In 2013, CMS introduced mandatory quality programs, beginning with value-based incentive payment (better known as the Hospital Value-Based Payment Program, or HVBP) and the readmission reduction policy (better known as the Hospital Readmission Reduction Program or HRRP). These programs were followed by the implementation of the hospital-acquired conditions penalty, better known as the HAC Reduction Program (HACRP). Along with these changes came increased visibility to mortality using severity of illness (SOI) and risk of mortality (ROM) which were closely aligned with reimbursement, making it easier to focus on quality and let reimbursement follow. In response to CMS changes, Core-CDI introduced new KPIs at HFMA that measure the total impact of CDI’s activities on net patient revenue. 

Today more than ever commercial payers are using artificial intelligence to review documentation and claims for clinical validation and medical necessity. Healthcare leaders are coming to realize focusing solely on securing diagnosis and specificity without achieving meaningful improvement in supportive documentation results in unnecessary, self-inflicted, nontechnical denials. In January of 2024, Core-CDI introduced pre-bill Revenue Optimizer technology to help healthcare systems take a proactive preemptive approach to denials and Clinical Documentation Integrity. A lot has changed since 2008 but Core-CDI's mission and true north hasn’t wavered. Get the documentation right from the start and everything else will follow.