Driving a Successful Documentation Improvement Program. LHIMA Presentation Presented by: Trudy Rioux
|
|
- Rudolf Shelton
- 7 years ago
- Views:
Transcription
1 Driving a Successful Documentation Improvement Program LHIMA Presentation Presented by: Trudy Rioux
2 Is a Program Needed? What is the baseline CMI (Case Mix Index) compared to other facilities within your peer group? For starters, review Med Par. How well is facility doing on risk of mortality? How well is facility doing on severity of illness? Can we create our own program or do we need to consult with a company that has software/reporting metrics/etc.?
3 Point of a Documentation Program: Bridging the Gap Bridging the gap between the physician's language and what is recognized in the code format and by Centers for Medicare and Medicaid Services (CMS) to reflect the severity and complexity of illness.
4 Before Starting a Program You need the following: Administrative buy in is a must and will aid in physician compliance. Alignment to meet the goals. Accountability for the physicians to answer clarifications/queries. Unanswered queries are assigned a medical record completion deficiency post discharge.
5 A Physician Champion It s necessary to have a physician champion to teach the clinical information to the coders and documentation specialists as needed. A Task Force meeting consisting of the documentation specialists, inpatient coding team, VP of revenue cycle, and the physician champion should be held monthly quarterly (depending on the need) which makes a strong team.
6 A Physician Champion Assists educating the physicians on staff about the upcoming program. Can keep a program alive by continuous education about the program at the monthly Medical Executive Committee Meetings.
7 Physician Documentation Equals Physician Documentation = ICD 10 codes ICD 10 codes = 1 MS DRG (Medicare Severity Diagnostic Related Group) per inpatient encounter MS DRG = Length of stay MS DRG = severity of illness, risk of mortality, physician profile, hospital profile MS DRG = Facility Reimbursement
8 Physician Pocket Card Creating a Physician pocket card with the top things clarified for is essential. As a documentation specialist works with a physician concurrently it s something tangible that can be distributed to include the clinical indicators for the condition.
9 Internal Organization Marketing There needs to be marketing about the documentation improvement program. This marketing/education needs to include physicians, nursing, ancillary care, etc. The organization as a whole needs an understanding as to why a documentation specialist might be clarifying about a diagnosis.
10 Which Population of Patients Should be Reviewed? Review just Medicare? Review Medicare Advantage? Review all payers that reimburse on the MS DRG > 55 years of age? Review all payers that reimburse on the MS DRG regardless of age?
11 Documentation Specialist Staffing 1 FTE for every 1,800 discharges This amount could depend on how pure the program is related to the working DRG, follow up and the other duties.
12 Duties of the Documentation Specialist Staff in addition to Clarifying for MS DRG Movement Identifying quality of care issues, HACs, PSIs Assisting with quality measures CHF, Pneumonia, MI, CVA Following queries post discharge if not answered concurrently Severity clarifications that have no impact on the MS DRG but potentially impact risk of mortality and severity of illness
13 New Documentation Specialist Training What has worked? 1 week of intense classroom training Learning the MS DRG system Learning the official coding rules Begin learning documentation strategies
14 New Documentation Specialist Training 6 weeks of rounding with a mentor (an existing documentation specialist; very beneficial to have the new person rotate with each existing documentation specialist) Following those 7 weeks, constant feedback to the new documentation specialist It takes 9 months to a year to yield a seasoned documentation specialist
15 Documentation Specialists Working with HIM Coders Include both the Documentation Specialist and the Coders in all continuing education meetings. Pairing each coder and doc spec for a coder/doc spec buddy system so they can use each other as a resource.
16 Scrubbing Charts Post Discharge Charts are sent to a supervisor review Q pre bill that do not have a CC or MCC prior to final coding. Even if the chart has a CC and the DRG could still use a MCC, the account will get scrubbed. A CC is good but a MCC is BETTER!
17 Scrubbing Charts Post Discharge If an opportunity is sited by the supervisor this is shared with the documentation specialist and coder. A determination is made whether a post discharge query will be generated.
18 Creating a Think Fast Documentation Opportunity Sheet is Helpful A think fast Document are tips on what the documentation specialist or coder should automatically consider when they see certain diagnoses documented. Just because a diagnosis is documented does not mean you will automatically be able to generate a clarification/query.
19 Creating a Think Fast Document Before clarifying you always have to have justification in the form of all of these: Risk factor Clinical indicators Treatment/monitoring
20 CVA Things to Consider.. Hemorrhagic conversion Cerebral edema or compression (look for terms on CT or MRI like sulcal effacement, shift, edema, etc) for a MCC
21 CHF Things to Consider The acuity (acute/decompensated and/or chronic) CHF in the setting of HCVD and HTN/CKD The type of heart failure (systolic/diastolic)
22 Things to Consider Pulmonary Condition (pneumonia, COPD, etc ) or CHF Acute respiratory failure for a mcc Pneumonia Aspiration, gram negative or other specified organism Bronchitis Aspiration
23 Things to Consider Localized infection (Pneumonia, Cellulitis, UTI, etc..) Clinical Sepsis (PDX) Dehydration, Volume Loss, Blood loss, diarrhea, vomiting, poor intake Acute Renal Failure or Acute Renal Failure w/atn
24 Things to Consider Altered Mental Status (AMS) Encephalopathy (mcc) Bedridden/Contracted Patient Functional Quad (mcc) PTCA/Stent coronary artery dissection (mcc)
25 Things to Consider.. More than one diagnosis meeting definition of pdx Can I flip it? One may be a mcc for the other Anemia GI bleed site (gastritis w/bleed, diverticulitis w/bleed, duodenal ulcer w/bleed)(mcc)
26 Things to Consider Post Surgery Hemoglobin/hematocrit Acute blood loss anemia (cc) Chest x ray atelectasis (cc) Cardiac conditions w/atrial fib as secondary Atrial flutter (cc) Persistent atrial fibrillation (cc)
27 Things to Consider.. All Patients Peruse Lab Sodium (hyponatremia cc) Lab Creat (AKI cc) Last Nursing Notes (skin for stage III or IV decubitus present on admission mcc)
28 HIV Things to Consider AIDS (B20) HIV manifestation currently or previously (B20) Injury (fracture, SDH, Internal injury, open wound) Multiple injured sites for MST(multiple significant trauma) MS DRG
29 Fracture Things to Consider Pathologic (non surgery patient could impact DRG) Chemo Patient Pancytopenia due to chemo (mcc)
30 The role of a Documentation Specialist Generating a worksheet on a patient is not beneficial if it s just a worksheet with no fruit. Yielding results by way of an impact clarification to improve the MS DRG or a severity clarification to appropriately reflect risk of mortality and severity of illness.
31 The role of the Documentation Specialist Yielding results by way of insuring the documentation meets the quality measure/core measure requirements. Yielding results by way of clarifying documentation around HACs (CMS hospital acquired conditions and PSI (patient safety indicators) to insure accurate reporting.
32 Monthly Measures for Each Documentation Specialist How many DRG matches have they had for the month? Meaning the documentation specialist s MS DRG matches the coders final MS DRG.
33 Monthly Measures for Each Documentation Specialist How many DRG changes based on additional documentation after their last review? A documentation specialist reviewing the chart daily or at a minimum every other day is essential to a successful program
34 Monthly Measures for Each Documentation Specialist How many DRG changes due to an incorrect code, a coding rule, or misinterpreting the documentation?
35 Monthly Measures of Program Success Overall CMI Medical CMI for a hospital with the majority being medical cases will be a good measure of how robust the program Surgical CMI
36 Monthly Measures of Program Success CC capture rate a cc is good but a mcc is better MCC capture rate Top 10 DRG Physician Agree Rate
37 Continuing Physician Education New Physician Orientation Hospital Medicine Group Orientation (HMG) Stay connected to HMG Monitor their query responses Is there one or two physicians not complying?
38 Physician Buy In/Participation Watching each physician s agree rate is a key factor A physician will not typically agree with every clarification However, we only generate clinically significant clarifications that meet risk factors, clinical indicator and treatment/monitoring.
39 Physician Buy In/Participation A solid program should strive for > 80% physician agree rate If a physician is declining 100% of good substantiated clarifications then the physician champion should review the cases to identify whether he needs to meet with the physician declining.
40 Physician Buy In/Participation If there is a hospital medicine group seeing the majority of all the patients then you need to make sure the whole group is engaged. Constant communication with the hospital medicine team leader is key. Attending their monthly or quarterly meetings providing documentation opportunities is important.
41 Other Program Measures Quarterly PEPPER Reports # of cases with only one CC/MCC; a solid bullet proof chart has 2 or more. CC/MCC capture External Audit Results don t be audit scared
42 RAC Payer Audits OIG Audits External Audits The majority of payers are on the band wagon of MS DRG validation. The auditors data mine to identify potentially problematic MS DRGs.
43 External Audits The auditors data mine accounts that contain only a CC or MCC. While a CC or MCC is good, 2 or more can potentially protect against being pulled for an audit.
44 External Audits An account with only one CC or MCC will be dissected apart to find a loop hole to discredit it. Auditors may not always know the coding rules. Always appeal as appropriate using the record documentation, coding conventions, official guidelines, and coding clinics to support the codes on the claim.
45 External Audit Follow up Realize when the coder simply made a mistake, misinterpreted, jumped to a conclusion too quickly, etc. Use these mistakes as education for the entire team and track it. Otherwise when what the auditor is citing is just not right, FIGHT with all you MIGHT!!
46 Goal Reflect the severity and complexity of each patient s illness. Get credit for the good care provided. Get paid for resource consumption.
47 Driving a Successful Documentation Improvement Program Trudy Rioux, CCS Manager, Coding and Documentation Baton Rouge General Medical Center
Certified Clinical Documentation Specialist Examination Content Outline - 2016
Certified Clinical Documentation Specialist Examination Content Outline - 2016 1. Healthcare Regulations, Reimbursement, and Documentation Requirements Related to the Inpatient Prospective Payment System
More informationThe Top 20 ICD-10 Documentation Issues That Cause DRG Changes
7th Annual Association for Clinical Documentation Improvement Specialists Conference The Top 20 ICD-10 Documentation Issues That Cause DRG Changes Donna Smith, RHIA Project Manager, Consulting Services
More informationThe Why and How of a CDI Program. Deb Neville, RHIA, CCS-P, Elsevier/MC Strategies Donna Bonno, CPC- CPC-I, QuadraMed September 12, 2012
The Why and How of a CDI Program Deb Neville, RHIA, CCS-P, Elsevier/MC Strategies Donna Bonno, CPC- CPC-I, QuadraMed September 12, 2012 Objectives Understand the reasons behind a Clinical Documentation
More informationTony Matejicka, DO, MPH, FACP Medical Director Coding and Utilization August 20, 2012
Tony Matejicka, DO, MPH, FACP Medical Director Coding and Utilization August 20, 2012 Understand the history of CMS to appreciate our clinical disconnect from Medicare reimbursement. Recognize terms from
More informationInsights and Best Practices for Clinical Documentation Improvement Programs
Insights and Best Practices for Clinical Documentation Improvement Programs In the face of alarming predictions about ICD-10 s administrative impact and its veritable explosion of new codes to wrangle
More informationStroke Coding Issues Presentation to: NorthEast Cerebrovascular Consortium
Stroke Coding Issues Presentation to: NorthEast Cerebrovascular Consortium October 30, 2008 Barry Libman, RHIA, CCS, CCS-P President, Barry Libman Inc. Stroke Coding Issues Outline Medical record documentation
More informationHCIM ICD-10 Training Online Course Catalog August 2015
HCIM ICD-10 Training Online Course Catalog August 2015 Course/Content Duration Quiz Duration CME Credits Assessments: Assessment: Provider - Baseline - E/M Emergency Department 45 5/1/2015 Assessment:
More informationLong term care coding issues for ICD-10-CM
Long term care coding issues for ICD-10-CM Coding Clinic, Fourth Quarter 2012 Pages: 90-98 Effective with discharges: October 1, 2012 Related Information Long Term Care Coding Issues for ICD-10-CM Coding
More informationPOLICY AND PROCEDURE MANUAL
Policy Title: Authorization for Observation vs. Inpatient Admission for Contracted Hospitals Primary Department: Affiliated Department(s): N/A Last Revision Date: 09/12/2014 Revision Dates: 12/16/2011;
More informationContinuous Quality Monitoring
Continuous to Maximize ICD-10 Proficiency and Organizational Benefits 1 2 The New Role of 3 Continuous ! A common strategy to maintain coding accuracy, continuous quality reviews have taken on greater
More informationSurvey on Coding Quality Measurement: Hospital Inpatient Acute Care
Survey on Coding Quality Measurement: Hospital Inpatient Acute Care In November 2007, the AHIMA e-him Quality Work Group on Coding Performance Measures and the Foundation of Research and Education (FORE)
More informationHFMA s Revenue Cycle Forum
A peer-to-peer online discussion community REPRINT July/August 2013 HFMA s Revenue Cycle Forum www.hfma.org/forums Understanding a Declining CMI: A Step-by-Step Analysis By Garri Garrison The first step
More informationICD-10 Implementation: No Margin, No Mission
ICD-10 Implementation: No Margin, No Mission October 6, 2014 Subtitle: ICD-WHEN? Page 0 Agenda ICD10 Background ICD9 ICD10 Transition ICD10 Assessment Tasks ICD10 Assessment Considerations ICD-10 Areas
More informationAll Patient Refined DRGs (APR-DRGs) An Overview. Presented by Treo Solutions
All Patient Refined DRGs (APR-DRGs) An Overview Presented by Treo Solutions Presentation Highlights History of inpatient classification systems APR-DRGs: what they are, how they work, and why they are
More informationThe Official Guidelines for coding and reporting using ICD-9-CM
Reporting Accurate Codes In the Era of Recovery Audit Contractor Reviews Sue Roehl, RHIT, CCS The Official Guidelines for coding and reporting using ICD-9-CM A set of rules that have been developed to
More informationClinical Support Versus Documentation: Determining the Best Approach for Appealing Denials
Clinical Support Versus Documentation: Determining the Best Approach for Appealing Denials Sharon Easterling, MHA, RHIA, CCS, CDIP, CPHM Recovery Analytics November 21, 2013 SLIDE 1 Disclaimer Panacea
More informationQuality Scorecard overall heart attack care overall heart failure overall pneumonia care overall surgical infection rate patient safety survival
Quality Scorecard s are required to report quality statistics to the s for Medicare and Medicaid Services (CMS) and the Department of Health (DOH). This information is made available at www.hospitalcompare.hhs.gov
More informationENGAGING PHYSICIANS FOR ICD-10: ALL ABOARD Engaging Physicians for ICD-10: All Aboard
ENGAGING PHYSICIANS FOR ICD-10: ALL ABOARD Engaging Physicians for ICD-10: All Aboard ICD-10 Lisa Kozakoff Principal Consultant Siemens Healthcare Lisa Kozakoff Principal Consultant Agenda Introduction
More informationMedicare Risk Adjustment and You. Health Plan of San Mateo Spring 2009
Medicare Risk Adjustment and You Health Plan of San Mateo Spring 2009 Background CMS reimburses health plans on a risk-adjusted basis: The sicker a member is expected to be, the more CMS pays a plan, which
More informationCompliance. TODAY November 2012. Meet Urton Anderson
Compliance TODAY November 2012 a publication of the health care compliance association www.hcca-info.org Meet Urton Anderson Clark W. Thompson Jr. Professor in Accounting Education McCombs School of Business
More informationThe electronic health record (EHR) has been a game-changer for CDI specialists.
Physician queries and the use of prior information: Reevaluating the role of the CDI specialist WHITE PAPER Summary: The following white paper examines the issue of whether to use information from a prior
More informationBenchmarking Coding Quality
Benchmarking Coding Quality Audio Seminar/Webinar July 24, 2008 Practical Tools for Seminar Learning Copyright 2008 American Health Information Management Association. All rights reserved. Disclaimer The
More informationPatient Criteria: Modeling in LTRAX
Patient Criteria: Modeling in LTRAX Mary Dalrymple Managing Director, LTRAX Kristen Smith, MHA, PT Senior Consultant Overview Objectives Review background on upcoming LTCH patient criteria Examine LTRAX
More informationRE: Medicare s Post-acute Transfer Policy and Condition Code 42 BACKGROUND
Memorandum TO: FROM: Glenn Hendrix Doug M. Hance DATE: RE: Medicare s Post-acute Transfer Policy and Condition Code 42 BACKGROUND Medicare s post-acute transfer policy distinguishes between discharges
More informationImportance of Revenue Cycle Continuous. Presentation Outline
Importance of Revenue Cycle Continuous Education EHR EMR ICD-10 Presented by: Gloria Doehling, Consultant, ICD-10 SME Encore Health Resources 21 September 2012 1 Presentation Outline Definitions Best Practice
More informationChapter Seven Value-based Purchasing
Chapter Seven Value-based Purchasing Value-based purchasing (VBP) is a pay-for-performance program that affects a significant and growing percentage of Medicare reimbursement for medical providers. It
More informationFY2015 Final Hospital Inpatient Rule Summary
FY2015 Final Hospital Inpatient Rule Summary Interventional Cardiology (IC) Peripheral Interventions (PI) Rhythm Management (RM) On August 4, 2014, the Centers for Medicare & Medicaid Services (CMS) released
More informationDocumentation Proliferation Effect in Electronic Medical Records. Adele Towers, MD and Mark Morsch, MS
Documentation Proliferation Effect in Electronic Medical Records Adele Towers, MD and Mark Morsch, MS DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not
More informationMASSACHUSETTS RESIDENTS CENTRAL MA. Acute Care Hospital Utilization Trends in Massachusetts FY2009-2012
ACUTE CARE HOSPITAL UTILIZATION TRENDS I N MASSACHUSETTS FY2009-2012 MASSACHUSETTS RESIDENTS CENTRAL MA Introduction The Center for Health Information and Analysis (CHIA) is publishing these inpatient,
More informationTUTORIAL: How to Code an Emergency Department (ED) Record
TUTORIAL: How to Code an Emergency Department (ED) Record Welcome! Assigning ICD-10-CM codes to diagnoses and CPT/HCPCS Level II codes to procedures/services for emergency department office records can
More informationAGENDA WHAT IS COMPUTER-ASSISTED CODING, REALLY? J03.0 F43.0 I10 A78 R52
R06.2 F43.0 I10 06BY3ZC J03.0 A78 03HK0MZ R52 0SG1430 COMPUTER-ASSISTED CODING AGENDA Evaluating and Understanding the Technology Review of Lessons Learned from Early Adopters Workflow and Analytics with
More informationHospitalized, but Not Admitted:
Hospitalized, but Not Admitted: Admission Status and Medical Necessity Bart Caponi, MD Division of Hospital Medicine Department of Medicine University of Wisconsin Disclaimers I have no disclosures to
More informationMedicare Advantage Risk Adjustment Data Validation CMS-HCC Pilot Study. Report to Medicare Advantage Organizations
Medicare Advantage Risk Adjustment Data Validation CMS-HCC Pilot Study Report to Medicare Advantage Organizations JULY 27, 2004 JULY 27, 2004 PAGE 1 Medicare Advantage Risk Adjustment Data Validation CMS-HCC
More informationPreparing for ICD-10 WellStar Medical Group Toolkit
Preparing for ICD-10 WellStar Medical Group Toolkit Preparing for ICD-10 On Oct. 1, 2015, WellStar will transition from ICD-9 to ICD-10 coding for all medical diagnoses and hospital procedures Systemwide.
More informationSee page 331 of HEDIS 2013 Tech Specs Vol 2. HEDIS specs apply to plans. RARE applies to hospitals. Plan All-Cause Readmissions (PCR) *++
Hospitalizations Inpatient Utilization General Hospital/Acute Care (IPU) * This measure summarizes utilization of acute inpatient care and services in the following categories: Total inpatient. Medicine.
More informationIt s Time to Transition to ICD-10
July 22, 2015 It s Time to Transition to ICD-10 What do the changes mean to your SNF? Presented by: Linda S. Little, RN-BSN Clinical Consultant HMM Consulting Office: (631) 265-6289 E-Mail: llittle@horanmm.com
More information2.b.vii Implementing the INTERACT Project (Inpatient Transfer Avoidance Program for SNF)
2.b.vii Implementing the INTERACT Project (Inpatient Transfer Avoidance Program for SNF) Project Objective: Skilled nursing facilities (SNFs) will implement the evidence based INTERACT program developed
More informationService delivery interventions
Service delivery interventions S A S H A S H E P P E R D D E P A R T M E N T O F P U B L I C H E A L T H, U N I V E R S I T Y O F O X F O R D CO- C O O R D I N A T I N G E D I T O R C O C H R A N E E P
More informationSupercharged CDI: NLP, intelligent workflow and CAC revolutionize CDI program at UPMC
White Paper Supercharged CDI: NLP, intelligent workflow and CAC revolutionize CDI program at UPMC In today s healthcare environment, information is the engine that drives activity and care delivery. But
More informationTHE VALUE OF A COMPLETE CODING QUALITY AUDIT PROGRAM. By Lisa Marks, RHIT, CCS, Coding Audit Director, Precyse
THE VALUE OF A COMPLETE CODING QUALITY AUDIT PROGRAM By Lisa Marks, RHIT, CCS, Coding Audit Director, Precyse TRUE OR FALSE: One coding audit a year of a random sample of 30 charts per coder is sufficient
More informationMonitoring Coding Compliance
Monitoring Coding Compliance Richard F. Averill, M.S. Coding compliance refers to the process of insuring that the coding of diagnoses and procedures complies with all coding rules and guidelines. Detection,
More informationHow To Improve A Hospital'S Performance
FY 16 MHAC Methodology Redesign HSCRC Performance Measurement Work Group February 20, 2014 1 Presentation Contents Background: Reason to change, guiding principles, timing Measurement Methodology Payment
More informationPhysician Scorecards. Clinical Documentation and Coding Improvement. Team Goals Metrics. Data Benchmarks Compliance.
Health Solutions Clinical Documentation and Coding Improvement Physician Scorecards Individual physician performance has a direct impact on a health system s financial, patient safety, and care quality
More informationGUIDE TO HOME HEALTH DIAGNOSIS CODES
GUIDE TO HOME HEALTH DIAGNOSIS CODES Proper selection of diagnoses codes for the Medicare OASIS Assessment The process of selecting correct diagnosis codes for the OASIS Start of Care, Re-Certification
More informationDefining the Core Clinical Documentation Set
Defining the Core Clinical Documentation Set for Coding Compliance Quality Healthcare Through Quality Information It is time to examine coding compliance policy and test it against the upcoming challenges
More informationData Analytics. Data Analytics: Next Step for Coding Specialists? 3/18/2016
Data Analytics: Next Step for Coding Specialists? AAHIM April 2016 Joy King Ewing, RHIA, CCS, CCDS Data Analytics Science of examining raw data to draw conclusions about that information. It is distinguished
More informationRisk Adjustment Factor (RAF) RADV June 1 st 2016
Risk Adjustment Factor (RAF) RADV June 1 st 2016 Disclaimer The information presented herein is for information purposes only. HIMS BMG Coding and Compliance Education has prepared this education using
More informationSupplemental Technical Information
An Introductory Analysis of Potentially Preventable Health Care Events in Minnesota Overview Supplemental Technical Information This document provides additional technical information on the 3M Health
More informationUsing Quality Metrics to Create and Distribute Savings in a Global Payments Environment
Using Quality Metrics to Create and Distribute Savings in a Global Payments Environment Illinois HFMA August 20, 2012 A member of Verras Healthcare International Clinical Case Management Four Focus Areas
More informationMASSACHUSETTS RESIDENTS WESTERN MA. Acute Care Hospital Utilization Trends in Massachusetts FY2009-2012
ACUTE CARE HOSPITAL UTILIZATION TRENDS I N MASSACHUSETTS FY2009-2012 MASSACHUSETTS RESIDENTS WESTERN MA Introduction The Center for Health Information and Analysis (CHIA) is publishing these inpatient,
More informationCLINTEGRITY 360 COMPUTER ASSISTED PHYSICIAN DOCUMENTATION
WHITE PAPER CLINTEGRITY 360 COMPUTER ASSISTED PHYSICIAN DOCUMENTATION Technology to Help Your Physicians with the Transition to ICD-10 In the changing world of healthcare reform, let Nuance Healthcare
More informationMASSACHUSETTS RESIDENTS NORTHEAST MA. Acute Care Hospital Utilization Trends in Massachusetts FY2009-2012
ACUTE CARE HOSPITAL UTILIZATION TRENDS I N MASSACHUSETTS FY2009-2012 MASSACHUSETTS RESIDENTS NORTHEAST MA Introduction The Center for Health Information and Analysis (CHIA) is publishing these inpatient,
More information9/15/2015. Learning objectives. Coding and compliance. Coding Compliance for the IDS Environment. Could Your Coding be Costing You Money?
Coding Compliance for the IDS Environment Could Your Coding be Costing You Money? Nancy Enos, FACMPE, CPC-I, CPMA, CEMC MGMA 2015 Annual Conference Learning objectives 1. Discover how administrators of
More informationLeadership Summit for Hospital and Post-Acute Long Term Care Providers May 12, 2015
Leveraging the Continuum to Avoid Unnecessary Utilization While Improving Quality Leadership Summit for Hospital and Post-Acute Long Term Care Providers May 12, 2015 Karim A. Habibi, FHFMA, MPH, MS Senior
More informationGuidelines for the Operation of Burn Centers
C h a p t e r 1 4 Guidelines for the Operation of Burn Centers............................................................. Each year in the United States, burn injuries result in more than 500,000 hospital
More informationKey Strategies for Ensuring Clinical Revenue Integrity with ICD-10
Key Strategies for Ensuring Clinical Revenue Integrity with ICD-10 Angela Carmichael, MBA, RHIA, CDIP, CCS, CCS-P Pyramid Healthcare Solutions, Clearwater, FL Melinda Tully, MSN, CCDS, CDIP J. A. Thomas
More informationThe Changing Face of Medical Necessity under ICD-10
The Changing Face of Medical Necessity under ICD-0 Sponsored by 95 N. Fine Ave #04 Fresno CA 93720-565 Phone: (559) 25-5038 Fax: (559) 25-5836 www.californiahia.org Program Handouts Monday, June 8, 205
More informationLinking Quality to Payment
Linking Quality to Payment Background Our nation s health care delivery system is undergoing a major transformation as reimbursement moves from a volume-based methodology to one based on value and quality.
More informationUW MEDICINE ICD-10. DRG Root Cause Analysis June 2014
UW MEDICINE ICD-10 DRG Root Cause Analysis June 2014 INTRODUCTION As medical charts are coded in ICD-10 and ICD-9, sometimes the DRG will shift. It is important to understand the cause of these shifts
More informationChallenges of the. Opportunities and. ICD-10 Transition
Opportunities and Challenges of the ICD-10 Transition Liz Curtis, RHIA, CHP Administrative Director, Medical Information Management The Ohio State University Wexner Medical Center Learning Objectives 1.
More informationICD-10 Preparation for Non- Coders in the Revenue Cycle
ICD-10 Preparation for Non- Coders in the Revenue Cycle September 24, 2015 Arkansas HFMA Revenue Cycle Seminar Susan Wallace, MEd, RHIA, CCS, CCDS, CDIP, FAHIMA Program Objectives Explain the impact of
More informationEliminating Pressure Ulcers in Ascension Health
Eliminating Pressure Ulcers in Ascension Health Cissy Shanks RN BSN CEN & Pam Kleinhelter RN MSN CNA-BC Nursing Managers St Vincent s Health System Jacksonville, Florida Objectives Participants will be
More informationNational Council for Behavioral Health
National Council for Behavioral Health Preparing your Organization for ICD-10 Implementation Presented by: Michael D. Flora, MBA, M.A.Ed, LCPC, LSW Senior Operations and Management Consultant David R.
More informationMedical Billing Requirements and ICD 10 Implementation Requirements
Are you ready for ICD 10? Denesecia Green, Senior Health Insurance Specialist Centers for Medicare & Medicaid Services Office of E Health Standards and Services ICD 10 Implementation The compliance deadline
More informationCMS Office of Public Affairs 202-690-6145 MEDICARE PROPOSES NEW HOSPITAL VALUE-BASED PURCHASING PROGRAM
For Immediate Release: Friday, January 07, 2011 Contact: CMS Office of Public Affairs 202-690-6145 MEDICARE PROPOSES NEW HOSPITAL VALUE-BASED PURCHASING PROGRAM OVERVIEW: Today the Centers for Medicare
More informationCDI MAIL. Ongoing Physician Training. Cathy Farraher, RN, BSN, MBA, CCM, CCDS
CDI MAIL Ongoing Physician Training Cathy Farraher, RN, BSN, MBA, CCM, CCDS is published by HCPro, a division of BLR Copyright 2015 HCPro, a division of BLR All rights reserved. Printed in the United States
More informationThe Physician Query Process & HCCA West Coast Regional Conference June 2010 Newport Beach, CA
The Physician Query Process & Compliance Issues HCCA West Coast Regional Conference June 2010 Newport Beach, CA Speaker Gloryanne Bryant, RHIA, RHIT, CCS, CCDS Managing Director of HIM, NCAL Revenue Cycle
More informationPROFESSIONAL BILLING COMPLIANCE TRAINING PROGRAM MODULE 5 OUTPATIENT OBSERVATION SERVICES
PROFESSIONAL BILLING COMPLIANCE TRAINING PROGRAM MODULE 5 OUTPATIENT OBSERVATION SERVICES Definition of Observation Care Medicare defines observation care* as: a well defined set of specific, clinically
More informationMS-DRG NEWS. Reporting Secondary Diagnoses that Impact MS-DRG Payment
MS- Effective 10/01/12 Inside this issue: Impact of Reporting Accuracy Impact More Than Payment 2 3 MCC s 4 Common CC s 5 Avoid Non- Specific Terminology 6 Reporting Secondary Diagnoses that Impact MS-DRG
More informationThe Third National Medicare RAC Summit
The Third National Medicare RAC Summit Major Hospital Vulnerabilities II: Medical Necessity and Clinical Documentation Issues in Medicaid and RAC Audits Edmund L. Lafer, MD Temple University Health System
More informationUsing Medicare Hospitalization Information and the MedPAR. Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota
Using Medicare Hospitalization Information and the MedPAR Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota MedPAR Medicare Provider Analysis and Review Includes information
More informationMar. 31, 2011 (202) 690-6145. Improving Quality of Care for Medicare Patients: Accountable Care Organizations
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Media Affairs MEDICARE FACT SHEET FOR IMMEDIATE RELEASE
More informationWhat is Data Analytics and How Does it Help Prepare Providers for ICD-10?
What is Data Analytics and How Does it Help Prepare Providers for ICD-10? June 2013 Kim Charland, BA, RHIT, CCS Senior Vice President of Clinical Consulting Services Panacea Healthcare Solutions, Inc.
More informationElectronic Health Record (EHR) Data Analysis Capabilities
Electronic Health Record (EHR) Data Analysis Capabilities January 2014 Boston Strategic Partners, Inc. 4 Wellington St. Suite 3 Boston, MA 02118 www.bostonsp.com Boston Strategic Partners is uniquely positioned
More informationTHE CITY OF VIRGINIA BEACH AND THE SCHOOL BOARD OF THE CITY OF VIRGINIA BEACH
THE CITY OF VIRGINIA BEACH AND THE SCHOOL BOARD OF THE CITY OF VIRGINIA BEACH OPTIMA November 7, 2013 TABLE OF CONTENTS Executive Summary... 1 Process Overview... 4 Areas of Testing... 5 Site Visit Selection...
More informationIn the second of a quarterly series of articles available to ACDIS members,
Coding Clinic update Conditions documented at the time of discharge, diabetes opportunities highlight important updates for CDI specialists W h i t e p a p e r Editor s note: The following article is provided
More informationHome Health Care Today: Higher Acuity Level of Patients Highly skilled Professionals Costeffective Uses of Technology Innovative Care Techniques
Comprehensive EHR Infrastructure Across the Health Care System The goal of the Administration and the Department of Health and Human Services to achieve an infrastructure for interoperable electronic health
More informationMEDICARE RISK ADJUSTMENT A PROSPECTIVE APPROACH TO RISK ADJUSTMENT AND ACCURATE DOCUMENTATION AND CODING
MEDICARE RISK ADJUSTMENT A PROSPECTIVE APPROACH TO RISK ADJUSTMENT AND ACCURATE DOCUMENTATION AND CODING WHAT IS RISK ADJUSTMENT? Risk Adjustment ensures that accurate payments are made to Medicare Advantage
More informationBreaking the Code: ICD-9-CM Coding in Details
Breaking the Code: ICD-9-CM Coding in Details ICD-9-CM diagnosis codes are 3- to 5-digit codes used to describe the clinical reason for a patient s treatment. They do not describe the service performed,
More informationClinical Governance Development Committee October 2007 Dr Foster RTM Alerts Progress Report
Clinical Governance Development Committee October 2007 Dr Foster RTM Alerts Progress Report 1. Background Information 1.1. Initial review of the tool in November 2006, and subsequent queries in January
More informationHealthcare Reform & Value Based Purchasing: Are You Ready?
Healthcare Reform & Value Based Purchasing: Are You Ready? Premier, Inc Jan Englert, Director-QUEST Poudre Valley Health System Sonja Wulff, VP Center for Performance Excellence Federal Register Statement:
More informationHow CDI is Revolutionizing the Transition to Value-Based Care
How CDI is Revolutionizing the Transition to Value-Based Care How CDI is Revolutionizing the Transition to Value-Based Care Creating a state-of-the-art clinical documentation improvement (CDI) program
More informationObjectives: 1. Gain a basic understanding of the various terms, concepts, and abbreviations involved in coding and billing.
Coding and Billing a Global Perspective Prepared for the American Academy of Orthopaedic Surgeons Business, Policy, and Practice Management in Orthopaedics Lecture Series William Beach, MD and Julie Balch
More informationOils. Heart-Healthy CONFERENCE ISSUE. American Heart Month. The Newest Trends in the Dairy-Free Aisle. Plan Healthful Vegan Diets
CONFERENCE ISSUE Vol. 17 No. 2 February 2015 The Magazine for Nutrition Professionals Heart-Healthy Oils Learn about the latest varieties and science on the healthful fats they contain. American Heart
More informationTrauma Audit & Research Network. CORE Screens user guide
Trauma Audit & Research Network CORE Screens user guide Launched January 2011 BACKGROUND From January 2011 onwards the TARN Electronic Data Collection & Reporting (edcr) system will allow users to choose
More informationClinical Documentation Improvement Program Inpatient Setting Our Implementation Journey
Clinical Documentation Improvement Program Inpatient Setting Our Implementation Journey Linda Dubiel, RHIA, Coding Director Mayo Clinic Health System NW WI Region WHIMA Conference May 2013 2011 MFMER slide-2
More informationMedicare Risk-Adjustment & Correct Coding 101. Rev. 10_31_14. Provider Training
Medicare Risk-Adjustment & Correct Coding 101 Rev. 10_31_14 Provider Training Objectives Medicare Advantage - Overview Risk Adjustment 101 Coding and Medical Record Documentation Requirements Medicare
More informationICD-10... What Are You Waiting For?
ICD-10... What Are You Waiting For? What is it? International classification for all general epidemiological, many health management purposes, and clinical use Published by the World Health Organization
More informationNAVIGATING THE MEDICARE MAZE OF REHABILITATIVE SERVICES
NAVIGATING THE MEDICARE MAZE OF REHABILITATIVE SERVICES NAVIGATING THE COMPLEXITY OF INSURANCE COVERAGE. Fox Rehabilitation is a private practice of physical, occupational, and speech therapists who specialize
More informationPOSITION DESCRIPTION/ COLUMBUS REGIONAL HEALTHCARE SYSTEM HEALTH INFORMATION MANAGEMENT
POSITION DESCRIPTION/ COLUMBUS REGIONAL HEALTHCARE SYSTEM JOB TITLE CODING SUPERVISOR JOB CODE 0172 DEPARTMENT FLSA (Exempt/Non-Exempt) HEALTH INFORMATION MANAGEMENT NON-EXEMPT DEPARTMENT DIRECTOR SIGNATURE
More informationICD-10 Executive Action Guide:
ICD-10 Executive Action Guide: A Roadmap to Ensuring a Successful Transition to a New Coding System 1 March 2014 American Hospital Association Introduction Transformative change initiatives such as the
More informationThe dictation system is provided for the clinical documentation of the patient record required for each hospital visit.
STATEMENT 3.2.14.1 STATEMENT ON DICTATION SYSTEM IN WINDSOR Undergraduate Medical Education Approved by: Clerkship & Electives Committee Date of original approval: August, 2013 Date of last review: August,
More informationIntroduction to Risk Adjustment Programs for Medicare Advantage and the Affordable Care Act (Commercial Health Insurance Exchange)
Introduction to Risk Adjustment Programs for Medicare Advantage and the Affordable Care Act (Commercial Health Insurance Exchange) November, 2014 An independent licensee of the Blue Cross and Blue Shield
More informationCMS Progress Toward Implementing Value-Based Purchasing
Centers for Medicare & Medicaid Services CMS Progress Toward Implementing Value-Based Purchasing Thomas B. Valuck, MD, JD Medical Officer & Senior Adviser Center for Medicare Management 1 CMS Quality Improvement
More informationExploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 4 th Quarter 2012
Exploring the Impact of the RAC Program on Hospitals Nationwide Results of AHA RACTRAC Survey, 4 th Quarter 2012 March 8, 2013 RAC 101 Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractors
More informationPhysician and other health professional services
O n l i n e A p p e n d i x e s 4 Physician and other health professional services 4-A O n l i n e A p p e n d i x Access to physician and other health professional services 4 a1 Access to physician care
More informationChronic Care Management (CCM) from a Physician Practice Administrator s Perspective
Chronic Care Management (CCM) from a Physician Practice Administrator s Perspective Chronic Care Management (CCM) from a Physician Practice Administrator s Perspective 1 ABOUT THE AUTHOR Dennis Breslin
More informationTruven Health Analytics: Market Expert Inpatient Volume Projection Methodology
Truven Health Analytics: Market Expert Inpatient Volume Projection Methodology Truven s inpatient volume forecaster produces five and ten year volume projections by DRG and zip code. Truven uses two primary
More information