- AHIMA has released two new clinical documentation improvement (CDI) toolkits on outpatient documentation and denials management to support the exchange of complete and accurate data across the care continuum.
“The documentation in a patient’s health record must hold the complete patient story, and that story does not stop when a patient leaves the hospital or when the records face the involved payer,” said AHIMA CEO Wylecia Wiggs Harris, PhD, CAE.
“It’s essential that HIM professionals have the tools they need to document each part of this story for these key audiences – from all parts of the healthcare continuum – to assure the best treatment can be delivered to the patient.”
These new toolkits from AHIMA will expand on the importance of complete and accurate coding in outpatient documentation and denials management.
The AHIMA Outpatient CDI toolkit examines the steps required to start an outpatient CDI program in non-hospital settings, such as physician clinics and emergency departments.
The toolkit contains a summary of how outpatient documentation differs from inpatient protocols, including details on the appropriate ICD-10 codes, drivers for outpatient CDI, and ways to approach each outpatient setting.
The kit also includes an outline of risk adjustment measures to consider, tools for using queries to support communication between CDI professionals and providers, and appendices such as a glossary of CDI terms relating to outpatient technologies.
When claims denials are not dealt with properly, they can have costly consequences. The AHIMA CDI and Coding Collaboration in Denials Management toolkit outlines the appeals process for denials management, as well as ways to prevent denials from occurring in the first place.
Documentation measures are also necessary to validate that payments are only made for claims that are for covered services. For large payers like Medicare, it is necessary that these services are properly coded. This toolkit will ensure that HIM professionals can compile an accurate representation of health services for Medicare and other large payers.
The toolkit includes an overview of the types of claims reviews that a specialist may encounter, a guide for building the case of a possible appeal, strategies for preventing denials, and appendices such as a pre-hire assessment and answer sheet for incoming CDI professionals.
AHIMA has long been at the forefront of CDI education, offering programs and resources to ensure meaningful clinical data is captured for the purposes of quality patient records and claims reimbursement.
These new toolkits will add to their efforts to promote seamless data communication across the healthcare industry.
The toolkits are free for AHIMA members and can be found online in AHIMA’s HIM Body of Knowledge and on AHIMA’s web store.