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Tip: Diversify your CDI education to keep staff engaged

Every CDI specialist knows how difficult it can be to set aside a whole hour or more for dedicated training and education. With productivity expectations and quotas, cutting out a sizable chunk of time for learning can be challenging. Diversifying CDI education tactics can help engage staff in more meaningful ways.

Though electronic health records (EHR) and technology sometimes complicate the CDI process in select ways, CDI managers and leaders can harness technology to increase educational reach. [more]

Q&A: Denial management teams

Have CDI questions?

Have CDI questions?

Q: What guidance do you have for building a denial management team?

A: As with any team, it is important to have the right players working together with identified roles and responsibilities established for each. The members of the denials management team should be representative of departments with a direct tie to the various types of denials. Include the following groups: [more]

Guest Post: Altered mental status remains a challenge in ICD-10-CM – part 2

James Kennedy, MD, CCS, CDIP

James Kennedy, MD, CCS, CDIP

By James Kennedy, MD, CCS, CDIP

Determine the underlying cause of the altered mental status

Remember that the various forms of altered mental states have underlying causes, which, if defined, diagnosed, and documented, accurately represent the patient’s condition for risk-adjustment purposes. Options include:

  • Neurodegenerative disorders. To the extent that it’s possible to state what the underlying degenerative brain disease is, please do so. Options include Alzheimer’s disease, Lewy-body dementia, late effects of multiple strokes, normal pressure hydrocephalus, some cases of Parkinson’s disease, and a host of others. Note: The term “multi-infarct dementia” requires additional documentation that it is the late effect of multiple strokes. Consider the word “encephalopathy” as well (see the next item) when documenting these underlying causes.

[more]

Symposium Update: Early bird hotel discount ends August 17

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The ACDIS Symposium: Outpatient CDI is currently sold out!

There are only a couple more days left to get a discounted hotel room rate for the ACDIS Symposium: Outpatient CDI. Reserve your room by Thursday, August 17 to take full advantage of the discount. The symposium takes place from September 18-19 at the Hilton Oak Brook Resort and Conference Center in Oak Brook, Illinois.

When you book your hotel room by August 17, you’ll get the discounted room rate at the Hilton Oak Brook Resort and Conference Center for $159 (tax and fees not included). To book by phone, call 866-275-6295 and mention ACDIS.

Please note that the Outpatient Symposium is sold out. If you have registered and know you won’t be able to attend, please notify customer service to allow others into the event.

 

Note from the Associate Director: Announcing a new outpatient version of the CDI Pocket Guide

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Associate Director Rebecca Hendren

By Rebecca Hendren

Outpatient CDI is a fast-growing area of the profession. So, I’m excited to announce a new resource that will be an incredibly useful tool for those expanding to the outpatient arena. Richard Pinson, MD, FACP, CCS, and Cynthia Tang, RHIA, CCS, authors of the CDI Pocket Guide, are currently finishing their work on a new version focused on Hierarchical Condition Categories (HCC): the 2018 Outpatient CDI Pocket Guide!

One of our guiding principles at ACDIS is to be at the forefront of changes in the industry. We want to provide our members with guidance, information, and resources they can turn to for education and clarification as they venture into new CDI focus areas. We’ve been publishing articles exploring the growing outpatient and ambulatory arena for several years now and will continue to do so as this segment of the profession grows and changes. We want to keep our fingers on the pulse of what’s going on and share that knowledge with our members.

We bring together leading thinkers in the profession who can share their expertise, whether through articles in the CDI Journal, innovative sessions at our annual conference or the new outpatient-focused ACDIS Symposium, or lively discussions in the ACDIS Forum.

I’m delighted that the trusted authors of the CDI Pocket Guide are equally forward thinking and partnered with us to develop a this new resource.

Please continue to let us know what information you need and what resources you would like ACDIS to offer. We really do listen to you and use your feedback to develop our editorial directions.

Editor’s note: Hendren is the associate director of membership and product development at ACDIS. Contact her at rhendren@acdis.org.

UnitedHealth Group, Inc. versus the United States of America: The case for CDI

Brian-Murphy

ACDIS Director Brian Murphy

By Brian Murphy

The work of a CDI professional can at times seem isolating and unimportant. Does it matter if a query gets answered? When we educate physicians and tell them what they document matters, are they listening?

Then a case comes along and demonstrates not just that the CDI profession does matter—but that it matters a lot.

That point was driven home to me while reading a May 16, 2017 court document, United States of America ex rel. Benjamin Poehling v. UnitedHealth Group, Inc., in which the Department of Justice (DOJ), alleges that UnitedHealth artificially increased Medicare Advantage (MA) reimbursement/Hierarchical Condition Category assignment by mining for non-supported diagnoses that were not documented/reported by the physician or through chart documentation.

The case is a qui tam—a lawsuit brought forward by a private individual. The plaintiff is Benjamin Poehling, the former Director of Finance for UnitedHealthcare Medicare & Retirement (and its predecessor Ovations), which was the group at United that managed its MA plans and its Medicare Part D prescription drug programs.

The lawsuit seeks to recover more than $1 billion under the False Claims Act. The total damages sought are unspecified but it’s a large case with a lot at stake.

This case has received quite a bit of coverage, too, from big newspapers like the New York Times and popular healthcare websites like Beckers Hospital Review and HealthLeaders Media.

There is a lot more to this case than this 103-page court document, though. In addition to Poehling’s case (filed in February 2017), another whistleblower, James Swoben, a former employee of Senior Care Action Network Health Plan and a consultant to the risk-adjustment industry, came forward with similar allegations in March.

In a very recent development, UnitedHealth Group’s lawyers are seeking to get the case dismissed, claiming that they are not required to validate the accuracy of diagnostic data submitted by healthcare providers.

I need to reiterate that, at this point, the claims asserted against UnitedHealth Group are only allegations and there have been no determinations of liability. It remains to be seen whether the case will even reach court.

However, the case ultimately resolves, it’s a very interesting, real-world, big-dollar example of the business of healthcare, raising the question of who is ultimately responsible for the accuracy of submitted diagnoses to Medicare (coders, CDI, administrative contractors, physicians?). It calls into question the oft-repeated adage that coders must code what the physician documents. It brings into even greater prominence the process of clinical validation, for which ACDIS recently released a new white paper.

Reading through these articles and the original court document, I thought to myself, if only UnitedHealth Group had a robust, compliant CDI process in place, this suit could have been prevented. More than anything, United States of America vs. UnitedHealth Group Inc. is confirmation that your work as a CDI professional matters, and that the broader CDI profession matters.

I plan to share my thoughts on this case in a series of blog posts here and I welcome your thoughts and commentary.

Editor’s note: To read the summary of the case, visit the DOJ website by clicking here. To read the court document in its entirety, click here. Brian Murphy is Director of the Association of Clinical Documentation Improvement Specialists (ACDIS). He can be reached at bmurphy@acdis.org.

 

 

Q&A: Coding chronic kidney disease, hypertension, and diabetes mellitus

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Laurie L. Prescott, RN, MSN, CCDS, CDIP, answered this question

Q: Let’s say a provider documented chronic kidney disease (CKD), 2/2 hypertension (HTN), and diabetes mellitus (DM), and the stage of CKD was not specified, but lab results show patient was in stage 2. Could I assign codes for CKD, stage unspecified, Hypertensive CKD w/ stage 1-4, and Type II DM. Do I need to assign a separate code for HTN?

A: Let’s break down the documentation.

CKD secondary to HTN and DM: With this documentation, we have two combination codes to assign—hypertensive CKD and diabetic CKD. We would also assign a code to reflect the stage of the CKD.

[more]

Guest Post: Altered mental status remains a challenge in ICD-10-CM – part 1

James Kennedy, MD, CCS, CDIP

James Kennedy, MD, CCS, CDIP

By James Kennedy, MD, CCS, CDIP

In ICD-10-CM, defining, diagnosing, and documenting the various forms of altered mental status and their underlying causes remains an ongoing challenge for physicians and their facilities.

Even the esteemed New England Journal of Medicine states that, “‘Altered mental status,’ a nonspecific term that is frequently used to describe alterations in alertness, cognition, or behavior, is commonly encountered in the emergency setting.” If you have a subscription or access through your medical library, review the discussion at www.nejm.org/doi/full/10.1056/NEJMcps1603154. [more]

Symposium Speaker Highlight: Whitley shares story of ambulatory success

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The ACDIS Symposium: Outpatient CDI takes place Sept. 18-19

Editor’s note: There are only 45 more days left until the first ever ACDIS Symposium: Outpatient CDI, September 18-19, in Oak Brook, Illinois. Last week, we brought you a Q&A with Laurie L. Prescott, MSN, RN, CCDS, CDIP, CRC, in CDI Strategies, but she’s not the only Symposium speaker we got to know recently. Today, we spoke with Yvonne Whitley, RN, BSN, CRCC, CPC, CRC, the supervisor for Novant Health Medical Group’s Ambulatory CDI team, who will present “Novant Health ambulatory CDI—How we’ve grown!” at the event. Please note that this event is filling up fast with limited seats remaining.

Q: Can you explain why you use the term “ambulatory” rather than “outpatient?”

A: The simple answer is that “outpatient” refers more to facilities such as wound care, same day surgery, infusion centers, etc. “Ambulatory,” on the other hand, refers to the provider clinics. Currently we only focus on the ambulatory setting.

Q: What was the biggest challenge you encountered during the implementation of your ambulatory CDI program?

[more]

Note from the Associate Editorial Director: A Little Local Chapter Love

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Associate Editorial Director Melissa Varnavas grabs a picture with a Local Chapter leader from Kentucky at the 2017 Conference!

By Melissa Varnavas

Next Friday, August 11, ACDIS Editor Linnea Archibald and I will head down to Newton, Massachusetts for the third-annual joint ACDIS/AHIMA New England CDI Symposium. The leaders of the MaHIMA, NYHIMA, and MA ACDIS have met for months to develop a comprehensive agenda to fit the educational needs of both coding and clinical documentation professionals.

The full-day event, sponsored by 3M, was originally the brainchild of then ACDIS Advisory Board member Walter Houlihan, director of HIM for Baystate Health in Springfield, Massachusetts. Houlihan, at the time, served as the president of the MaHIMA and, although his time in that role was ending, he had yet to see his vision for a multi-state event come to pass. After mentioning his hopes in a passing phone call, we decided to see if we could, in fact, bring this idea to fruition. The first year, more than 100 attendees arrived. The second held nearly 160. Baystate Health generously hosted those first two events.

This year, attendance has topped 200 and the registration has closed due to the constraints of the room size (although there is a wait list).

This is an amazing story about the importance of collaboration and the value of networking and education in our tiny slice of the healthcare industry we serve. And it’s a story that’s not just happening in New England but is playing out across the country. Every week in this email newsletter, we list local chapter upcoming events and offer a tip or tale about what’s happening at the local level. Recently, on ACDIS Radio, we remarked about the number of full-day events coming up.

In August, not only do we have the New England event but also North Carolina and Florida are holding full-day educational sessions. In September, both California and Alabama hold full-day events. The California event will be its third annual, and generally gathers more than 200 attendees. The leaders from each of the three Missouri ACDIS chapters have been meeting for more than a year to plan their big full day event coming up in October. Last year there were nearly 150 attendees and this year they expect to reach 200 attendees as well. South Carolina and Oregon also hold events in October and although it’s still in the planning stages, Texas hopes to have a full-day event in October too.

These volunteer leaders have done a tremendous job planning these events for the benefit of their communities. We cannot thank them enough for their efforts and hope that you, too, reach out to them, volunteer, attend, extend your own involvement in this, our ever growing, ACDIS community.

Editor’s Note: Varnavas is the Associate Editorial Director for ACDIS. To find out about what’s happening in your neighborhood visit the local chapter page. To learn more about starting a chapter or networking group, scroll down below the map to read our local chapter leadership resources. Contact her at mvarnavas@acdis.org.