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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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
Hi there.
I am the manager of my outpatient CDI program, and we are using the Epic OPA process for pre-visit reviews.
We do use all 3 options, and I tell my team to follow this thought process:
Addition: Provider has previously documented the condition with full supporting evidence in the previous year and the CDI specialist can "predict" that the condition will continue to be applicable for the patient in this calendar year (like diabetes).
Comment: Provider did not document the condition with full supporting evidence in the previous year but the CDI specialist can "predict" that the condition will continue to be applicable OR there is conflicting documentation in the chart that the provider needs to address (like a diabetic neuropathy with lack of evidence of the neuropathy).
Do not certify: Provider did or did not document the condition will evidence in the previous year, but the CDI Specialist can "predict" that the condition is no longer applicable to the patient (like acute stroke, active cancer, etc).
The important part of choosing the right option is it is indicated to the provider on their side (if you haven't seen it, ask your Epic team to share what it looks like). My providers like the immediate call out of either a green check (telling them they are on the right track with their documentation), a paper note (looks like a piece of paper, indicating they need to do something different), or a big red X (indicating that they may have previously chosen the wrong code).
We consider any written note to the provider a query, regardless of the option chosen. These are audited and require compliance....always including clinical indicators, options/choices for providers, etc.
Hope this helps.
Lindsey