A clinical documentation improvement (CDI) advancement ladder is a useful mechanism for attracting and retaining top talent among clinical documentation specialists in an increasingly competitive market. The advancement ladder is a detailed path to professional growth that outlines incremental rewards for both clinical and nonclinical members of the CDI team.
Although advancement ladders traditionally have been available only to nurses in clinical settings, this type of career growth model can extend to both coders and clinicians through newly defined, clinical-documentation-specialist-specific ladder levels. By adopting a CDI advancement ladder, hospitals and health systems can minimize staff turnover and attract the best candidates, thus saving money and better reflecting quality of care.
The three recommended levels of clinical documentation specialists (CDS I, II, and III) range from new to experienced staff.
The CDS I should correctly identify physician query opportunities more than 90 percent of the time, interact with the physician to discuss queries more than 80 percent of the time, and accurately reconcile all cases more than 95 percent of the time. In addition, the CDS I should be proficient in query writing and should escalate immediately when physicians are unresponsive, according to the query escalation policy.
The CDS II should demonstrate all the skills of the CDS I, with an error rate of less than 5 percent. Further, the CDS II should be expected to attain certification via the Association of Clinical Documentation Improvement Specialists or the American Health Information Management Association.
Finally, the CDS II should be able to function as a team leader and be expected to volunteer for special projects, such as developing physician education materials.
In addition to the CDS I and II skills noted above, the CDS III should be able to serve as a CDI department manager, a database manager for the tracking tool, and/or a reports specialist for data that does not fit into a standard report from the tracking tool. A CDS III should be able to represent his or her peers on internal hospital committees and participate in senior leadership meetings to present CDI program metrics.
Clinical documentation specialists are in high demand, in both inpatient and outpatient settings, so financial incentives are worthwhile. A 3 percent pay raise for promotion of a specialist from CDS I to CDS II is recommended, and the recommended raise for elevation from CDS II to CDS III is 5 percent.