SMRT Doc  |  Adult & Pediatric CDI Programs

The acronym S.M.R.T. stands for Saying Medically Relevant Things. It is our contention that a large communication gap exists between the originators of most clinical documentation (providers) and those applying codes and combating reimbursement issues.

This language gap leads healthcare organizations to misrepresent the complexity and disease burden of their patient populations resulting in both peer comparison inaccuracies and payment differentials.

Engagement, Specificity and Accuracy are the true cornerstones of our management philosophy. To achieve engagement, each major actor in the CDI process and corresponding feedback loops (including clinical, the CDIS team, HIM coders and revenue integrity) must understand how this is done, why it is strategically important and what the CDI process can do for them specifically. Specificity and accuracy are a byproduct of both relevant (things they see every day and can act upon immediately following the information exchange) training, and, understanding the measurement mechanisms in the CDI feedback machine that lead to overall increases in peer comparison and financial performance.

A defensible revenue strategy, one that can withstand audit reviews and medical necessity denials, starts with accurate and complete clinical documentation coupled with a common lexicon understood by CDI professionals and coders. When these factors are in place, problem isolation, justified reimbursement, ROI and peer comparison become inevitable results of addressing the problem and not its symptoms.