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How Do I Become a Certified Clinical Documentation Specialist?

Nurse talking with patient in doctors office

Question:

Dear Donna, I would like to know how to become a Certified Clinical Documentation Specialist. I have looked into the Association of Clinical Documentation Improvement Specialists, but does that group offer the proper national certification? Does CCDS involve a lot of writing? Is it a desk job? I am not good with writing, but I have five years of nursing experience on a step-down ICU unit.

Justyna

Dear Donna replies:

Dear Justyna, I'm not sure why you are interested in becoming a CCDS if you don't know anything about it. Also, there is no point in looking into certification before you try it out to see whether becoming a CCDS is something you want to do. Besides which, you have to have some related experience before being eligible for certification. As with most specialties, you don't need to get certified before you can work in the specialty. As a CCDS, you would do education and chart review. You also would work with staff members and physicians to be sure documentation is timely, accurate and complete in order to meet quality standards, minimize liability, maximize reimbursement and so on. It is also helpful to know about coding and billing practices. The Association of Clinical Documentation Improvement Specialists (www.hcpro.com/acdis) is the relevant professional association. I suggest that you do some informational interviewing (www.Nurse.com/Cardillo/Interviewing) with a few nurses working in the specialty before making further moves. Find them through the association, by asking around or by calling area hospitals and locating those doing this in your local area.

Good luck, Donna

  Prepare for the CDIS exam with the Clinical Documentation Improvement Specialist Certification Review Course. Nurse.com offers a fully online self-paced prep course.