Remote CDI: A Remote Possibility?

EDITOR’S NOTE:

During a recent edition of Talk Ten Tuesdays, Dr. Erica Remer responded to a listener’s question about clinical documentation integrity specialist (CDIS) working remotely. Here is Dr. Remer’s response.

As I tell residents, historically, charting and chart review was done on the floor, because that’s where the chart was. Clinical documentation integrity specialists (CDISs) and providers, consultants, and attendings could comingle and communicate. The workflow certainly changed with the implementation of the electronic medical record.

So the question becomes, if the provider doesn’t have to physically be at bedside to document, does the CDIS have to be in-house? I liken it to the dilemma of “do you have to import every lab and radiology report into every progress note?” Spoiler alert, I think the answer to that one is a resounding “no,” too.

The technology certainly can sustain remote CDI. Chart review; querying and documentation; tracking of outstanding queries, responses, and productivity metrics; and data analysis can all be done electronically. You can reach a provider by pager, Spectralink phone, or cell phone. Heck, you could do a quote-unquote face-to-face with a provider by Facetime or Skype.

The pros of remote CDI are the following:

  1. Some CDI professionals would like the flexibility and ability to work at home, and a happy employee is a more productive employee. I can relate; sometimes I even do Talk-Ten-Tuesdays in my workout clothes, without makeup on!
  2. Eliminating a commute can increase productivity. It is easier to work an extra 20 minutes to finish up a task when you know you are already at your end destination, and you can actually work with a cold.
  3. Literature supports an increase in productivity of around 30 percent.
  4. There is also a reported decrease in overhead costs.
  5. Finally, retention is at least as important as recruitment. If the facility down the road allows for remote CDI, your employee may jump ship.

Cons include the following:

  1. There is potential degradation of the relationship with providers. It can be an uphill battle to have CDI be accepted when we are right in their faces, let alone out of sight, out of mind.
  2. Administrative concerns about productivity could be allayed by accountability safeguards and metrics.
  3. There are legitimate privacy and security concerns.
  4. There can be difficulty setting personal and professional boundaries. You have to be clear where your work day ends and your private life begins.
  5. There is the threat of loneliness and isolation. Don’t underestimate the value of the camaraderie, and the liberal exchange of ideas and knowledge is quite beneficial.

My opinion is that remote working is not for every employee, but that it is very doable for a system. There should always be some on-site presence interacting with providers and performing verbal concurrent queries, multidisciplinary rounding, and education. There should be at least monthly CDI meetings to keep everyone up to speed and engaged. Only experienced CDISs should be given off-site privileges.

However, I think the ideal is always going to be a combination of remote and onsite presence. How many hours a day, or days a week, how many CDISs at a time will vary by facility and culture, but personally, I think remote CDI is becoming normative.

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Erica E. Remer, MD, CCDS

Erica Remer, MD, FACEP, CCDS, has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. As physician advisor for University Hospitals Health System in Cleveland, Ohio for four years, she trained 2,700 providers in ICD-10, closed hundreds of queries, fought numerous DRG clinical determination and medical necessity denials, and educated CDI specialists and healthcare providers with engaging, case-based presentations. She transitioned to independent consulting in July 2016. Dr. Remer is a member of the ICD10monitor editorial board and is the co-host on the popular Talk Ten Tuesdays weekly, live Internet radio broadcasts.

Related Stories

Denied!

Denied!

According to an Experian Health Data report, the rate of insurance denials is increasing, up to between 10 to 15 percent. Anecdotally, hospitals can confirm

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

HIM coding expert, Kay Piper, RHIA, CDIP, CCS, reviews the guidance and updates coders and CDIs on important information in each of the AHA’s 2024 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 15, 2024

Trending News

SPRING INTO SAVINGS! Get 21% OFF during our exclusive two-day sale starting 3/21/2024. Use SPRING24 at checkout to claim this offer. Click here to learn more →