RSSAll Entries in the "Growing your program" Category

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]

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]

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]

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

Brian-Murphy

ACDIS Director Brian Murphy

Part 4 (click here to view part 1, click here to view part 2, and click here to view part 3)

By Brian D. Murphy

In Part 1 of this series I introduced the developing story of UnitedHealth Group, Inc. vs. the United States of America. In Part 2, I detailed the facts of the case. Part 3 looked at the regulations and commentary regarding claims submission to Medicare Advantage and the ramifications for CDI. Part 4, discusses recent developments of the case.

Since I wrote my initial three parts of the developing case of UnitedHealth Group, Inc. vs. the United States of America there has been a huge development on the legal front. Round 1 of the case of UnitedHealth Group, Inc. vs. the Unites States of America is over, and the decisive winner (at least in the matter of one complaint filed by the DOJ) is United. [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]

Note from the ACDIS Director: Saying thanks to some key individuals and influences

Birthday cupcake

Thanks for celebrating ACDIS’ 10th birthday with us!

Ten years have passed since we founded the Association of Clinical Documentation Improvement Specialists, and to say I have met some good people along the way is a gross understatement. I have met some GREAT people over the last decade, without whom ACDIS would not be where it is today.

Here are just a few: [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]

Note from the Associate Editorial Director: What’s so special about ACDIS?

IMG_1136-small

Associate Editorial Director Melissa Varnavas

By Melissa Varnavas

In short, the membership. There are more than 5,500 ACDIS members now as we celebrate our 10th anniversary. That’s the size of a city. Sure, it’s not a large city but it’s definitely a community. It’s a community that’s chosen to live together and work together and ensure that its neighbors succeed. And that’s an amazing and special thing to be a part of in this day and age.

But it’s been that way since the start of the organization. Back then everyone was scrambling to figure out the best way to do this job. Back then everyone was looking for the best clinical indicators to help win their physicians over. Back then everyone was struggling to find their niche within the hospital hierarchy of department reporting structure. So everyone shared. Everyone shared just about everything they possibly could. [more]

Outpatient CDI Workshop: Join us for five weeks of education and networking

outpatient CDI workshop

Join us tomorrow as we kick-off the Outpatient CDI Workshop!

Due to the overwhelming success of our first ever ACDIS Symposium: Outpatient CDI, ACDIS has responded with a one-of-a-kind multimedia platform to keep the education, networking, and development going—right from your home office.

The Outpatient CDI Workshop features a broad sampling of the presentations delivered at the ACDIS Symposium in an easy-to-access online format. Participants in the Workshop will also enjoy facilitated collaboration with their peers and event presenters.

Take part in an ideas lightning round with the ability to send questions to presenters, enjoy conversation with your fellow attendees through an email discussion group, and participate in a live networking and problem-solving call with workshop participants and moderators. Get your outpatient CDI program off the ground with help from your peers and the experts at ACDIS! [more]

Note from the instructor: Reminiscing over 10 years in CDI

SharmeBrodie_May2017

Sharme Brodie, RN, CCDS

By Sharme Brodie, RN, CCDS

One of the wonderful things that time allows us is the ability to look back with an experienced eye and either learn from the past or at the very least have some fun with it.

I remember my first weeks as a CDI specialist as if it just happened. It was a  grueling hiring process and I was thrilled to have gotten the job. Looking back, I have no idea why I thought this would be a good step in my career. None of us knew at that time what we were doing and we had no idea what to expect from this new profession. [more]