Achieving Outpatient CDI: Part IV

EDITOR’S NOTE: The following is part of a series on outpatient clinical documentation integrity (CDI). Part III was published on May 9, 2017 in the ICD10monitor eNews.

Outpatient CDI specialists must first and foremost exhibit the mindset and display characteristics of a businessperson. This individual should be capable of identifying, developing, and tailoring a business plan to effectively execute the goals and objectives of the CDI program.

Each outpatient CDI specialist must recognize that he or she is running a business within a business, entailing constantly maintaining a pulse on business operations; tailoring activities in a just-in-time manner while still meeting the educational needs and desires of physicians; and understanding and practically applying best-practice principles and standards in their daily practice of medicine. A specific CDI initiative or project may require revisions and critical thinking skills in midstream. 

Requisite Skill Sets, Core Competencies, and Knowledge Bases

The following represents the requisite skill sets, core competencies, and knowledge bases of a competent outpatient CDI specialist, at a minimum to fulfill the goals, objectives, roles, and responsibilities of an outpatient CDI program:

• Clinical knowledge and acumen
• Interpersonal skills
• Effective communication skills
• Self-starting (no hand holding!)
• Appetite and commitment for continual learning
• Self-motivation
• Willingness to invest time
• Business mindset and openness
• Creativity inspiration
• Proactive and forward-thinking attitude
• Strong negotiating skills
• Marketing skills
• Persuasiveness
• Public speaking ability
• Keen knowledge of Medicare and other third-party payor regulations governing documentation and cover requirements
• Outpatient coding knowledge with practical hands-on experience
• Exemplary research skills

In addition, the following general skill sets and core competencies are mandatory for the selection and hiring process:

• Teamwork
• Leadership
• Adaptability
• Reliability
• Critical thinking
• Integrity
• Decision making
• Honesty
• Work standards
• Problem solving
• Stress tolerance
• Organizing
• Relationship building

Getting Started: A Reasonable Approach

The selection, interviewing, and hiring process can often be daunting. Resumes may be front-loaded with buzzwords and puffery, and candidates may present themselves well during the interview process but not as well thereafter. After the vetting and hiring process is completed, you may find that the individual is missing several of the critical practical skills necessary to contribute to the success of an outpatient CDI initiative.

What should you do to avoid such a misstep in the hiring process? It is highly recommended that the process include several case studies and clinical scenarios with role plays to afford the opportunity to view the candidate “in action.” Clinical scenarios include providing Health Insurance Portability and Accountability Act (HIPAA) cases in which key documentation elements are missing or incomplete, such as a scenario of a nonspecific diagnosis for a physician-ordered test; an operative report with nonspecific preoperative and postoperative diagnoses; or operative reports without an encompassing indication for a procedure. Other such scenarios could include presenting several business ideas and requesting the candidate to outline how they would research the idea, determine if the idea can be brought to market, develop a sales and marketing plan, and identify a target audience.

Ask them how they would overcome objections and resistance from decision-makers for the product and how they would proceed in the event that the product fell out of favor with customers. How would they deal with an angry, unreasonable customer? By incorporating clinical and business scenarios into the interview process, you will gain a keen perspective of whether the candidate indeed possesses a solid foundation for success in the rollout of an outpatient CDI initiative.

A word of caution is in order: do not overlook the importance of and short-change the selection, interview, and hiring process. After conducting due diligence, planning, organizing, and developing, sell the program to all relevant parties within the hospital. Invest the time and take the lead in the staffing process, keeping an open mind as it pertains to deciding who will make a competent outpatient CDI specialist.

Don’t fall into the limited mindset that the candidate must be a nurse; this is a misnomer and fallacy that must be dispelled in the outpatient CDI arena.