Accurate identification of severity of illness is critical for risk adjustment, which ensures that patient outcomes and costs are appropriately contextualized based on patient complexity. Clinical documentation improvement (CDI) specialists are experts in ensuring that medical records accurately reflect the patient’s condition, diagnoses, and procedures, which directly impacts risk adjustment models and cost reporting.
Option A (Clinical documentation improvement specialist): CDI specialists work with providers to improve the accuracy and completeness of clinical documentation, which is essential for capturing severity of illness. According to NAHQ CPHQ study materials, CDI programs enhance coding accuracy, which supports risk adjustment methodologies (e.g., Hierarchical Condition Categories or Charlson Comorbidity Index) used in quality and cost reporting. This makes them the most relevant team member for this goal.
Option B (Chief financial officer): The CFO oversees financial strategy but does not specialize in clinical documentation or severity of illness. Their role is more relevant to budgeting and financial outcomes, not direct risk adjustment.
Option C (Risk manager): Risk managers focus on mitigating liability and patient safety risks, not on clinical documentation or severity of illness for risk adjustment purposes. Their role is tangential to this objective.
Option D (Nursing staff): While nursing staff contribute to patient care documentation, they are not specifically trained in CDI or risk adjustment processes. Their role is supportive but not primary in this context.
[Reference: NAHQ CPHQ Study Guide, Domain 4: Performance and Process Improvement, emphasizes the role of CDI specialists in improving documentation accuracy to support risk adjustment and quality reporting., , , ]
