CDI.  Some great information here.  I'm wondering where you got the data to review? Denial, payor contracts, etc?  Did that come your Quality Department?  Thanks!
  • I am very interested in learning about OP CDI.  Some great information here.  I'm wondering where you got the data to review? Denial, payor contracts, etc?  Did that come your Quality Department?  Thanks!

    Karen.schaefer@stjoe.org
  • Our outpatient program started by using quality data given to us from our ACO. Given that data and the opportunity we saw, we started with primary care physician practices focusing on HCC's and gap closures. We also audit the coding department as well at 100% on our ACO payer population (Medicare advantage plans). We have more recently started working with our ACO and working with the offices on the education and auditing of medicare wellness visits and transition of care visits. We also have an RN in the surgical area that focus's on status C cases. And another RN in the ER who works with E/M leveling and infusion/medication documentation. 
  • longl1 said:
    Thanks for your info...  Does your inpatient CDI review the observation patients in house?  We currently employ a CT surgeon and soon adding pulmonologists..



    We currently do not review observation charts. We specifically focus on our primary care physician group and cardiology physician group.
    ssipunu said:

    Hi LeeAnn,

    I started down the OP path about two years ago. All of these areas, as you know, are considered OP but I had to determine where to start. I did that by looking at a lot of data (denial, payor contracts, etc.). Our facility owned physician group had contracts with Medicare Advantage payers, and there was a bonus opportunity there if we improved our RAF score. This is where we found our biggest opportunity right off the bat. We are now part of an ACO and participate in a MSSP. So there is significant opportunity. Our OP CDI program is expanding to the larger medical group this summer. We started out small in one region with just family medicine and internal medicine physicians and then expanded it to Cardiology and plan on expanding further to endo and neuro. We have shifted from reviewing MA patients to Straight Medicare, and our other ACO products.


  • We obtained the data from payor contracts and our quality department. I did comb through denial data to see where we had denials based on ICD-10 CM codes as well.



    I am very interested in learning about OP CDI.  Some great information here.  I'm wondering where you got the data to review? Denial, payor contracts, etc?  Did that come your Quality Department?  Thanks!


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