CDIP for ICD-10: Best Practices for CDIP Monitoring and Reporting

Transcription

1 CDIP fr ICD-10: Best Practices fr CDIP Mnitring and Reprting Part 4 f a 4-Part Series Presented By: Kim Charland, BA, RHIT, CCS Senir Vice President f Clinical Cnsulting Services Panacea Healthcare Slutins SLIDE 1

2 Disclaimer Panacea has prepared this seminar using fficial Centers fr Medicare and Medicaid Services (CMS) dcuments and ther pertinent regulatry and industry resurces. It is designed t prvide accurate and authritative infrmatin n the subject matter. Every reasnable effrt has been made t ensure its accuracy. Nevertheless, the ultimate respnsibility fr crrect use f the cding system and the publicatin lies with the user. Panacea, its emplyees, agents and staff make n representatin, warranty r guarantee that this infrmatin is errr-free r that the use f this material will prevent differences f pinin r disputes with payers. The cmpany will bear n respnsibility r liability fr the results r cnsequences f the use f this material. The publicatin is prvided as is withut warranty f any kind, either expressed r implied, including, but nt limited t, implied warranties r merchantability and fitness fr a particular purpse. The infrmatin presented is based n the experience and interpretatin f the publisher. Thugh all f the infrmatin has been carefully researched and checked fr accuracy and cmpleteness, the publisher des nt accept any respnsibility r liability with regard t errrs, missins, misuse r misinterpretatin. Current Prcedural Terminlgy (CPT ) is cpyright 2011 American Medical Assciatin. All Rights Reserved. N fee schedules, basic units, relative values, r related listings are included in CPT. The AMA assumes n liability fr the data cntained herein. Applicable FARS/DFARS restrictins apply t gvernment use. CPT is a trademark f the American Medical Assciatin. Cpyright 2013 by Panacea. All rights reserved. N part f this presentatin may be reprduced in any frm whatsever withut written permissin frm the publisher Published by Panacea, 287 East Sixth Street, Suite 400, St. Paul, MN PANACEA Healthcare Slutins, Inc. SLIDE 2

3 Tday s Objectives Review CDIP data cllectin elements Learn what ICD-10 data elements yu shuld add t yur CDIP data cllectin and tracking Learn hw t mnitr the effectiveness f yur CDI Prgram Learn effective ways t share yur CDIP data with yur Administratin and Identify if yur CDI tracking tl is wrking fr yu 2013 PANACEA Healthcare Slutins, Inc. SLIDE 3

4 Why Every Hspital Needs a CDIP Rle f a Clinical Dcumentatin Imprvement Prgram Imprve the quality f clinical dcumentatin regardless f the impact n revenue Reduce cmpliance risks related t regulatry audits (RAC, MIC, OIG, etc.) Impact reprting f quality f care and severity f patients Impact CMS Quality Measures, pay fr perfrmance and value based purchasing 2013 PANACEA Healthcare Slutins, Inc. SLIDE 4

5 Why Every Hspital Needs a CDIP Results f a Clinical Dcumentatin Prgram By imprving clinical dcumentatin, facilities can impact: Dcumentatin needs fr ICD-9 cding Dcumentatin needs fr ICD-10 cding Dcumentatin needs fr medical necessity which can impact SOI (Severity f Illness) and ROM (Risk f Mrtality) 2013 PANACEA Healthcare Slutins, Inc. SLIDE 5

6 Cmpnents f a CDIP Wrk Flw Decide n daily duties and wrk flw: Hw will admissins be identified and divided amng staff n a daily basis What payers will be included Will ther functins related t quality and cre measures be included/integrated What type f data will be cllected Hw will the data be cllected Wh will enter the data and when Hw will the data be shared 2013 PANACEA Healthcare Slutins, Inc. SLIDE 6

7 Cmpnents f a CDIP Data Cllectin Define the data that yur CDS will cllect based n the fllwing: CDS prductivity Physician cmpliance and participatin with the prgram Type f data being tracked Financial impact 2013 PANACEA Healthcare Slutins, Inc. SLIDE 7

8 CDIP Data Elements Demgraphic / Infrmatinal: Admit date Age Unit Insurance Rm Physician name Encunter Physician # MR # Admit fr: Patient name Discharge date Sex LOS (Length f Stay) 2013 PANACEA Healthcare Slutins, Inc. SLIDE 8

9 CDIP Data Elements MS-DRG Data CDS name CDS review date Wrking MS-DRG Wrking MS-DRG weight Target MS-DRG Target MS-DRG weight CDS cmments 2013 PANACEA Healthcare Slutins, Inc. SLIDE 9

10 CDIP Data Elements MS-DRG Data (cn t) Needed t ptimize Waiting fr Ntes 2013 PANACEA Healthcare Slutins, Inc. SLIDE 10

11 CDIP Data Elements Cncurrent Query Statistics CDS name Date f initial query Physician name and/r # Physician specialty Type f query* Query wrking MS-DRG Query wrking MS-DRG weight 2013 PANACEA Healthcare Slutins, Inc. SLIDE 11

12 CDIP Data Elements Cncurrent Query Statistics (cn t) Query target MS-DRG Query target MS-DRG weight Query sent via: ( , EHR, paper) Date f physician respnse Type f physician respnse** Fllw-up t query Impact t MS-DRG*** Date entered int CDI tracking tl 2013 PANACEA Healthcare Slutins, Inc. SLIDE 12

13 CDIP Data Elements * Query type: A. Sepsis / Ursepsis I. Renal Failure B. Anemia J. Skin Ulcer C. Pneumnia K. CVA / TIA D. Respiratry Failure L. Surgical Cmplicatin E. Malnutritin M. Diabetic Disrder F. Heart Failure N. POA G. COPD O. Surgical Debridement H. Acute MI P. Other 2013 PANACEA Healthcare Slutins, Inc. SLIDE 13

14 CDIP Data Elements ** Physician Respnse A - MD agrees D MD disagrees NR N respnse W Waiting respnse 2013 PANACEA Healthcare Slutins, Inc. SLIDE 14

15 CDIP Data Elements *** Impact t MS-DRG Principal diagnsis MCC CC SOI / ROM (if using APR-DRGs) HAC POA Other diagnsis Principle prcedure Other prcedure 2013 PANACEA Healthcare Slutins, Inc. SLIDE 15

16 HIM Data Elements Fllw-up t a written cncurrent query, finish the query data cllectin prcess. New retrspective query (CDIP staff has nt queried prir), fllw same data cllectin as CDSs fr a new query, but track as an HIM retrspective query (CDI staff will want t review new retrspective queries t see if anything was missed cncurrently PANACEA Healthcare Slutins, Inc. SLIDE 16

17 HIM Data Elements Retrspective Query Statistics Cder name Date f query Physician name and/r # Physician specialty Type f query Query wrking MS-DRG Query wrking MS-DRG weight 2013 PANACEA Healthcare Slutins, Inc. SLIDE 17

18 HIM Data Elements Retrspective Query Statistics (cn t) Query target MS-DRG Query target MS-DRG weight Query sent via: ( , EHR, paper) Date f physician respnse Type f physician respnse Fllw-up t query Impact t MS-DRG Date entered int CDI tracking tl 2013 PANACEA Healthcare Slutins, Inc. SLIDE 18

19 CDIP Data Elements Query type: A. Sepsis / Ursepsis I. Renal Failure B. Anemia J. Skin Ulcer C. Pneumnia K. CVA / TIA D. Respiratry Failure L. Surgical Cmplicatin E. Malnutritin M. Diabetic Disrder F. Heart Failure N. POA G. COPD O. Surgical Debridement H. Acute MI P. Other 2013 PANACEA Healthcare Slutins, Inc. SLIDE 19

20 CDIP Data Elements Physician Respnse A - MD agrees D MD disagrees NR N respnse W Waiting respnse 2013 PANACEA Healthcare Slutins, Inc. SLIDE 20

21 Nn-Traditinal CDIP Data Elements Severity f Illness Risk f Mrtality Medical Necessity Inpatient admissin Shrt stays Observatin Outpatient services Quality Cre Measures Patient Satisfactin 2013 PANACEA Healthcare Slutins, Inc. SLIDE 21

22 CDIP / HIM ICD-10 Data Elements ICD-10-CM (Specialty and Diagnsis Gruping) Signs and symptms Cnditins that are / are nt an integral part f the disease prcess Multiple cding fr a single cnditin Acute and chrnic cnditins Cmbinatin cde Sequela (late effects) Impending r threatened cnditin 2013 PANACEA Healthcare Slutins, Inc. SLIDE 22

23 CDIP / HIM ICD-10 Data Elements ICD-10-CM (cn t) Laterality Syndrmes Cmplicatins f care Unspecified diagnsis cde (utpatient CDI) 2013 PANACEA Healthcare Slutins, Inc. SLIDE 23

24 CDIP / HIM ICD-10 Data Elements ICD-10-PCS (Specialty and Prcedure Type) Inpatient prcedure type Rt peratin Bdy part Apprach Device Qualifier Outpatient prcedure type 2013 PANACEA Healthcare Slutins, Inc. SLIDE 24

25 CDIP / HIM ICD-10 Data Elements ICD-10 MS-DRGs: DRG shifts likely t ccur: Opprtunity t imprve physician dcumentatin Attributed t expanded I-10 classificatin system, cding guidelines, and/r cde assignment 2013 PANACEA Healthcare Slutins, Inc. SLIDE 25

26 CDIP / HIM ICD-10 Data Elements Track ICD-10 Dcumentatin Opprtunities / Gaps By: MS-DRG Specialty Physician Financial impact 2013 PANACEA Healthcare Slutins, Inc. SLIDE 26

27 Reprting CDIP Data CDIP Functinality Overall and by CDS Cmparisn amng CDS s By CDS # queries cmpared t # f admissin # f queries per day (actual and average) # f initial queries # f fllw-up queries Success rate fr respnse 2013 PANACEA Healthcare Slutins, Inc. SLIDE 27

28 Reprts: CDI Cncurrent Queries CDS Cncurrent Review Rate Cncurrent Query Rate Cncurrent MD Respnse Rate Cncurrent MD Agreement Rate CDS 1 CDS 2 CDS PANACEA Healthcare Slutins, Inc. SLIDE 28

29 Reprts: Query Rate / Respnse Queries Quarter r Mnth Target % Reached Cncurrent: Admissin review rate Cncurrent Query: Physician rate Cncurrent Query: Physician respnse Cncurrent Query: Physician validatin Retrspective Query: Physician rate Retrspective Query: Physician respnse Retrspective Query: Physician validatin 2013 PANACEA Healthcare Slutins, Inc. SLIDE 29

30 Reprting CDIP Data Query Infrmatin (MS-DRG and ICD-9) By Department / Specialty By Physician By Mnth and Annual Ttal admissins Ttal admissins reviewed % queried % agreed / disagreed / n respnse Respnse type Query type 2013 PANACEA Healthcare Slutins, Inc. SLIDE 30

31 Reprts: Cncurrent Queries by Specialty Specialty Cncurrent Query Rate Cncurrent Query Respnse Rate Cncurrent Query Agreement Rate Cncurrent Query N Respnse Rate Cardilgy General Surgery Urlgy Hspitalists Orthpedic 2013 PANACEA Healthcare Slutins, Inc. SLIDE 31

32 Reprting CDIP Data Educatinal Opprtunities Type f queries By mnth / annual By specialty By physician CDI vs HIM query ICD PANACEA Healthcare Slutins, Inc. SLIDE 32

33 Reprts: Query Type Query Type Jan-13 # Feb-13 # March-13 # April-13 # May-13 # A B C D 2013 PANACEA Healthcare Slutins, Inc. SLIDE 33

34 Reprts: CDI fr Physicians Physician: Dr. Smith Achievement % Target % Difference Cncurrent Query Rate Cncurrent Query Respnse Rate Retrspective Query Rate Retrspective Query Respnse Rate ICD-9 Dcumentatin Accuracy ICD-10 Dcumentatin Accuracy Als: Trend by Query Type SOI and ROM 2013 PANACEA Healthcare Slutins, Inc. SLIDE 34

35 Reprts: ICD-10 Dcumentatin Opprtunity MR # Diagnsis Prc Current DRG Current DRG Weight Ptential DRG Ptential DRG Weight DRG Weight Diff. Reasn Apprach and site f cartid artery (03CK0ZZ) ( ) Pulmnary Emblism as cmplicatin f previus surgery (T81.718A) Lac. head repaired skin vs subcu / face vs scalp (0JQ00ZZ / 0JQ10ZZ) ( ) Excisin vs. resectin f ileum (0DBB0ZZ) ( ) Site f small bwel, ttal vs. partial (0DN8477, 0DB80ZZ) 2013 PANACEA Healthcare Slutins, Inc. SLIDE 35

36 Reprts: CDIP Mnitring MR # Admit Date CDS Wrking DRG Agree Y/N Reviewer DRG Cn. Query Type Agree Y / N If N CDS Query Missed Query 2013 PANACEA Healthcare Slutins, Inc. SLIDE 36

37 Reprting CDIP Data Financial Impact ICD-9 Prjected impact CDI Actual CDI HIM LOS CMI 2013 PANACEA Healthcare Slutins, Inc. SLIDE 37

38 Case Mix Index ICD-9 cdes MS-DRG Relative weight Medicare base rate Payment per case MS-DRG Relative Weight x Medicare Base Rate = Payment 2013 PANACEA Healthcare Slutins, Inc. SLIDE 38

39 Reprts: CMI Calculatin MS- DRG Descriptin Relative Weight X Base Rate = Payment 2013 PANACEA Healthcare Slutins, Inc. SLIDE 39

40 Case Mix Index CMI is critical t Finance Average payment per discharge Ttal IPPS payments Resurces Budget Success f Revenue Cycle 2013 PANACEA Healthcare Slutins, Inc. SLIDE 40

41 Reprts: CDIP Administratin Dash Bard Mnth Mnth Department Spec N Query Query Ttal Reviews Percent Queried N Query Query Ttal Reviews Percent Queried Medicine Cardiac FM ENT Urlgy Ttals IM Onc Hsp Card CVS Query Prcess: Query Agreement Query Disagreement N Respnse t Query Reviews: Admissins Percent Reviewed Ptential Reimbursement Enhancement Actual Reimbursement Enhancement CMI Impact 2013 PANACEA Healthcare Slutins, Inc. SLIDE 41

42 Reprts: CDIP Management Dashbard Cncurrent Queries Written Cncurrent Query Respnse Rate Cncurrent Reviews: # f Admissin Reviewed Ttal Admissins Admissins with >1 Query HIM Retrspective Queries: # f CDI Fllw-up Queries # f New Queries Respnse Rate Jan Feb March YTD 2013 PANACEA Healthcare Slutins, Inc. SLIDE 42

43 CDIP Reprting Reprting Design reprts t trend data based n recipient: Administratin Medical staff CDI Sftware shuld all much slicing and dicing f CDIP data 2013 PANACEA Healthcare Slutins, Inc. SLIDE 43

44 Keys t a Successful CDIP Administrative Supprt Apprpriate staffing Chesive staff Strng leadership Cllabrative with ther departments DATA COLLECTION REPORT RESULTS 2013 PANACEA Healthcare Slutins, Inc. SLIDE 44

45 Thank Yu Fr Attending! 2013 PANACEA Healthcare Slutins, Inc. SLIDE 45