What is the next step the CDIP should take?

A clinical documentation integrity practitioner (CDIP) has been successful in getting physicians to respond to queries. However, when the CDIP poses a query to a specific doctor, there is no response at all. The CDIP has tried face-to-face conversations, calling, emails, texts, but still gets no response.

What is the next step the CDIP should take?
A . Elevate the issue to the physician advisor/champion after the CDI supervisor has reviewed the case and deemed the query appropriate
B . Report the doctor to the Vice President of Medical Affairs so the doctor understands the importance of clinical documentation
C . Hold a meeting with the CDI director and the doctor to find out why the doctor is not responding to the queries
D . Warn the other CDIPs that the doctor is a non-responder and to forego querying

View Answer

Answer: A

Explanation:

According to the Guidelines for Achieving a Compliant Query Practice (2019 Update) – AHIMA1, a query escalation policy should describe how to handle situations in which an answer is not received, an inappropriate answer or comment is provided, etc. The escalation policy should address when the issue is brought to the physician advisor, the department director, or administration with defined actions as to the responsibilities at each level. The policies should reflect a method of response that can realistically occur for the organization1. In this case, since the CDIP has tried multiple methods of communication with the doctor but still gets no response, the CDIP should elevate the issue to the physician advisor/champion, who can facilitate communication and education with the doctor and ensure documentation integrity and compliance1. However, before escalating the issue, the CDIP should consult with the CDI supervisor to review the case and confirm that the query is appropriate, relevant, and compliant with the query guidelines1. This would ensure that the escalation is justified and not based on personal bias or preference.

The other options are not advisable because they either involve skipping the escalation policy, reporting the doctor without proper review or feedback, holding a meeting without involving the physician advisor/champion, or giving up on querying altogether.

References:

Guidelines for Achieving a Compliant Query Practice (2019 Update) – AHIMA1