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ACDIS Position Paper available: Defining CDI roles and responsibilities

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

New Position Paper defines CDI roles and responsibilities.

Struggling to define the role of a CDI specialist in your facility? Let us help with this complimentary position paper from ACDIS. This position paper seeks to clarify the role of the CDI specialist and provide guidance in developing appropriate policies, procedures, and job descriptions for CDI departments. The CDI specialist’s role is complex and requires expert knowledge of clinical care and applicable coding guidelines, as well as an ability to communicate effectively with the clinical care team.

Click here to read the entire position paper now.

2014 Advisory Board open voting begins; deadline to vote January 31!

If you are an ACDIS member please vote for four new volunteers to represent you on the Advisory Board.

If you are an ACDIS member please vote for four new volunteers to represent you on the Advisory Board.

Voting is now open for four ACDIS advisory board positions, for terms of service starting in 2014 through the end of 2016. Log on to the ACDIS website to select the four candidates you believe are the best fit for the association, and then cast your vote. You may only vote once.

The results of the election will be announced in early February.

ACDIS advisors are important, volunteer positions that help shape the direction of the association and provide leadership, expertise, and representation for the membership. The term of service is a maximum of three years.

The voting page includes the nominees’ background in CDI and information on why they are seeking election. The vote will close end of business day on Friday, January 31.

If you have any questions, please e-mail ACDIS Director Brian Murphy at bmurphy@hcpro.com.

Understand how HCC changes relate to physician quality scores, reimbursement

Tips for ICD-10 queries.

Tips for ICD-10 queries.

By James S. Kennedy, MD, CCS, CDIP

Although most physicians have heard of DRGs with inpatient admissions, only those invested in accountable care organizations and independent practice associations are likely familiar with hierarchical conditions classifications (HCCs). Based on ICD-9-CM codes submitted by physicians or hospitals in a calendar year for documented diagnoses requiring assessment, management, or treatment, HCCs will significantly change in 2014 with additions and deletions as well as relative weight changes.

Physicians documentation will need to improve related to HCCs because one of the goals of the Patient Protection and Affordable Care Act (PPACA) is to encourage provider efficiency, defined by CMS as a ratio of observed to expected costs and outcomes for selected populations. And, to this end, CMS is developing efficiency measurement metrics that will influence reimbursement and may be reported on its Physician Compare website (http://tinyurl.com/ mnq89rh). These include:

  • CMS Episode Grouper for Medicare. Part of CMS’ Quality and Resource Use Reports, currently focused on cardiac conditions and pneumonia. Learn more at http://tinyurl.com/2013CMSEG.
  • CMS Physician Value-Based Payment Modifier. Applicable to groups of 100 or more providers in calendar year (CY) 2015, potentially groups of 10 or more providers in CY2016, and all others in CY2017, its calculation involves the total per capita cost measure for Medicare fee-for-service and the Medicare spending per beneficiary models using CMS’ HCCs. Read more in the CY2014 CMS Proposed Physician Fee Schedule, available at http://www.gpo.gov/fdsys/pkg/FR- 2013-07-19/pdf/2013-16547.pdf

Editor’s note: This article is an excerpt from the Featured Article on the ACDIS homepage and was originally published in the December 2013 edition of Medical Records Briefings. James S. Kennedy, MD, CCS, CDIP, is president of CDIMD.com. A past ACDIS Advisory Board member, Kennedy is a general internist and certified coder, specializing in clinical effectiveness, medical informatics, and clinical documentation and coding improvement strategies. Contact him at 615-479-7021 or at jkennedy@cdimd.com.

Quarterly Conference Call for ACDIS members scheduled

Don't miss the November quarterly conference call for ACDIS members.

Don’t miss the November quarterly conference call for ACDIS members.

Our next quarterly conference call is scheduled for Thursday, November 21, from 1-2 p.m. ET. To access the call, please dial the toll-free number that was emailed to you.

If you did not receive the email dial-in information please email Penny Richards at prichards@cdiassociation.com at least one-day prior to the call.

Due to heavy call volume, please dial in 10 minutes prior to the start of the program. These calls are offered as a means for ACDIS members to network with one another and to discuss any clinical documentation improvement related issues.

We will have a few ACDIS Advisory Board members on the call as well. We encourage your comments, thoughts, and questions during the call. If you would like to submit a topic or question for discussion please email ACDIS Director Brian Murphy at bmurphy@cdiassociation.com

Reminder: Applications for advisory board openings due Friday

The application period for four new ACDIS advisory board members is now open. The deadline for returning completed applications is November 15, 2013. A nominating committee and the ACDIS membership will make final selections by January 2014.

ACDIS advisors are important, volunteer positions that help shape the direction of the association and provide leadership and expertise for the membership. The term of service is a maximum of three years. The role and expectations of ACDIS advisory board members is described on the advisory board page.

Please fill out and submit the application form here: http://www.keysurvey.com/f/557833/77cd/

Applications open for ACDIS advisory board positions

The application period for four new ACDIS advisory board members is now open. The deadline for returning completed applications is November 15, 2013. A nominating committee and the ACDIS membership will make final selections by January 2014.

ACDIS advisors are important, volunteer positions that help shape the direction of the association and provide leadership and expertise for the membership. The term of service is a maximum of three years. The role and expectations of ACDIS advisory board members is described on the advisory board page.

Please fill out and submit the application form here: http://www.keysurvey.com/f/557833/77cd/

Guest Post: Accurate documentation for terminal patients

ACDIS Advisory Board member Trey La Charite, MD, co-presents a two-day preconference event regarding the role of the physician advisor in CDI efforts

ACDIS Advisory Board member Trey La Charite, MD.

by Trey La Charité, MD

Sadly, there are patients who will not survive their current level of illness regardless of the best efforts of their physicians and their medical facility. The providers caring for these patients are often at risk of  underreporting those patients’ severity of illness and risk of mortality.

CDI professionals must educate facilities and physicians about the importance of accurately capturing the entire disease process  description because physicians, unfortunately, are frequently reluctant to document additional disease  processes in the charts of patients who are obviously about to die. Let’s look at one example before discussing possible causes.

A CDI specialist reviews a case on the floor or in the ICU and notices “prognosis grim” written several times in the medical record. The physician, however, neglected to document one or more strikingly  obvious diagnoses from the patient’s record. The CDI specialist queries the physician about the absent disease processes, asking whether those diagnoses are present and how they might affect the patient’s  current clinical situation. The queries go unanswered. The CDI specialist follows up with the physician, which proves unproductive.

The physician replies, “I’m not going to write that. That patient is about to die.” There are numerous reasons physicians take this position, and while this is not an exhaustive list, you may have heard some of these excuses at one time or another:

  • “I don’t want to ‘penalize’ the patient.”
  • “I don’t want to bilk the insurance company.”
  • “I don’t want to stick the family with a higher bill.”
  • “It just doesn’t feel right.”
  • “Why do you need that? They are going to die. How much sicker do you need them to look?”

By examining the faulty and misguided rationale behind these excuses, we can develop an appropriate response when confronted with a similar situation in the future.

Your providers are not “penalizing” the patient. When properly documented, the principal diagnosis and the circumstances leading to the current medical situation are firmly established in the medical record. There is no penalty to the patient for accurately describing how sick he or she is. On a personal note, I believe patients’ families gain some solace, if they choose to review the records, from the documentation
of the severity of their loved one’s illness simply by knowing the full extent of the condition.  Furthermore, there is a clear benefit from an epidemiological standpoint to tracking disease processes  and identifying the toll those diseases take on our society.

Providing diluted documentation related to the severity of a patient’s illness also dilutes our ability to provide that larger societal insight. As  providers, our job is to take care of those patients to the best of our abilities. If we do not have a clear and inclusive picture of the various factors that play a role in a patient’s potential recovery, how can we effectively manage that patient in the hopes of providing a reasonable outcome?

Editor’s Note: This article is an excerpt from the April 2013 edition of CDI Journal. La Charité is a hospitalist with the University of Tennessee Hospitalists at the University of Tennessee Medical Center at Knoxville, and an ACDIS Advisory Board member. He is board certified in internal medicine and has been a practicing hospitalist since 2002.  Contact him at clachari@utmck.edu.

ACDIS membership quarterly conference call Thursday, February 14

Happy Valentine’s Day from ACDIS. Join the Quarterly Conference Call Thursday, February 14.

Our next quarterly conference call is scheduled for Thursday, February 14, from 1-2 p.m. ET. To access the call, ACDIS members have been provided a toll-free number via email. If you have not received this email please contact ACDIS Member Services Director Penny Richards at prichards@cdiassociation.com or by phone at 781-639-1872, ext. 3423.

These calls are offered as a means for ACDIS members to network with one another and to discuss any clinical documentation improvement related issues. We will have a few ACDIS Advisory Board members on the call as well. We encourage your comments, thoughts, and questions during the call.

If you have a question to ask, or suggestions for discussion on the upcoming call, please e-mail me at bmurphy@cdiassociation.com. Conference calls are a great way to ask a question, air any and all concerns, or gather input on a policy or procedure at your hospital. While we cannot guarantee your question or discussion point will be addressed on the call, we will try to work in as many as possible.

Membership chooses new Advisory Board leadership

ACDIS members chose four new leaders this week via a robust recruiting, review, and voting process. (Read more about the elections process on the ACDIS website.) Our sincere congratulations to the following new board members who will serve a three-year term.

Donald A. Butler, RN, BSN, CDI manager, Vidant Medical Center, Greenville, N.C. Background / Qualifications in CDI: Currently manager of the 10-member CDI team at Vidant (a 860-bed tertiary care center serving the eastern third of North Carolina).  Additionally, working with the four other individual CDI specialists at Vidant Health hospitals. Leader of CDI since the program was implemented in March 2006.  Served 11 years as a U.S. Navy nurse with a broad variety of clinical experiences, including labor and delivery, emergency, and primary care. Served in several leadership roles (was the department head for an obstetrics/pediatric clinic, performance improvement and accreditation coordinator) as well as program development such as annual school physical program, standardizing asthma and ADD care, emergency case management and CDI.  Actively involved with CDI through presentations locally and nationally, participating with CDI Week development and active contributions with the ACDIS Blog and CDI Talk.  Honored as the 2011 CDI Professional of the Year by ACDIS.

Sylvia Hoffman, RN, CCDS, CCDI, CDIP, President, CEO, Sylvia Hoffman CDI Consulting; adjunct boot camp instructor HCPro, Inc. Background/qualifications in CDI: Served as a CDI specialist in a 1,000-bed teaching hospital in Tampa, Fla., before starting her own Tampa-based CDI consulting practice. Worked as an educational consultant for documentation integrity with DocuComp, LLC, and was employed as a senior associate in the Forensic Division at KPMG, providing clinical documentation education and retrospective record reviews for compliance, integrity, and quality throughout the south east. Has 15 years acute care-hospital experience and 10 years of case management experience. Presently serves as an adjunct educator for HCPro in the areas of CDI and ICD-10, teaching Boot Camps and providing on-line educational seminars. Past-president of the Florida ACDIS regional chapter.

Walter Houlihan, MBA, RHIA, CCS, Director, HIM and Clinical Documentation, Baystate Health. Background/qualifications in CDI: Worked in the HIM field for more than 30 years, initially coding medical records at Columbia Presbyterian Medical Center, in New York City (NYC) in the 1970’s, then overseeing physician documentation in medical records at academic teaching facilities in NYC and Chicago. At Baystate Health assisted with developing a CDI program that has improved the quality of documentation and subsequently administrative data. Baystate Health received numerous national quality awards, most notably being recognized as a top 60 medical center in the U.S. from Reuters and Leapfrog. Led the effort to prepare Baystate Health for ICD-10 and plans to start the process of dual coding of ICD-9 and ICD-10 in a few months. Has spoken at numerous association meetings and conferences on the importance of improving clinical documentation, most importantly for the continuity of quality patient care and an accurate representation of hospital and provider patient care services. Enjoys the collaboration between ACDIS professionals at meetings in the New England and New York City areas.  Member of AHIMA and HIMSS.

James E. Vance, MD, MBA, CEO, Physician Executive Management Services LLC; associate medical director, BCE Healthcare Advisors. Background/qualifications in CDI: Began work in CDI as a physician consultant with JA Thomas and Associates (JATA) in 2003-2004. Now serves as associate medical director for BCE Technology, a physician documentation compliance training organization (2004-present). Specializes in improving physician documentation compliance with Medicare documentation rules, and improving physician medical necessity documentation in the medical record. Experience includes clarifying medical necessity, clinical documentation “beyond the essentials,” case management physician advisor training, and third party physician advisor training for level of care admission decisions. Experience includes developing an “academic” CDI model and RAC appeal physician advisor training.

Advisory Board Voting Open

Voting is now open for four ACDIS advisory board positions, for terms of service starting in 2013 through the end of 2015. Log on to the ACDIS website to select the four candidates you believe are the best fit for the association, and then cast your vote.

The results of the election will be announced in early February.

ACDIS advisors are important, volunteer positions that help shape the direction of the association and provide leadership, expertise, and representation for the membership. The term of service is a maximum of three years.

The voting page includes the nominees’ background in CDI and information on why they are seeking election. The vote will close end of business day on Thursday, January 31.

If you have any questions, please e-mail ACDIS Director Brian Murphy at bmurphy@cdiassociation.com.