Essential Leadership and Management Skills in CDI

Course Modules

1. Introduction to CDI

We recognize that often individuals are assigned the responsibility of management of a CDI department or CDI staff without pre-existing knowledge of the role and responsibilities. This course begins with a discussion about the role and the regulatory guidance that directs CDI practice.

2. IPPS & MS-DRGS

Keeping with the same tenet as module 1, we discuss the Inpatient Prospective Payment System and the CDI function related to code assignment and MS-DRG grouping. This module offers a surface dive into CDI function and how it impacts the inpatient population.

3. Introduction to Outpatient CDI

We discuss the evolution of CDI into the outpatient setting. We review CDI efforts related to emergency department, observation and primary care/clinic reviews reviews. The discussion continues speaking to the various missions related to outpatient CDI to include: denials prevention, risk adjustment, charge capture and quality.

4. Other Payer Systems

The discussion of healthcare reimbursement is continued touching on a number of methodologies within both the inpatient and outpatient settings to include bundled payments, accountable care organizations, risk adjustment, provider billing etc.

5. Health Care Data & Public Reporting

The impact of CDI function upon quality reporting is well established within the industry. We discuss a number of the CMS quality monitors and CDI function related to the reporting of this data and organizational reimbursement.

6. CDI Practice: Record Review & Query

This module reviews the basics of CDI function to include record review and query compliance.

7. Revenue Cycle Audit Activities

Understanding compliance is a core competency for CDI function. This module speaks to the number of efforts in place to monitor compliance to include RAC, OIG, and PEPPER data.

8. CDI Metrics

A manager must monitor and communicate staff function and effectiveness. We discuss a number of standard metrics used to measure departmental function and benchmarking.

9. Managing Your CDI Staff

Managing a staff can be a challenge. This module offers direction related to functions of managing a staff and CDI program to include screening applicants, interview, hire and training. The discussion includes considerations related to remote CDI function and competency assessment.

10. Directing Your CDI Department

Differing from management is the responsibilities of directing a department. This module offers guidance related to departmental mission, reporting structure, staffing models, written policies, job roles etc.

11. CDI Expansion: Managing Change

The impact of CDI is growing, managers must thoughtfully engage in this process to plan change and grow your department and mission.

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Essential Leadership and Management Skills in CDI

Course Outline/Agenda

Day 1 (8:00 a.m. — 5:00 p.m. to include lunch break, 30 minute, and 4 10‐15 minute breaks)*

Introduction to CDI

Impact of Documentation
Roles- CDI & Coding Professionals
UHDDS Definitions/Reportable Diagnoses
ICD-10 CM/PCS
The Official Guidelines for Coding & Reporting

IPPS & MS-DRGS

IPPS Reimbursement Methodology
CDI Process & IPPS

Introduction to Outpatient CDI

ED setting
Observation patients
Primary Care/Clinic Settings

Other Payer Systems

APR DRGs
Bundled Payment
Per Diem Rates
Risk Adjustment
Medicaid
Commercial Insurance
OPPS (APCs, Evaluation & Management)

*The timing may change as the course is presented to allow for discussion.

Day 2 (8:00 a.m. — 5:00 p.m. to include lunch break, 30 minute, and 4 10‐15 minute breaks)*

Health Care Data & Public Reporting

Public Reported Data
Adverse/Never Events
CMS Quality Measures
Hospital Readmission Reduction Program
Hospital Acquired Condition Reduction Program
Hospital Value Based Purchasing
Patient Safety Indicators
MACRA

CDI Practice- Record Review & Query

The CDI Process of Record Review
          Inpatient Setting
          Outpatient Setting
Compliant Query Practice

Revenue Cycle Audit Activities

Comprehensive Error Rate Testing
Recovery Auditors
Program Safeguard Contractors
Office of the Inspector General
Medicare Administrative Contractors
Quality Integrity Organizations
Supplemental Medical Review Contractor
Risk Adjustment Audit Validation
Commercial Audits
PEPPER Data

CDI Metrics

Key Metrics Used in CDI
Using Metrics to evaluate:
          CDI Productivity
          Provider Engagement
          Educational Needs
          Staff Performance

* The timing may change as the course is presented to allow for discussion.

Day 3 (8:00 a.m. — 4:00 p.m. to include lunch break, 30 minute, and 4 10‐15 minute breaks)*

Managing Your CDI Staff

Traits/credentials of a successful CDI
CDI Job Descriptions
Interview/Hire/Train
Preceptors & Mentors
Evaluating Staff Performance
Career ladders
Competency Assessment
Remote CDI

Directing Your CDI Department

Key Department Policies
          Query
          Escalation
          Reconciliation
          Internal Audit
          Staffing
          Remote Employment
          Dress Code
Specific CDI Job Roles
          Physician Advisor
          CDI Educator
          CDI Auditor
          CDI Analyst
          CDI Denial Management
          Committees & Groups
          Provider Engagement
          Multi Campus Management
          Vendor Contracting 

CDI Expansion- Managing Change

Potential areas of expansion
Managing the process of expansion

* The timing may change as the course is presented to allow for discussion.

Essential Leadership and Management Skills in CDI

Learning Objectives

1. Explain how organizations are reimbursed under the IPPS

2. Understand the significance of the MS-DRG reimbursement methodology and discuss its associated key elements like Present on Admission (POA) and Hospital Acquired Conditions (HACs)
3. Compare and contrast the IPPS and OPPS
4. Discuss OPPS topics such as APCs, provider E&M, HCCs
5. Discuss payment methodologies such as bundled payments, ACOs, risk adjustment, per diem rates, Medicaid and private insurances
6. Discuss the use and impact of publicly reported healthcare data
7. Discuss CMS quality reporting and potential for CDI impact
• HRRP
• HVBP
• PSI
• HACRP
• MACRA/MIPS
8. Describe the traditional role of the Clinical Documentation Specialist (CDS)
9. Define the role of a “query” in CDI/coding
10. Identify and discuss the resources available to guide when and how to query based on professional industry standards
11. Recognize the importance of creating policies to define the query process and discuss the basic elements that should be addressed in the policy
12. Describe the function and focus of the following audit initiatives
• Comprehensive Error Rate Testing
• Recovery Auditors
• Program Safeguard Contractors and Zone Program Integrity Contractor
• Office of Inspector General
• Medicare Administrative Contractor
• Quality Integrity Organization
• Supplemental Medical Review Contractor
• Commercial Audit
• Risk Adjustment Data Validation
13. Discuss the skill set & personality traits of a desirable CDI specialists
14. Identify items to be included within a CDIS Job description
15. Discuss the planning and implementation of an interview
16. Identify steps needed to develop a thorough & complete training plan
17. Apply the concept of career ladders to CDIS
18. Identify methods of competency assessment/employee performance assessment
19. Discuss the pros & cons related to remote CDI practice
20. Identify policy considerations related to the management of remote staff 
21. Identify key departmental policies related to CDI
22. Discuss Specific job roles related to CDI & their responsibilities
23. Discuss CDI reporting structures & communications within an organization
24. Discuss opportunities and methods related to provider engagement
25. Identify considerations applied to managing across several facilities
26. Discuss the many possible foci of a CDI Program
27. State the importance of a clear, defined departmental mission
28. Demonstrate how to use a mission statement to evaluate needs related to growth and expansion of the CDI department
29. Discuss how to communicate your concerns related to expansion of your present responsibilities

Essential Leadership and Management Skills in CDI

Continuing Education

Association of Clinical Documentation Integrity Specialists (ACDIS)
This program has been approved for 21.5 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification and CCDS-O (outpatient) certification, offered as a service of the Association of Clinical Documentation Integrity Specialists (ACDIS).

AAPC
This program has prior approval of the AAPC for 21.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the AAPC of the program, content or the program sponsor.

American Health Information Management Association (AHIMA)
This program has been approved for 21.5 CE credits for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).