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Last Week on CDI Talk: Tracking DRG mismatches

Editor’s Note: CDI Talk is a networking forum for ACDIS members in which members ask pressing questions can garner the opinion and expertise of their peers. Join by clicking on the CDI Talk tab on the ACDIS website.

Hospital processes often differ when a working or concurrent DRG does not match the final billed DRG, and how they handle the reconciliation process.

Open dialogue is the most valuable tool we have to grow the CDI profession.

Open dialogue is the most valuable tool we have to grow the CDI profession.

As we saw on a January 2 discussion on CDI Talk, some feel checking matches should be a requirement, while others are not sure if matching the concurrent and final DRGs is necessary.

Mark LeBlanc, RN, MBA, CCDS, Director CDI Services at The Wilshire Group in Minneapolis, MN, and an ACDIS advisory board member, launched the discussion, asking fellow CDI Talk members whether or not their CDI programs have a benchmark for CDI and coder DRG matches and, if so, what tactics they use. LeBlanc also questioned how many programs have their coders use the CDI-determined codes to finalize their DRG, and how many have coders start from scratch and then compare their final DRG to the concurrent DRG.

One participant, Angelisa Romanello, RN, BSN, FNS, CCDS, Manager of Clinical Documentation Improvement, Quality and Compliance at the CJW Medical Center in Richmond, Virginia,
,has a program where CDI specialists and coders scan and exchange worksheets online. Whether or not coders review CDI worksheets in her facility is unclear, she said. A report is sent to both the CDI and coding staff monthly with the CDI and coder match results, but they do not use it as a metric for staffing evaluation due to the volume in their facilities, their staff size, and the fact that their CDI specialists rarely see the discharge summary.

Another participant, Deanne Wilk, BSN, RN, CCS, AHIMA approved ICD-10-CM/PCS Trainer, Clinical Documentation Improvement and Inpatient Coding Manager for the HIMS Department at the Good Samaritan Health System in Lebanon, Pennsylvania, said at her facility, staff review DRG mismatches as educational opportunities. CDI and coding meet monthly to discuss the significant discrepancies, if any. Coding staff reviews any CDI code assignments and reenters codes as needed. From this view, coding and CDI should collaborate, and coding should review work done by CDI as a secondary check to ensure coding accuracy.

Other participants, such as Donald Butler, RN, BSN, CDI Manager at the Vidant Medical Center in Greenville, NC, agreed with close collaboration between CDI and coding. However, be aware of review cycle and staffing, as well as limitations in available documentation at the time of CDI reviews in regard to how that impacts the accuracy of a working DRG.

What do you think? Join the discussions or post your own questions by logging on to the ACDIS homepage and registering under the CDI Talk tab. Read our blog for regular updates on some of our most popular CDI Talk discussions.

Conference Update: Call for poster presentations open

Share your CDI success with ACDIS conference attendees.

Share your CDI success with ACDIS conference attendees.

Have you thought about presenting a poster at the 2015 ACDIS conference in San Antonio? It’s a great opportunity to showcase your organization’s CDI program and success with a national audience. This popular event is always well-received by conference attendees. To give you an idea of what you might present, here is a partial list of topics from last year (you can view them in the Forms & Tools Library under “conference materials”):

  • Work flow, tracking processes, DG denials
  • Anatomy of an effective query
  • Documentation impact on quality, reimbursement
  • Pediatric-specific tip sheets per service line
  • Transforming from I-9 to I-10
  • Effective provider communication and education
  • Physician champions in urology
  • Malnutrition documentation
  • Charting query success
  • The value of ancillary services

Posters will be on display in the exhibit hall throughout the conference. Presenters are required to be on site for a dedicated time, one to two hours, to speak with conference attendees about their poster. Presenters may bring handouts, though these are not required.

We’ll take a photo of each poster and post it along with a one-page description (due from each presenter) on the ACDIS website following the conference.

To apply to present a poster in San Antonio, click this link, download the application, and return it by February 13. The conference committee will review the applications and select acceptable ideas for conference presentation. Limit, one poster per facility will be approved. Presenters receive a $200 discount off their conference registration fee (one discount per poster).

Email Penny Richards with questions.

Advisory Board Voting set; cast your ballot today

January may not feel like election season; most of the pomp and star-spangled banners of the political season fluttered down months ago. Nevertheless, the ACDIS (electronic) ballot box has been primed and dusted, ready for the amazing new candidates who stepped forward this year.

More than 50 volunteers submitted their resumes to the nomination committee. The committee, made up of four members of the existing advisory board, administration, and an at-large ACDIS member, have reviewed the applications, interviewed candidates, and selected 12 individuals from various professional backgrounds as finalists for the ACDIS Advisory Board.

Now it is up the ACDIS membership to review the candidates’ information and choose the individuals you believe will best serve the association for the next three years.

Remember, voting is open only to ACDIS members. Voting instructions are included on the top of the voting page. You must cast four votes total: two votes in group one, and one vote in groups two and three. Once your vote is cast your access to the voting page will be closed to prevent any individual from voting twice.

Note, too, that we are grateful for every one of the individuals who took time to submit their nomination to serve on the advisory board.

Voting will close at the end of the day (11:59 p.m., Eastern) on Thursday, January 29. Please click on this link and login to your ACDIS account to vote. 

The candidates are:

  • Group 1 (RN background): Claudia E. Baker, Terri McCubbin Graves, Melinda Matthews, Karen Newhouser, Judy Schade, and Paula Tatum
  • Group 2 (MD background): James P. Fee, Thomas W. Huth, and Charles E. Pitzele
  • Group 3 (HIM/coding background): Krystal Haynes, Melissa K. McLeod, Anny Pang Yuen

CDI Boot Camp Update: Physician Advisor Boot Camp slated for February

CDI Boot Camps are everywhere. Why not bring one to your facility?

CDI Boot Camps are everywhere. Why not bring one to your facility?

The next Physician Advisor’s Role in CDI Boot Camp takes place February 5-6 in San Diego. The two-day Boot Camp prepares physician advisors to successfully fulfill the duties of their job. They’ll walk away with a firm understanding of clarification opportunities in each Major Diagnostic Category, new techniques for engaging medical staff in CDI, and new avenues for CDI program growth.

It includes new ICD-10 documentation requirements and how to ensure full and accurate physician documentation to properly code records for ICD-10 as well as information on inpatient quality measures and the physician advisor’s role in Medicare Value-Based Purchasing.

News: Study reveals overspending on U.S. billing and insurance paperwork

CMS says new date for ICD-10-CM/PCS implementation set for 2015.

Billing paperwork costs billions

Healthcare organizations spent approximately $471 billion on paperwork related to billing and insurance in 2012, with 80% of that potentially wasted, according to the study “Billing and insurance-related administrative costs in United States’ health care: synthesis of micro-costing evidence,” published in BMC Health Services Research.

Using a standard definition of “billing and insurance-related costs” (BIR), researchers found that physician practices spent approximately $70 billion, hospitals spent roughly $74 billion, and other institutions (e.g., nursing homes, home health care agencies, prescription drug, and medical supply companies) spent approximately $94 billion. Private insurers spent approximately $198 billion on BIR compared to $35 billion spent by government-sponsored health insurance programs.

Adopting a simplified, single-payer insurance system similar to Medicare could save the U.S. approximately $375 billion annually or more than $1 trillion in three years.

Editor’s Note: This article originally published in the HIM-HIPAA Insider.

News: Physician group offers position paper on EHR use

ICD-10 testing process in play

ACP offers EHR insight

There’s no arguing that the face of physician documentation has changed and will continue change under ongoing advances in electronic health records (EHRs), according to a new position statement from the American College of Physicians (ACP) which recommended limitations on copy/paste, increased emphasis of open-dialogue versus structured data, and further study of the effectiveness of electronic health records, among other items in its recent position paper on clinical documentation in the 21st Century.

With increased EHR use comes increased information—both useful and sometimes unwieldy. Longer, denser records often leads to difficulties in finding the most pertinent information necessary for all parties involved.

Physicians need to leverage EHRs’ capabilities to improve patient care including:

  • effectively displaying historical information in rich context
  • supporting critical thinking
  • enabling efficient and effective documentation
  • supporting appropriate and secure sharing of useful and usable information with others

“These features are unlikely to be optimized as long as the format and content of clinical documentation are primarily based on coding and other regulatory requirements,” the paper states. “Physicians must learn to leverage the enormous and growing capabilities of EHR technology without diminishing or devaluing the importance of narrative entries. Cooperation is needed among industry health care providers, health care systems, government, and insurers to continue to improve the documentation. We must work together to fundamentally change the EHR from a passive recipient of information to an active virtual care team member.”

Editor’s Note: For additional information consider reading the following related articles: