PIH Health Successfully Launches CDI Program Through Guidehouse Engagement

Challenge

A provider’s clinical documentation improvement (CDI) program is vital to its revenue cycle health. A strong CDI program can fix the gaps in cost and quality reporting and — given the amount of change related to electronic health records, ICD-10 and recovery audit contractor audits — there is added impetus for a laser-focused program to target quality documentation and accurate reimbursement. Trained CDI specialists review clinical documents and provide feedback to physicians as part of an ongoing effort to maintain the quality of documentation and provide certainty that the care delivery corresponds to the diagnoses being made.

In 2017, PIH Health partnered with Guidehouse to launch a new CDI program. The initiative required additional CDI specialists who needed training and support.

Solution

Working with Guidehouse, the CDI specialists at PIH Health underwent a seven-week training period onsite that included formal classroom education on all Medicare Severity-Diagnosis Related Groups, CDI strategies, and the compliant query process. Additionally, the specialists benefitted from mentoring and one-on-one shadowing — guidance that assisted them in their daily workflow process.

The program’s new workflow design included best practice CDI record review and placement of compliant queries, actions that proved to increase productivity over time. To continue the success and growth of the CDI program, a steering committee was developed that fosters ongoing interaction of the executive team and the CDI specialists. Auditing will be scheduled by the leadership team as part of the oversight function.

Results