RSSAuthor Archive for Linnea Archibald

Linnea Archibald

Linnea Archibald is the CDI editor for the Association of Clinical Documentation Improvement Specialists (ACDIS). In this role, she helps out with the website, blog, social media, newsletter, and the CDI Journal. If you have any questions, feel free to email her.

The ACDIS Blog is moving!

Blog migration

Starting January 1, 2018, the ACDIS Blog will live on acdis.org!

Since 2008, the ACDIS Blog has lived on this WordPress site. But, all good things must come to an end.

Starting on January 1, the ACDIS Blog content will be migrated to a new home on acdis.org. This will make it even easier for you to stay on top of all the content, news, tips, and tales from your CDI peers ACDIS has to offer—not just what appears in the Blog stream.

To ease the transition, this Blog will remain live until January 1. Please take some time to download and save any of those particularly helpful pieces you’ve come to cherish. Although we will be migrating most of the previous content we will not be migrating everything.

Between now and January 1, no new content will be posted to this WordPress site. We trust this will not cause you any major concern. Please note that you can always subscribe to our weekly, free, email newsletter CDI Strategies to stay on top of news and ACDIS updates in the meantime.

When the transition is complete, you’ll be able to go to acdis.org, click on the “Publications” tab, and select “CDI Blog” from the dropdown menu. That link will take you to the new blog page where you’ll find all the new and previous selected blog posts.

If you have any question, please let us know! We want this transition to be as smooth as possible for all our readers.

We look forward to many more years of great CDI Blog content in our new home!

 

 

 

Book excerpt: Unexpected CDI effects

Trey La Charité, MD, FACP, SFHM, CCDS

Trey La Charité, MD, FACP, SFHM, CCDS

By Trey La Charité, MD, FACP, SFHM, CCDS

No new hospital initiative operates in a vacuum. And there is no way to anticipate every consequence of your CDI program. Even with the best intentions, there will be downstream consequences to navigate.

Let’s start with the first place your program’s effects will be noticed: the medical records department. If you didn’t know, your medical records department maintained a Discharged Not Final Billed (DNFB) or Discharged Not Final Coded (DNFC) list before the advent of your CDI program. [more]

Q&A: Acute pulmonary insufficiency

Have CDI questions?

Have CDI questions?

Q: What should we do about the documentation of “acute pulmonary insufficiency?” What indicators are you using for this in comparison to querying for acute respiratory failure? Acute pulmonary insufficiency is an MCC following surgery but it is also a potential patient safety indicator (PSI) if it’s failure. 

A: Our process is to review the chart and see if it meets clinical evidence for additional specificity such as acute respiratory failure. If it does not, does it meet clinical evidence for acute respiratory distress (now that there is a new code for that condition)? If it does not, then our CDI teams would not query. If it does meet the criteria, we would add all the relevant information from the record on the query and ask the physician if, in his or her medical opinion, the documented acute pulmonary insufficiency could be further specified. [more]

Note from the Instructor: Is your CDI program stagnating? Get out of the rut and fast!

AllenFrady_May2017

Allen Frady, RN, BSN, CCDS, CCS, CRC

By Allen Frady, RN, BSN, CCDS, CCS, CRC

The basic tenant of learning CDI is learning how MS-DRGs work, and the tiered structure of CC and MCC levels. That is the first step, to be sure, but it is not the final destination. In the new era of quality based reimbursement, there are a number of growth opportunities. And yet, I believe many (if not most) CDI programs are either missing completely or performing poorly in meeting them. In the age of bundled DRGs, 30-day readmissions, hospital acquired conditions, Medicare Advantage Plans, patient safety indicators, quality reporting, and mortality rankings, if you find yourself having a harder and harder time justifying the value of proper documentation to your chief financial officer, take another look at the current state of affairs. [more]

Book excerpt: Peer review to ensure compliant query practices

Start your weekend with some CDI reading!

Start your weekend with some CDI reading!

By Marion Kruse, BSN, RN, MBA, and Jennifer Cavagnac, CCDS

Every CDI program should objectively evaluate the outcomes, processes, and compliance of their CDI efforts. Auditing and monitoring provides oversight for the CDI program, insight into physician documentation and collaboration, and objective evaluation of the performance and effectiveness of individual CDI staff members as measured against your facility’s policies and priorities.

According to AHIMA’s “Managing an Effective Query Process” “Healthcare entities should consider establishing an auditing and monitoring program as a means to improve their query processes.” [more]

Q&A: Tracking denials

denials poll

Did you know 55% say CDI is involved in the denials management and appeals process?

Q: When looking at denials timelines, what information should be noted?

A: There are many critical time elements to capture during the denial appeals process. It is recommended that you add these to your denials database. If that is not possible, an alternative spreadsheet or database should be developed. The first date to track is the date that the denial or remittance advice (zero or underpayment) was received. The amount of time allowed to file your appeal will vary from payer to payer. When tracking timelines, it is important to note the: [more]

Guest post: Compliance risks abound in HCCs

James Kennedy, MD, CCS, CDIP

James Kennedy, MD, CCS, CDIP

by James S. Kennedy, MD, CCS, CDIP

Let’s discuss the compliance risks CDI and coding professionals need to address related with hierarchical condition categories related to the MACRA.

Coding must be based on provider documentation, not what is entered on a superbill or computer software. ICD-10-CM code assignment is based solely on a provider’s documentation in the legal medical record, according to the 2017 ICD-10-CM Official Guidelines and Coding Clinic, Fourth Quarter, 2016, pp. 147–149. The problem is that many physicians document one way in their notes and then pick an ICD-10-CM code in their billing software or superbill that would not be assigned if one applies ICD-10-CM coding conventions based on the provider’s documentation.  [more]

Note from the ACDIS Editor: CDI Journal focuses on reimbursement concerns

LA-new headshot

ACDIS Editor Linnea Archibald

By Linnea Archibald

Though any CDI specialist will tell you this profession isn’t about money, a facility’s reimbursement can certainly be affected by CDI professionals’ work. Because of this undeniable fact, we’ve dedicated the November/December edition of the CDI Journal to the multi-faceted world of reimbursement.

Within the newest edition’s pages, you’ll find valuable information covering reimbursement topics such as using PEPPER data for denial defense and tracking CMI metrics. You’ll also get a glimpse into the non-reimbursement fueled world of PPS-exempt cancer centers. [more]

Guest post: Time to learn about HCCs

James S. Kennedy, MD, CCS, CDIP

James S. Kennedy, MD, CCS, CDIP

by James S. Kennedy, MD, CCS, CDIP

Now that you’ve finally mastered coding compliance with DRGs and quality measures, now it is time to learn the new risk-adjustment method, Hierarchical Condition Categories (HCC).

HCCs are to physicians what DRGs are to hospitals and, as such, are subject to government and Recovery Auditor scrutiny. In fact, a whistleblower accused United Healthcare of “upcoding” ICD-10-CM diagnosis codes affecting HCC-derived risk-adjustment factor scores, mentioning that CMS overpaid insurers by $14.1 billion in 2013 alone, according to an article in the New York Times in May. [more]

Q&A: Acceptable documentation for HCCs

Have CDI questions?

Have CDI questions?

Q: What clinical documentation is acceptable to pull Hierarchical Condition Category (HCC) information from for reporting purposes? Would you code from history of present illness, past medical history, active problem list, or the assessment?

A: Follow the coding guidelines when reporting diagnosis codes for HCC purposes. The coding guidelines don’t change with HCCs. As long as the documentation meets the MEAT (monitored, evaluated, assessed, treated) criteria, it can be reported from anywhere in the note. [more]