Supervisor for coding and reimbursement

Sample Answer

That is an excellent and critical undertaking! As a supervisor for coding and reimbursement tasked with creating a new Clinical Documentation Improvement (CDI) program, the planning and implementation phase requires a comprehensive, multi-faceted approach.

Here are the key considerations I would address, structured across the main phases of the program's development:

📋 Phase 1: Planning and Assessment

The goal of this phase is to establish the foundation, secure resources, and define the program's scope and targets.

1. Needs Assessment and Baseline Data Analysis

Current State Review: Analyze historical data (e.g., last 12-24 months) on Case Mix Index (CMI), Diagnosis-Related Group (DRG) shifts, denial rates related to documentation, physician query rates, and documentation compliance scores.

Target Areas: Identify specific clinical services or physician groups with the largest opportunities for documentation improvement (e.g., Sepsis, Malnutrition, Respiratory Failure, high-volume/high-cost DRGs).

Financial Impact: Calculate a preliminary Return on Investment (ROI) by estimating the potential revenue impact of an accurate CMI and reduced denials. This is crucial for securing executive buy-in.

. Program Structure and Scope

Scope Definition: Determine if the program will initially focus on inpatient acute care only, or if it will immediately include observation, outpatient, or provider-based clinics.

Staffing Model: Decide on the number of CDI Specialists (CDIS) needed. Considerations include:

Nurse-to-Bed Ratio: Typically 1 CDI specialist per 80-120 beds, depending on case complexity.

Staff Credentials: Determine the necessary credentials (e.g., RN, MD, RHIA, CCDS, CDIP). A mix of clinical and coding expertise is ideal.

Technology and Tools: Identify the need for a dedicated CDI software platform (for concurrent review, query tracking, and reporting) and its necessary integration with the Electronic Health Record (EHR).

3. Executive Sponsorship and Physician Buy-in

Securing a Champion: Identify a key physician leader (e.g., CMO, VP of Medical Affairs) and an executive sponsor (e.g., CFO, COO) to champion the program.

Value Proposition: Tailor the message to different stakeholders:

Physicians: Focus on data accuracy, quality scores, Public Health Reporting (e.g., PSI, HAC), and avoiding administrative burdens.