Which group is involved in the feedback loop between denials, management, and clinical documentation improvement (CDI) program staff?

The feedback loop between denials, management, and the clinical documentation improvement (CDI) program staff is primarily facilitated by the compliance group. The compliance department plays a crucial role in ensuring that the organization adheres to legal and regulatory requirements, which includes monitoring and addressing claim denials. They analyze trends resulting from denials and work with the CDI staff to ensure that documentation adequately supports the medical necessity of services provided. This collaboration helps improve documentation practices and can reduce future denials, ultimately leading to better compliance and revenue cycle management.

Additionally, by addressing issues raised in denials, the compliance team can influence the policies and procedures that the organization adopts, creating a more structured approach to clinical documentation. The involvement of compliance in this feedback loop is vital as it ensures that both clinical and administrative staff are aware of compliance standards and how documentation impacts them, fostering an environment of continuous improvement.