Epic Risk Adjustment Pre-Visit Reviews
Hello,
For those who utilize the pre-visit CDI workflows within Epic, how is your team handling the set up? For example, does your team use all 3 options such as "addition", "do not certify" and "comment" and how does this factor into compliance with the compliant query guidelines. For the comments and suggestions from the CDI reviewer that appear in the OPA for the provider, are you including specific clinical indicators or simply directing providers to a specific date or service or lab?
Thank you!
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Comments
All great questions!
From my experience, the biggest compliance challenge is to ensure the OPA default is not set to add a diagnosis without physician review. For query guidelines adherence there needs to be firm clinical indicators to ask for a diagnosis and an "other" option for multiple choice, which is supplied by the choices above IMO. It is giving the provider the option to say "yes, it is correct and I am adding it" (addition) or "I disagree" (do not certify) or "other" (comment).
Each case is specific and I would encourage CDI to adhere to the ACDIS/AHIMA query guidelines when placing comments into the OPA as it is essentially a query.
Hope that helps.
Jessica