RSSAll Entries in the "Outpatient" Category

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]

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]

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 Associate Director: Symposium lookback and a preview of things to come

R_Hendren

Rebecca Hendren

By Rebecca Hendren

Two weeks ago we held our inaugural ACDIS Symposium: Outpatient CDI in the intimate setting of a suburban Chicago hotel. The hotel was surrounded by a beautiful golf course, where the first golden colors of autumn were beginning to emerge on the trees, and the setting made us feel somewhat cut off from the rest of the world as we spent two days discussing the new frontier in CDI.

We had sessions focused on practical issues, such as building compliant queries in the outpatient setting, and we had sessions from organizations that have established outpatient programs, where the speakers shared how they do it and their lessons learned along the way.

But the most fun parts were the times that we had open discussions. It was fascinating to hear everyone talking together and sharing ideas and thoughts. We all learned a lot and people made connections to lean on as they develop their outpatient programs. [more]

CDI Week Q&A: CDI Expansion

Peppers, Rhonda

Rhonda Peppers, RN, BS, CCDS

As part of the seventh annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Rhonda Peppers, RN, BS, CCDS, a CDI specialist at Care Coordinators, MedPartners, in Tampa, Florida, and a member of the 2017 CDI Week Committee, answered these questions on CDI expansion. Contact her at rhondapeppers@benefis.org.

Q: When did you first get involved in CDI, and what was your CDI program’s focus?

A: I started working in CDI in 2011, and our program’s focus was on earning money. We were given monthly monetary totals on the queries we wrote. We were very competitive. Our goal was to see who could make the most money. As a matter of fact, I was told when I first started that we were not to write the query if it was for severity of illness (SOI) or risk of mortality (ROM), just write the ones for MCCs and CCs.

Q: How has the focus of your CDI program changed over the years? [more]

Q&A: Credentialing for outpatient CDI

Have CDI questions?

Have CDI questions?

Q: I’ve heard lately that outpatient CDI specialists are less likely to be registered nurses. Is there a reason there may be more coders in this arena?

A: While many outpatient CDI specialists do hold an RN credential, there are good reasons for having coders fill the roll, says Allen Frady, RN, BSN, CCDS, CCS, CDI education specialist for HCPro in Middleton, Massachusetts.

“There are a lot of very specific documentation requirements for evaluation and management (E/M), observation codes, interventional radiology, etc., which RN CDI specialists don’t typically learn,” he says. Additionally, coders may already be comfortable working in a physician practice setting and have a familiarity with hierarchical condition categories (HCC). [more]

Note from the Associate Editorial Director: Join us on the ACDIS stage

Join us in San Antonio!

Join us in San Antonio!

by Melissa Varnavas

We started small, with just a handful of members. Their excitement, infectious. Soon ACDIS Director Brian Murphy organized a conference, nearly 200 people attended. There were just 13 speakers at that event.

Not a day goes by that we don’t marvel at the growth of the clinical documentation improvement profession. With the 10th annual ACDIS conference in the books and ACDIS’ 10th birthday coming up in October, we can’t help but see the association’s trajectory as an extension of that growth.

[more]

Symposium Update: Early bird hotel discount ends August 17

outpatient logo

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

R_Hendren

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.