Is CDI about to embark on a long journey to reinvent Itself? There is no arguing that artificial intelligence (AI) and natural language processing (NLP) are making inroads in the healthcare revenue cycle, creating better efficiencies with the automation of a multitude of historically manually performed tasks, thereby reducing positions that were once performed by staff. AI is clearly beginning to take hold and make significant inroads in the clinical documentation integrity (CDI) space. I have noticed serval posts on LinkedIn, as well as in Becker's Healthcare e-newsletters, discussing the role of AI in the revenue cycle. Just recently, there was a blog post published in KevinMD titled "How an AI bot transformed my EHR experience (KevinMD blog)" centering on how AI streamlined the provider's documentation and charting in the electronic health record (EHR) by scanning through the documentation as the note is being completed, providing suggested diagnoses with associated ICD-10 codes.

Clinical documentation is key to demonstrating value in outcomes-based medicine. Complete documentation helps to validate patient outcomes by reflecting the severity of a patient's medical condition, sharing key data with subsequent caregivers and optimizing claims processing and reimbursement. Although clinicians may think they are writing excellent clinical notes, physicians' unfamiliarity with ICD-10 coding often means their notes fail to meet heightened standards for specificity. When this happens, patient outcomes might not accurately reflect the quality of care provided, and may even negatively influence provider performance scores. "Once the final [patient] bill is established and sent out, that becomes what the rest of the world sees about the care you provided for that patient," Anthony Oliva, MD, vice president and CMO at Nuance, said during a discussion April 18 at Becker's Hospital Review's 8th Annual Meeting in Chicago.

Physicians today face increased pressure to produce more accurate, complete and compliant clinical documentation while simultaneously maintaining their focus on patient care and satisfaction. However, without better clinical documentation processes and technology in place, physicians and hospitals risk receiving inaccurate quality scores and lower reimbursement rates. CMS continues to advance the level of reimbursement it ties to clinical performance. By 2018, CMS expects to base payment criteria for Medicare value-based purchasing programs wholly on clinical performance according to efficiency of care (25 percent), patient outcomes (25 percent), patient experience (25 percent) and safety (25 percent). To achieve full reimbursement from payers in value-based care, "clinical coding should capture the complexity of the patient's condition -- the number and severity of comorbidities, the relationships between conditions and the results of treatments and interventions," Anthony Oliva, MD, vice president and CMO at Nuance, said during a webinar sponsored by Becker's Hospital Review Jan. 24.