Web Articles
When CDI Fails
Outpatient CDI
Are Most CDI Programs a Sham?
“When AI Speaks After Discharge: Are Diagnoses Truly Clinically Defensible?”
CDI Is Not a Revenue Hack—It’s the Patient’s Clinical Story- Staying On The Right Side Of The Ride
Here’s a fact‑based explanation of how the trends identified by the HHS Office of Inspector General (OIG) and the RAND Corporation December 2024 study relate to CDI More>>
When Optimization Backfires: How CFO-Driven CDI and AI Tools Can Increase Payer Denials and Financial Risk
Hospital Chief Financial Officers face unprecedented pressure to stabilize margins, optimize inpatient reimbursement, and offset the financial headwinds More>>
Financial Margin Optimization, CDI Expansion, and the Evolution of Payer and Medicare Contractor Oversight
Hospitals face intensifying pressure to optimize margins while navigating unprecedented scrutiny from commercial More>>
Stop Denials Before They Start
Clinical Documentation Integrity (CDI), medical coding, and hospital revenue cycle teams play a mission‑critical role in translating the clinical reality of patient care into accurate data, compliant claims More>>
Your CDI Program Might Be Driving Revenue — Or Driving an OIG Audit
Hospitals rolling out AI tools to “enhance” documentation may think they’re capturing missed revenue—but Medicare sees something very different. When AI starts manufacturing More>>
Aggressive CDI queries today, OIG audits Tomorrow. Risk Isn’t Optional.
Chief Financial Officers should be extremely concerned about the compliance risks and financial exposure created by traditional, query-driven CDI programs—especially when those More>>
Chasing Higher DRGs Is Costing Hospitals Millions — and CDI & CFOs Don't Even Realize It
This is a valid question- Why is it that CFOs and the CDI profession fail to connect the dots and associate chasing revenue using AI-driven CDI platforms to scoop up CCs/MCCs is counterproductive More>>
CDI Must Evolve—Or Hospitals Will Pay the Price
For more than a decade, Clinical Documentation Integrity (CDI) programs have operated within a narrow, reactive framework: conduct retrospective reviews, identify gaps after the fact, and issue queries to “fix” documentation just before coding. This model has been institutionalized, budgeted for, More>>
CDI “Maximization” AI: The New Engine of Upcoding Risk
Modern CDI software increasingly uses algorithmic prompts to push CC/MCC capture, often without clinical correlation. These tools nudge providers toward language that embellishes severity, More>>
The CDI ROI Crisis: Why Hospitals & CFOs Lose Millions Chasing Illusory Revenue
The Clinical Documentation Improvement (CDI) profession emerged with noble intentions: improving clarity of the medical record, ensuring accurate diagnosis reporting, and More>>
Why CFOs Using CDI Programs to Increase Reimbursement Is a Hoax — and a Monumental Compliance Risk
The CDI Illusion: How Reimbursement-Driven Strategies Expose CFOs to Compliance Risk More>>
What It Will Take for CFOs to Realize the Truth About CDI?
Hospitals and CFOs remain trapped in a short-sighted cycle where Clinical Documentation Integrity (CDI) programs are primarily valued for their ability to “lift” Case Mix Index (CMI) and maximize revenue through CC/MCC capture. More>>
Strategic CDI: Turning Documentation Integrity Into Organizational Advantage
The CDI profession must embrace clinical transformation, representing CDI 2.0. CDI 2.0 incorporates role-based versus More>>
Rebill Roulette: CFOs, Guard Your Revenue
Rebilling Medicare for a higher-weighted DRG after an initial reimbursement can carry significant reimbursement and compliance risks. Here’s a detailed breakdown: More>>
The Great CDI KPI Deception: What CFO Aren't Being Told
If you are relying on the following on traditional CDI KPIs to judge and assess performance of your CDI program, you are not considering the entire picture. The average cost of most CDI programs More>>
The Sepsis Money Loop: From Query to Audit & Denial Risk
A deep-dive explanation of the financial and compliance incentives behind CDI (Clinical Documentation Improvement) programs for sepsis, how that connects to improper coding, and why this has been a persistent issue. More>>
CDI Software That Focuses on Diagnosis Capture Without Documentation Improvement Creates A Mirage
Hospital CFOs are increasingly targeted by technology vendors that promise “diagnosis capture” platforms capable of generating More>>
Why CFOs Fall Into the Trap
CFOs are often misled by the “revenue enhancement” narrative rather than true revenue integrity. CFOs can unlock greater, sustainable revenue integrity by shifting focus from DRG optimization to documentation integrity. More>>
Revenue Isn’t Found in Codes—It’s Built in Documentation
Why most hospital leaders do not clearly understand the difference between a CDI program focused on coding/billing support and one focused on denial management and documentation integrity: More>>
Are Query Centric CDI Programs Effective?
Query-centric Clinical Documentation Integrity (CDI) programs often fail to drive lasting, sustainable results because they focus too narrowly on query volume and retrospective documentation correction More>>
Why CFOs Must Refocus: From CMI and CC/MCC Capture to Optimized Inpatient Claims
“CFOs: Own the Revenue Game”
CFOs must lead a transition from query-centric CDI and retrospective index watching to proactive documentation optimization as part of a broader clinical and financial integrity strategy.
CDI Consulting Firms- Driving or Delaying CDI Transformation
Many hospital leaders are beginning to realize that CDI consulting firms, while valuable in certain respects, have also played a major role in stalling the true clinical transformation of CDI programs. More>>
Stronger Documentation, Stronger Revenue: Why CDI Matters
A core skill for CDI specialists that often determines whether inpatient status is supported or denied due to a lack of medical necessity is being able to review the medical record and identify insufficiencies in physician documentation that detract More>>
You Don't Know What You Don't Know in CDI and AI Adaptation
Many CDI professionals are unaware of how rapidly AI is reshaping documentation, coding, and compliance—and how their current models may become obsolete. More>>
Balancing CDI Program Benefits While Mitigating Risks
Hospitals can mitigate compliance risks in their inpatient Clinical Documentation Improvement (CDI) programs amid the Medicare Improper Payment Reduction Strategy by implementing proactive measures More>>
Hospital Finances- CDI Programs Can Help or Hinder Depending.....
Current CDI (Clinical Documentation Integrity) programs that function primarily as retrospective, reactive, transaction-based query processes—where CDI staff review records after admission and sometimes after discharge, More>>
Do Current CDI Key Performance Indicators Reliably Measure CDI Performance and Outcomes?
Ingrained in most CDI Programs as measures of success and overall performance of CDI programs, measures that are presented to More>>
Does AI Have the Ability to Alleviate Payer Denials Effectively
Bottom line: AI won’t eliminate denials, but it can significantly reduce them by catching errors early, improving documentation, and predicting high-risk claims More>>
Advancing the CDI Profession- Acquiring the Skill Sets
What are the skill sets, core competencies, and knowledge base that CDI professionals need if they want to move beyond query-driven, transactional work and truly operate at the top of their game More>>
Is Your CDI Program Providing Real Value
The majority of hospitals have invested heavily in Clinical Documentation Integrity Programs with sunk costs that CFOs believe are providing a solid return on investment. In reality, More>>
CDI Week 2025- Developing A Reason To Celebrate
If CDI (Clinical Documentation Integrity) professionals want a real reason to celebrate ACDIS Week 2025 (Sept 15–19), it shouldn’t just be about balloons and slogans. It should be about More>>
Why the ACDIS article titled “2025 CDI Week Q&A preview: Denial Management” does not deliver on the promise of advancing physician documentation
Let’s dive into and explore the obvious limitations of this article. My goal in this post is not to barrage ACDIS but instead to provide More>>
Getting It Right- H & P Documentation That Tells the Patient's Clinical Story
The History & Physical (H&P) examination is a critical first step in establishing the foundation of a patient’s clinical care. Beyond meeting regulatory requirements, well-documented H&Ps provide a clear, More>>
Is CDI Positioned and Capable of Alleviating Medical Necessity and Clinical Validation Denials?
I was recently asked by a mid-sized hospital CFO why he is experiencing increasing medical necessity and clinical validation denials, despite investing heavily in his CDI program. More>>
When the Patient’s Story is Missing, CDI is Just a Façade
Limiting CDI reviews to coding or reimbursement overlooks critical opportunities to improve patient care, compliance, and operational efficiency. A holistic approach ensures documentation fully captures the patient’s story More>>
The Reality of Sunken Costs with Little Return on Investment
Annual cost includes salary, benefits, software license, training, IT costs, and consulting costs. The Loss in CDI Programs More>>
How CDI and CDI Consulting Companies Are Contributing to Their Irrelevance
Clinical Documentation Integrity (CDI) programs and consulting companies in bed with ACDIS have long positioned themselves as critical to hospital revenue optimization and compliance. More>>
CDI Is Not In The Business of Coding
Why Coding-Focused CDI Limits Operational Improvement in Physician Documentation. Focusing on coding means documentation is addressed after patient care is complete. More>>
Clinical Documentation Integrity (CDI): A Sham or a Missed Opportunity?
Executive Summary: Clinical Documentation Integrity (CDI) programs were introduced with the promise of improving patient care, supporting clinical accuracy, and ensuring appropriate More>>
Effective documentation Denials Avoidance
CDI professionals review inpatient encounters for completeness and accuracy of provider documentation geared towards the capture of diagnoses supporting optimal compliant coding. More>>
A Fool With A Tool Is Still A Fool
The saying "A fool with a tool is still a fool" applies to Clinical Documentation Improvement (CDI) software because technology alone cannot compensate for a lack of understanding, training, or judgment. This applies to Clinical Documentation Improvement (CDI) software. More>>
CDI Proficiencies- Check Off List
A highly skilled Clinical Documentation Integrity Specialist (CDIS) plays a critical role in ensuring accurate, complete, and compliant clinical documentation that supports patient care, helps establish medical necessity for More>>
Rethinking Current CDI Key Performance Indicators
Should CDI professionals rethink how they present/talk about CDI KPIs with physician. Put the activities in a framework that physicians can easily relate to? More>>
Physician Documentation Integrity Software- Is it the Panacea CFOs Are Led to Believe.
More and more hospitals and health systems are deploying clinical documentation improvement (CDI) software on the premise that software will enhance the efficiency of the CDI Specialists in More>>
At the Intersection of CDI and the False Claims Act
Excellent topic to be discussed at this week's Monitor Monday with Chuck Buck at the helm. While there are many benefits of implementing and operating a Clinical Documentation Integrity program More>>
Are CC/MCC and CMI Increase Indicative of Financial Performance?
The roles of VP of Revenue Cycle and CFOs are pivotal in managing the financial health of healthcare organizations, and both must take a comprehensive approach to ensure sustainable, long-term success. More>>
Remote CDI- Is It Really Effective?
Onsite Clinical Documentation Improvement (CDI) programs are designed to enhance the accuracy, completeness, and specificity of medical documentation. When these programs operate remotely More>>
Physician’s Preferences – CDI Programs- Stop the Queries
Physicians want a Clinical Documentation Integrity (CDI) program that is efficient, minimally disruptive, and truly beneficial to patient care and compliance. Here are the key elements More>>
Importance of Emergency Department Documentation
In my review of countless medical necessity payer denials and level of care downgrades for clients, a common theme arises for the primary contributing factor, poor documentation in the Emergency Department. More>>
CDI Programs Generate Denials!
CDI (Clinical Documentation Improvement) program queries are a part of ensuring accurate clinical documentation, but often they result in denials for a variety of reasons. More>>
CFO's- Is Your CDI Program a Real Benefit or Drag to the Hospital's Finances
Clinical Documentation Integrity (CDI) programs are designed to ensure that patient records accurately reflect the care provided, which in turn supports appropriate reimbursement. More>>
Measuring Clinical Documentation Integrity Program Success-The Truth
CFOs must carefully evaluate their current Clinical Documentation Improvement (CDI) program initiatives for several important reasons, rather than relying solely on current Key Performance Indicators (KPIs) as the sole measure of success. More>>
Why CDI Queries May Be Counterproductive
CDI reviews the record, identifies a query opportunity, issues a query, physician responds in the affirmative, More>>
Physician Documentation Training- Centerpiece of CDI Programs
A missing component in most CDI programs is the delivery of physician documentation training. More>>
Finally Friday - Proudly Serving Healthcare Providers
Register below to watch it on-demand. More>>
The Hidden Cost of CDI Programs- Bringing It To The Top
Hospital CFOs may struggle to fully understand the hidden costs of Clinical Documentation Improvement (CDI) programs for several reasons. More>>
Physician Documentation Excellence- Addressing the CDI Misnomer-Setting the Record Straight
In essence, "physician documentation excellence" is about mastering the clinical aspects of documentation, whereas CDI specialists focus on improving the quality of documentation More>>
AI Advancement- Will This Impact the CDI Profession?
Artificial intelligence (AI) has the potential to significantly impact many fields, including clinical documentation integrity (CDI). While AI is unlikely to completely replace Clinical Documentation Integrity Specialists (CDIS) More>>
Achieving Physician Documentation Excellence
Learning from Mike Kertes, National Director of CDI for CDIA in Australia, shared his wisdom in CDI with Cesar M Limjoco MD and myself discussing a wide array of topics in CDI. More>>
Effective CDI Processes-Focusing on Communication of Patient Care
Typical key performance indicators (KPIs) of Clinical Documentation Improvement (CDI) programs do not effectively measure the performance the program for several reasons. More>>
Championing Integrity in CDI
Cesar M. Limjoco, M.D., Faisal Chawla, and I joined forces to produce the first of a series of podcasts titled Championing Integrity in CDI. More>>
Copy & Paste- Foe or Ally
The electronic health record can be the physician’s foe or opponent, depending upon how the record is used and the information charted. More>>
Are CDI Programs Operating at the Top of Their Game?
The clinical documentation integrity (CDI) profession began its heyday in 2008, with the advent of the Medicare Severity Diagnosis-Related Group (MS-DRG) system that built and expanded upon the simpler system consisting of DRGs with complications and comorbidities (CCs) or major CCs (MCCs) and those without. More>>
Rebranding and Repurposing CDI Programs
Clinical documentation improvement (CDI) typically focuses on improving the accuracy and specificity of physician documentation, especially regarding diagnoses. While this focus is crucial for several reasons—such as ensuring proper reimbursement, supporting quality metrics, and enhancing patient care—it does not always achieve "true physician documentation excellence" for several reasons: More>>
CDI Operational Performance: A Construct
I recently engaged in a fascinating discussion with Dr. Jake Martin on the “Top 10 Key Components of An Effective CDI Program,” More>>
Physician Documentation Report - First Things First.
The medical record serves as a communication tool first and foremost with reimbursement as a byproduct of complete and More>>
Measuring CDI Performance: A Truthful Conclusion
I was recently asked by a chief financial officer (CFO) what other clinical documentation integrity (CDI) More>>
Opportunity Abounds for CDI – So Seize the Moment!
Jan. 1 has brought us new evaluation and management (E&M) guidelines for inpatient and observation encounters.More>>
Tread Lightly with Sepsis MS-DRGs
MS-DRGs 872 and 871, Septicemia or Severe Sepsis with MCC and without MCC, respectively, More >>
Is Your CDI Program Delivering ROI?
A conversation with a CFO of a large academic medical center regarding the significant financial headwind all hospitals and health systems are currently facing, More >>
CDI and Compliance: The Offense of Being Naked
Diagnosis without supporting the judgment of the physician’s documentation is the phenomenon of nakedness. More>>
Denial Prevention versus Denial Facilitation
The COVID-19 public health emergency (PHE) has unleashed untoward burden More >>
Is Your CDI Program Putting You in the Danger Zone?
CDI programs may be exposing hospitals to costly compliance risks and financial exposure More>>
Learn To Frustrate Payer Auditors When They Send You Denials
Time and time again many a medical necessity denial More >>
Explosive OIG Report Raises Red Flags for Providers, CDI Professionals
The U.S. Department of Health and Human Services (HHS) Office More >>
A Passion for Improvement
Glenn Krauss is an avid CDI supporter. His passion for making CDI the best can be heard More>>
Applying the Toyota Way Principles to CDI
There have been numerous articles and other materials written promoting More >>
Preservation: A Fundamental Component to Revenue Optimization
An American Hospital Association (AHA) report More >>
Progress Notes-There Is More Than Meets the Eye From A CDI Perspective
Progress Notes serve to facilitate the reporting of the physician’s More >>
Outpatient CDI Programs: Are They Poised for Effectiveness and Success?
Outpatient CDI programs have moved into the mainstream More>>
Role-Based Versus Task-Based Clinical Documentation Integrity: A Major Determinant of Operational Performance
Role-based versus task-based business processes More >>
Does CDI Play A Role in Establishing Medical Necessity?
The question of whether CDI plays a role in the establishment More>>
"How Do You See the Future of CDI?" Glenn and Ernie review the answers and comments made by YOU.
A Discussion About How to Save Your Facility More>>
A CDI Revolution Unfolding
I have always been convinced of the strong capabilities of current CDI More>>
New Data Supports Need for CDI Improvement
The 2019 Medicare Fee-for-Service Supplemental Improper Payment Data Report was recently released More>>
Clinical Documentation Improvement: A Fresh Perspective
The latest trend in clinical documentation improvement is within More>>
Searching for Efficiency in the CDI Process
“Efficiency” may be defined in many ways, including the following More>>
What's Ruining Medicine for Physicians
Paperwork and administrative burdens ranks 1st on the list of issues ruining medicine for physicians. More>>
Clinical Documentation Integrity Programs Eroding Net Patient Revenue
Clinical documentation integrity (CDI) programs, combined with the actions More>>
Integrity: The Missing Component in CDI
There is much discussion and movement in the clinical CDI industry regarding More>>
Coding And The 99223 Heavy Hand
Seen the State of Hospital Medicine report for 2018? have, and there is erudition galore. Here More>>
Assessing Inpatient Hospital Billing for Medicare Beneficiaries
In 2016, hospitals billed Medicare $114 billion for inpatient hospital stays More>>
Five crucial points to consider-strengthening CDI programs towards optimizing the revenue cycle
CDI improvement programs have existed for More>>
CDI Seen in New Light as OIG is Poised to Validate DRGs
As many of you are aware, the U.S. Department of Health and Human Services More>>
CDI: Moving to Improve Patient Outcomes
In my article published last week, titled Moving in the Right Direction in More>>
Misguidance Regarding What Defines Outcomes of CDI
Performance with a purpose must be the driving force for More>>
Reporting the Over-Reliance on the Query Process
The hallmark of any true clinical documentation integrity (CDI) program More>>
For The Record: May 2018
Committed to enhancing the health information profession More>>
Getting to the Root Cause of Clinical Documentation Improvement
By now I am confident that most in CDI industry More>>
Moving from Denial Management to Prevention
An estimated 20 percent of all healthcare claims in the U.S. are denied each year. More>>
Electronic Health Record Closed Claims Study: Navigating the Rising Risks of EHRs
A patient was treated with trigger point injections of opioids More>>
Finally Friday
THIS WEEK on “Finally Friday!” More>>
Why CDI Often Times Goes off the Rails
A well-guided, thought-out, directed mission is paramount to driving and ensuring success More>>
Outpatient CDI: A Clinical Perspective
The first article of this series provided an overview, identifying and singling out key shortcomings More>>
Why Most CDI Programs Fail to Engage Physicians
The majority of CDI programs fail to effectively engage More>>
CDI: Is Your Toolkit Well Stocked?
A recent outlook report released by Moody’s Investors Services spells More>>
Glenn Krauss
Glenn Krauss, President and CEO, is a nationally recognized CDI/Revenue Cycle expert and speaker. He has worked with healthcare systems, independent hospitals, and clinics, ranging from large academic medical centers and fully integrated urban healthcare systems to community hospitals, critical access hospitals, and Federal Qualified Healthcare Centers.
Contact Core CDI
