Clinical Validation and the Role of the CDI Professional
Accurate medical coding is important now more than ever. Payers rely on codes to measure the quality of care provided to their beneficiaries, and coded data is also used to validate the medical necessity of rendered services. CDI specialists are uniquely positioned to unify efforts to report claims data that accurately reflects the clinical scenario and the provider’s intent. However, to accomplish this, the CDI specialist must understand how clinical validation relates to payment denials and quality measure performance validation. In this white paper written published by the Association of Clinical Documentation Improvement Specialists (ACDIS), co-author Lisa Romanello, MSHI, BSN, RN, CCDS, a CDI expert with Prism, provides guidance to help standardize how CDI and coding professionals define and apply clinical validation techniques to accurately reflect clinical scenarios and minimize denials.