Our client is large U.S. health system with multiple hospitals across the Southeast. This case study highlights findings from a comprehensive CDI audit evaluating query compliance, missed opportunities, and coding accuracy.
Post-audit results delivered actionable insights to strengthen documentation and drive financial performance.
Challenge
Our client sought deeper insight into the effectiveness of its CDI and coding practices. Leadership aimed to better understand query compliance, missed query opportunities by internal CDIS, and documentation accuracy across facilities. Greater visibility was needed to evaluate performance consistency and uncover issues impacting compliance and revenue.
Solution
Managed Resources conducted a comprehensive review of 300 inpatient accounts across multiple hospital locations to assess documentation and coding performance. Our audit sample provided leadership with systemic trends, compliance risks, and recurring missed query opportunities to enable strategic decision-making and operational enhancements.
Results
Our audit findings revealed that 47% of sampled accounts had query opportunities resulting in undercaptured patient complexity, lost revenue, and variability in documentation performance.
Missed query opportunities affecting DRG assignment equated to an average financial impact of $1.6K per account and an estimated $2.1M in annual revenue opportunity.
Top 4 DRGs With Missed Query Opportunities
- Sepsis (854, 871, 872) – 11%
- Heart Failure (291) – 7%
- Respiratory Infections & Pneumonia (177, 193) – 6%
- Cardiac Arrhythmia (308, 309) – 5%
Top 4 Missed Query Opportunities
- Acute Blood Loss Anemia (D62) – 12%
- Hyponatremia (E87.1) – 12%
- Acute Kidney Injury (N17.9) – 10%
- Sepsis (A41.9) – 6%
Top 4 Missed Query Opportunity Types
- Missing CC (at least 1) – 41%
- Missing MCC (at least 1) – 18%
- Clinical Validation Clarification – 13%
- Impact Principal Diagnosis Assignment – 9%
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Conclusion
This CDI audit demonstrated the measurable financial and performance impact of missed query opportunities across the health system. By identifying documentation gaps and DRG-impacting opportunities, leadership gained clear visibility into both revenue upside and process improvement needs.
Strengthening CDI practices supports accurate capture of patient complexity and sustains long-term financial integrity for leaders committed to operational consistency and strategic growth.
Connect with Managed Resources to learn more about the benefits of CDI audits, or schedule a complimentary CDI Assessment to pilot our services.