Conduct internal reviews to prevent overreporting of HACs and PSIs

Why This Topic Matters

Hospitals can face payment penalties and public quality reporting consequences when PSI and HAC counts are overstated. The article is relevant to CDI leaders, coders, physician advisors, and revenue integrity teams evaluating internal audit and reconciliation processes.

Article Sections

1. Root cause analysis of averted PSIs and HACs

   Describes a CDI-led review workflow used to identify records associated with PSI and HAC measures and route them through multiple levels of clinical and coding review. The section also discusses the operational purpose of the process and its relationship to quality reporting and reimbursement risk.

2. Benefits of a CDI reconciler

   Summarizes a CDI reconciliation approach used to align coding and documentation reviews, including retrospective audit activity and remote work arrangements. The section focuses on operational results, staffing considerations, and reimbursement impact.