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Clinical Documentation Improvement  
 Proprietary technology and comprehensive education for complete and accurate patient documentation and optimized reimbursement


Documentation requirements will continue to increase in complexity with ever changing rules and regulations, new reimbursement methods and the transition to ICD-10.  All of these quality-related initiatives will challenge hospitals to maintain appropriate clinical documentation staff knowledge for optimal coding accuracy. MedAssets offers a CDI program that combines proprietary leave-behind technology with expert consulting to improve the integrity of clinical documentation. Designed as a holistic solution, the program delivers the automation tools and knowledge needed to create and sustain an informed, efficient clinical documentation staff and a profitable, compliant organization.  

Improve Profitability and Compliance
Accurate documentation links directly to strong financial performance.  A concerted effort on clinical documentation optimization can help hospitals gain a significant return on investment — as much as four to 10 times the initial cost. The MedAssets CDI program helps healthcare organizations realize immediate and positive cash flow by increasing staff efficiency and understanding of existing and new compliance and regulatory issues. It also introduces automation for more timely clinical queries and identification of supportable reimbursement for patient care resources.  Below are other key capabilities that will help your organization achieve the most complete and highest quality documentation possible

  • Reduces future exposure to Recovery Audit Contractor (RAC) recoupments
  • Decreases discharged not final billed (DNFB)
  • Improves publicly reported mortality-based quality scores
  • Facilitates faster coding and reduces billing cycles
  • Analyzes conditions and procedures for the most appropriate Diagnosis Related Group (DRG) to achieve a higher case mix index 
  • Identifies and addresses documentation gaps prior to the ICD-10 transition to minimize potential revenue losses
  • Provides for the most appropriate length of stay based on severity of illness to identify the true outlier population
  • Provides accurate data and detailed documentation for Centers for Medicare and Medicaid Services (CMS) quality measures, pay-for-performance and other national reporting initiative
  • Addresses potential DRG exposure areas by providing more comprehensive documentation
  • Reduces future exposure to Recovery Audit Contractor (RAC) recoupments

Increase Accuracy and Efficiency through Proprietary Technology
Via a Health Level 7 (HL7) feed of patient demographics, the CDI Manager application puts data at the fingertips of your clinical documentation specialists to streamline identification of clinical indicators that impact the DRG, severity of illness and risk of mortality. The application’s intuitive design makes it easy for users to navigate, and supports the enhanced workflow. The system is designed to conduct concurrent review to facilitate improved capture of accurate data at the point of care to eliminate duplication and facilitate a more accurate and complete medical record. 

  • Enables clinical documentation specialists  to view canned queries to better  capture clinical indicators and procedures, such as severity of illness of the patient population and to “right size” the length of stay appropriate to the DRG requirements
  • Generates physician queries in real-time during documentation review, thus increasing the physician response rate and clinical documentation specialist efficiency
  • Alerts clinical documentation specialists to follow-up on  unresolved physician queries
  • Reduces staff query development process  to less than five minutes
  • Web-based reporting tool integrates clinical, financial and demographic data to assist the management team in trend analysis and tracking of  financial benefits, performance and productivity—any time, any where

Assessment and Education to Sustain Benefits
MedAssets comprehensive CDI program offers a thorough assessment to uncover clinical documentation opportunities and exposures. The assessment can be packaged with a customized, eight-week onsite didactic education program and up to five years of ongoing education. The investment in education will empower your key stakeholders to make any necessary adjustments in documentation practices going forward to sustain success, production and accountability.

  • Multiple one-on-one interactive sessions, proven for adoption of the required documentation and mindset among medical staff
  • Targeted re-education, when appropriate, with robust reporting through MedAssets Clinical Documentation Improvement software
  • Weekly conference calls immediately following implementation
  • Quarterly continuing education opportunities to foster stability and continued buy-in
  • Ongoing analysis and tracking to focus efforts and increase results

 Revenue Impact from Clinical Documentation Improvement Program

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Improve your
Operating Margins

MedAssets improves
and sustains
operating margins
by 1.5% to 5%.

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