In which area does Clinical Documentation Improvement (CDI) primarily contribute?

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Clinical Documentation Improvement (CDI) primarily contributes to enhancing the accuracy of medical records and coding. The essence of CDI is to ensure that clinical documentation accurately reflects the patient's conditions, treatments, and the care provided. This accurate documentation is crucial for various reasons, such as ensuring appropriate reimbursement, facilitating better patient care, and preventing legal issues.

By improving the accuracy of medical records, CDI teams help create a clearer picture of a patient’s healthcare journey. This, in turn, leads to more precise coding, as coders rely on comprehensive and accurate clinical documentation to assign codes correctly. Quality documentation also plays a vital role during audits and reviews, as it helps substantiate the actions taken and services rendered.

The other options tend to misunderstand the function of CDI. For instance, CDI aims to streamline processes and improve accuracy rather than increase wait times or require fewer clinical assessments. It may also lead to a reduction in coding errors as a byproduct of improved documentation; however, the primary focus remains on achieving a higher standard of accuracy in medical records and coding.

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