In 2008 Glenn Krauss founded Core-CDI to “get back to the core” of clinical documentation. Providing educational knowledge sharing on documentation principles and standards to CDI professionals and educational services to providers. To achieve quality documentation and outcomes Glenn felt there is simply no substitute for physician documentation training starting with the establishment of medical necessity for hospital level of care and accurate and complete capture of the physician's clinical judgment and medical decision making. 

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 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 KPI’s 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 mission and true north hasn’t waivered. Get the documentation right from the start and everything else will follow…