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Focusing On CDI Measures That Truly Matter

February 19, 2018






Use of Case-Mix as a Proxy for Judging Effectiveness of CDI Programs


The use of case-mix as a proxy for judging the effectiveness of clinical documentation improvement programs can be characterized as an unreliable imprecise measure of overall success.  While case-mix over time can potentially increase over time as clinical specificity in diagnoses capture improves, there are a myriad of contributing factors that control the ultimate calculation of case-mix.  Attributing improvement in documentation to increases and fluctuations in realized numbers is a misnomer and falsehood. Case-mix index can be considered at best to be an instantaneous approximation of revenue the Chief Financial Officer can collect under the best possible scenario. Unfortunately, the measure of case-mix is thought of as the standard measure of return on investment for clinical documentation improvement programs. From case-mix emanate other supporting key performance indicators that drive CDI operational processes which are inefficient, ineffective, counterproductive and counterintuitive. Present day Key Performance Indicators place an overemphasis upon volume of chart reviews versus quality of chart reviews. The actual impact the CDI professional can potentially have will come from a concerted focus upon identifying real opportunities for clinical documentation improvement that are sustainable over time.


Preferred CDI Key Performance Indicators


The preferred reliable standards for Key Performance Indicators consists of elements that accurately report achievement of meaningful improvement in documentation to the mutual benefit of the patient, the physician, all other healthcare stakeholders and the hospital. Let’s review some of these preferred Key Performance Indicators that we should be considering and subscribing to in reporting progress and strides of impacting positive measurable change in overall physician documentation patterns over time. Here are some suggestions to consider:


·       Total number of retrospective queries post coding for documentation clarification per month

·       Total dollar value of retrospective queries post coding for documentation clarification per month

·       Average time in suspense per month of retrospective queries post coding for documentation clarification per 


·       Total number and dollar value of accounts per month:


        o     DRG down-codes

        o     Clinical validation denials

        o     Medical necessity denials

·       Average time spent appealing claims for DRG down-codes, clinical validation denials and medical necessity  


·       Average costs appealing claims per month for DRG down-codes, clinical validation denials and medical necessity 


·       Net days in accounts receivable

·       Cash collection as a percentage of net patient services revenue