RSSAll Entries in the "Policies & procedures" Category

Note from the Associate Editorial Director: Consider the peer audit

IMG_1136-small

Associate Editorial Director Melissa Varnavas

By Melissa Varnavas

Back in 2015, 40% of ACDIS Radio listeners (of the October 28, 2015, broadcast) indicated their CDI program had an established query auditing process in place. Another 29% said they had some type of query review practices established but they only informally or occasionally take the time to examine the efforts of CDI specialists.

ACDIS has long advocated for some type of regular query practice audit and review—be that driven by the CDI program manager or director or peer-to-peer amongst the CDI team. Donald A. Butler, RN, BSN, then the CDI manager at North Carolina facility authored a White Paper regarding the auditing process and provided an in-depth PowerPoint presentation regarding the benefits back in 2012. In 2013, a number of professionals described the importance of such reviews and pulled the lid off for a glimpse inside their own processes in a CDI Journal article. [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]

Book excerpt: Defining clinical documentation and coding standards in the revenue cycle, integrating real-time auditing, part 2

Lamkin_Elizabeth

by Elizabeth Lamkin, MHA, ACHE

by Elizabeth Lamkin, MHA, ACHE

To reinforce formal documentation education provided to physicians and staff, open chart auditing and real-time education is needed. Effective facilities typically have a CDI program staffed with trained professionals to concurrently audit every open chart and query providers to obtain clarifications and additional documentation when needed.

Placing CDI staff on the clinical units to audit chart documentation in real time and personally interact with physicians and other clinical staff, often helps with education effectiveness as well. The CDI specialist can query the physician to explain why the documentation does not meet criteria or does not really tell the story of the patient’s condition.

[more]

Measuring the effect of HCCs, part 1

Editor’s note: This article originally appeared in the Revenue Cycle Advisor. For more information about Hierarchical Condition Categories (HCCs), read this article from the CDI Journal by Gloryanne Bryant, RHIA, RHIT, CCS, CCDS. To read the second part of this article, come back to the blog next week. The views expressed do not necessarily represent those of ACDIS or its advisory board.

Evolving reimbursement methodologies and regulations can make it difficult for an organization to prepare for the future. Some may choose to stick to current processes but savvy organizations should be looking ahead. Risk-adjusted and value-based models are the future of reimbursement, for both commercial and government payers. Organizations must keep the doors open today while building a solid foundation for the years to come.

These changes and challenges require organizations to pay attention to a sometimes neglected coding topic: hierarchical condition categories (HCC). HCCs are the basis for risk adjustments for reimbursement models like Medicare Advantage, accountable care organizations (ACO), and other value-based purchasing measures such as Medicare Spending Per Beneficiary. Poor understanding and application of HCCs mean that a hospital’s patients may be much sicker in reality than they appear to be on paper. And that will hit reimbursement hard.

Because HCCs generally apply to only certain patient populations, identifying those patients from the start can help focus efforts. Work with information systems, EHR vendor, and front desk staff to ensure an understanding of the financial classes or insurance plans for Medicare Advantage patients. It can sometimes be difficult for a provider organization to pin down the impact of HCCs because it’s less straightforward than other models, says Monica Pappas, RHIA, president of MPA Consulting, Inc., in Long Beach, California. Medicare Advantage payments are calculated once a year and the rate is set by CMS, communicated to the payer, and then to the provider via contract.  “The complexity comes from the fact that all of the hospital’s inpatient and outpatient data, plus the professional data is merged at the health plan and then scrubbed and ultimately submitted to CMS,” says Pappas

CMS analyses the data. The agency then determines what the yearly payment will be for a patient based on that patient’s particular set of aggregated data.

Some organizations may not even be aware of how HCCs affect Medicare Advantage payments, says James P. Fee, MD, CCS, CCDS, vice president of Enjoin, Collierville, Tennessee and a hospitalist at Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana. If an organization did not have a risk-bearing contract with its Medicare Advantage payer, it didn’t need to know about HCCs. The onus would be on the payer to drive risk scores to determine capitated rates and prospective payments with CMS for the fiscal year. But new reimbursement models are changing the game for providers. Health Care Options (HCO), ACOs, and the Merit-based Incentive Payment System (MIPS) all use HCC risk adjustments. Providers taking part in these programs are suddenly getting interested in HCCs, Fee says, but they may have more to learn than they realize.

“HCCs are going to be the next greatest impact for CDI, whether that be determining a capitated rate and prospective payment models such as Medicare Advantage, to some of the next gen ACOs and ACOs in general,” Fee says. “HCCs run the gamut if you look at the industry in general. It’s a changing world for organizations because if you haven’t been in this space then you’re not quite aware.”

 

Guest Post: Creating an inpatient coding compliance plan

Rose Dunn

Rose Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS

by Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS

To limit exposure to claim denials and external reviews, the best safeguard for a facility is a robust, effective internal coding compliance policy, plan, and program.

Begin by reviewing any existing coding policies and procedures to determine whether they are consistent with the organization’s compliance plan, as well as the latest Official Guidelines for Coding and Reporting. If your department lacks compliance policies and procedures, excellent resources are available at JustCoding, ACDIS, AHIMA and the Hospital Corporation of America.

A facility’s coding compliance plan may be a subsection of the policy. If you format your compliance plan as a subsection, the document should be labeled “coding compliance policy and plan.” The plan component should be much more detailed and include the specifics of what, when, and how often. Each organization should tailor its coding compliance plan to its organization.

When developing a new coding compliance plan, managers should begin by asking these questions:

  • Why am I establishing a plan?
  • What will I review?
  • How will I select a sample?
  • How will I assess accuracy?
  • What action will I take when the results are known?
  • How will I monitor progress?

The coding manager should collaborate with the compliance officer in developing the plan. Some components that should be considered when you create your plan are:

Purpose: The purpose of the XYZ Hospital Compliance Plan is to improve the accuracy and integrity of patient data, ensure minimal variation in coding practices, serve as a conduit to improve provider documentation in the electronic patient record, and support XYZ Hospital’s ability to receive its entitled reimbursement for the services it and its providers provide.

Expectation: Staff (employees and, when applicable, contracted staff) will strive to maintain the highest level of professional and ethical standards in the performance of their coding duties. Staff will be trained and oriented in all applicable federal and state laws and regulations that apply to coding and documentation as relates to their positions.

Adherence to these guidelines is imperative. Where any questions or uncertainty regarding these requirements exists, it is the responsibility of the employee to seek guidance from a certified coding specialist, health information administrator, or another qualified coding professional. Staff will be familiar with prohibited and unethical conduct that relates to coding and billing as outlined in the facility compliance plan. Staff will comply with AHIMA’s Code of Ethics.

Education:

  • All coders, billers, and providers will receive orientation and training in the fundamentals of compliant coding and billing. Continuing education will be provided in the form of handouts, memos, journals, in-services, and formal education as available and approved. To keep up with changes in regulatory requirements, coding changes, and proper coding procedures, it is the staff member’s responsibility to further his or her knowledge by reading all handouts, memos, and journals provided, and actively participating in available in-services and formal education workshops.
  • All coders, billers, and providers will receive training in coding, documentation, and billing compliance issues on an annual basis or more frequently as need dictates. The training will be coordinated by the coding compliance subcommittee in conjunction with or in addition to training provided by the compliance office.

Coding resources: Coding staff shall have access to the following resources to facilitate their coding duties:

  • Encoder
  • Computer with dual monitors
  • Coding books: ICD-10-CM for diagnoses and ICD-10-PCS for inpatient procedures; other reference materials will be maintained in the coding manager’s office

Coding conventions and guidelines: The guidelines and conventions to be followed for codes to be reported on claims will be:

  • Coding Clinic published by the American Hospital Association
  • Official Guidelines for Coding and Reporting published by CMS and the National Center for Health Statistics

Editor’s note: This article was originally published in JustCoding. Dunn is a past president of the American Health Information Management Association and recipient of its 1997 Distinguished Member and 2008 Legacy awards. In 2011, she served as the interim CEO of AHIMA and received a Distinguished Service Award from its board of directors. Dunn is the chief operating officer of First Class Solutions, Inc., a health information management consulting firm based in St. Louis. Opinions expressed are that of the author and do not necessarily represent HCPro, ACDIS, or any of its subsidiaries. This article is excerpted from JustCoding’s Practical Guide to Coding Management.

 

Q&A: Finding focus for CC/MCC reviews

haik

William Haik, MD, FCCP, CDIP

Editor’s note: William Haik, MD, FCCP, CDIP, director of DRG Review, Inc. answered the following questions in conjunction with his webinar, “FY 2017 ICD-10-CM CC/MCC List with Revisions: Clinical Indicators and Query Opportunities.” To purchase the on-demand version of the webinar, click here. The views expressed do not necessarily represent those of ACDIS or its advisory board.

Q: I’m having trouble with querying physicians for complication codes. Could you please provide guidance?

A: This is difficult. Unless there is an (coding) index directive, query the attending physician to determine if a condition occurring after surgery is due to, or caused by, the surgical procedure (such as atelectasis following surgery). From a medical perspective, the conditions which occur after surgery are not typically due to the surgery, but are due to other factors such as in atelectasis, operative pain, sedation, supine position, etc. Therefore, when I ask, it is when there is a high probability of being related to the surgical procedure (hematoma, excess hemorrhage which is addressed intraoperatively or immediately post-operatively). 

Q: Does systemic inflammatory response syndrome (SIRS) with pneumonia qualify for sepsis or should this be queried?

A: Unfortunately, in ICD-10-CM, there is no coding index entry for SIRS, and the previous index entry in ICD-9-CM for SIRS with infection no longer leads to sepsis. Therefore, the physician must be queried to clarify the documentation and assign an appropriate code.

Q: Should we query when the physicians use accelerated or malignant hypertension (HTN) in regards to hypertensive emergency/urgency?

A: Yes, as the former terms now are considered unspecified, a more specific condition should be sought.

Q: Would a physician query be necessary if the physician documentation indicates malnutrition (CC) and the dietician’s assessment documents mild to moderate malnutrition (CC)?

A: It is unnecessary to query a physician regarding the non-specific documentation of malnutrition. If the physician documents mild or moderate malnutrition, one would assign malnutrition, not otherwise specified, unless the physician specifies further.

Q: Do you have any suggestions for what CDI professionals should do if the physician documents a diagnosis but it is not supported by documentation in the chart or by clinical indicators?

A: I would ask the physician to review the record along with enclosed medical criteria regarding the condition in question. I have developed a handbook which provides evidence-based clinical indicators for common medical conditions. (For a copy, email Behaik@aol.com.)

Q: Should we query for electrolyte abnormalities on gastric bypass patients. We are told imbalances are normal due to diet restrictions.

A: Although electrolyte disturbances are common in gastric bypass patients, they are not normal and not integral to the procedure. The physician would typically would treated the patient if the levels were significantly clinically deranged. In this setting, I would query the attending physician to determine if the levels are merely lab abnormalities or if they should be clinically significant and reportable.

Q: When acute respiratory failure is reported in the postop period and is integral to the procedure (for example, the patient remains on mechanical ventilation for less than two days following post op), do we have to query to see if it is significant or should we code without a query?

A: From a clinical perspective, I assume major surgery (cardiopulmonary, esophageal, gastrointestinal resection surgery) often require prolonged ventilation. In minor surgeries, such as prostate biopsies, extremity surgeries, etc., if the patient is on mechanical ventilation longer than 24-hours and assuming the patient is awake, then I would tend to query regarding post-operative respiratory failure, particularly if there is a medical complication such as aspiration pneumonia, pulmonary edema, etc.

Q: What’s the difference between acute respiratory failure and acute pulmonary insufficiency? Would oxygen dependent Chronic Obstructive Pulmonary Disease (COPD) be insufficiency instead of failure?

A: Acute respiratory failure is a life-threatening condition which is typified by a pO2 of less than 60 on room air (in patients with previously normal lungs) in the clinical situation of a patient with rapid respirations and increased work of breathing in the acute setting. Acute pulmonary/respiratory insufficiency is a poorly defined term merely meaning non-life-threatening impairment of gas exchange. Therefore, it does not represent a pO2 of less than 60 (in patients with previously normal lungs), but not a completely normal pO2. Oxygen-dependent COPD is consistent with chronic respiratory failure as to obtain oxygen (via Medicare) one must have a pO2 of less than 60.

Q: Post-operative pulmonary insufficiency is an MCC, but post-operative respiratory insufficiency is neither a CC/MCC. Is there a way to differentiate these two diagnoses?

A: There is no medical differentiation between pulmonary and respiratory insufficiency. This is merely an idiosyncrasy of ICD-10-CM.

Q: According to resources, a lactate less than 1.0mmol/L, which is normal, is considered a sepsis indicator. Why is this an appropriate indicator if it is within normal limits rather than greater than 2 which is abnormal?

A: Despite the “normal” limits of lactate up to 2.2 in most hospitals, it has been determined, retroactively, a lactic acid level of greater than 1 is a finding seen in sepsis. It is not specific as there are other hypoperfusion states and/or chronic liver disease which may result in an elevated lactic acid level. Therefore, it must only be interpreted in the appropriate clinical circumstances.

Q: Is healthcare associated pneumonia (HCAP) synonymous with hospital acquired pneumonia?

A: They are similar, but not synonymous. HCAP includes nursing homes, long-term acute care facilities, chemotherapy, and dialysis centers. Hospital-acquired pneumonia requires a hospitalization of at least a three-day stay. The pathogenic organisms are similar as is the treatment.

Guest Post: It begins and ends in Patient Safety

Jocelyn Murray

Jocelyn Murray, RN, CCDS

By Jocelyn E. Murray, RN, CCDS

My CDI journey began at a level one trauma and teaching hospital in New Mexico. I accepted a permanent recruitment position and relocated out west. I shifted my career role from case management into CDI Implementation. There, I reported directly to the Chief Safety Officer, a well-respected medical professor for the university.

The CDI program (CDIP) implementation focus at the university hospital was on patient safety. How else would I be enticed to change scope of practice? I wanted to continue my nursing mission and help insure quality patient care. The CDIP aimed to:

  • Identify documentation omissions
  • Capture unexpected postoperative events
  • Clarify if the events were inclusions of care or unexpected outcomes
  • Identify any adverse effects during the patient encounter

The CDIP focused on improved quality by means of safety and risk identification linked to inpatient care. We provided lunch-and-learn sessions for insight to the medical and surgical provider teams. The forums reviewed quality and safety findings, provided documentation education and launched a query process as part of the CDI review to obtain documentation clarification necessary. The CDI specialist acted in a liaison role to utilization review (UR)/case management, quality, and nursing, and raised awareness of the identified untoward events that occurred during inpatient care. The CDIP brought awareness to the multidisciplinary team and new processes of documentation capture were established. New processes of identification for early intervention were also an indirect result of the awareness.

It’s now eight years later, and CDIP expansion led to a nationwide implementation of necessary CDI software tools, the improvement in financial impact tracking and reporting, capture of secondary comorbid (CC/MCC) diagnoses, and recognition of APR-DRG severity of illness/risk of mortality (SOI/ROM) indicators. All actions assisted in the practice’s more accurate capture of patient acuity and identifying the severity of care provided.

Nevertheless, the CDIP role in quality and safety recognition has never faltered. Quality documentation and Value-Based Purchasing (VBP) data transparency kept a light on patient safety, and the lost revenue impact associated has now been identified. Patient safety indicator (PSI) reviews remain a key component of CDIP practice for documentation excellence. PSIs have a critical impact on practice performance and the identity of PSI exclusions can protect facilities from financial loss. A wide variety of agencies offer public reports comparing both hospitals and physicians, allowing the savvy patient to choose only the safest, highest rated medical and surgical care. Does your program have a clear picture of the report and what impact it makes?

The impact of imprecise documentation with inaccurate coded data is measurable. Consider a random consultant audit of 14 facility records, four of the records identify likely inaccurately coded cases triggering established PSIs. The inaccuracy carries an error weight of greater than 28% on both the practice and provider quality statistics and corresponding revenue impact. CDIP PSI audits are critical; they increase compliance adjustment and the ROI. CDI specialists with quality training insight recognize the key diagnostic terms required to accurately clarify untoward event documentation in a safety audit. The list includes some of the following:

  • Inclusion
  • Exclusion
  • Clinically indicated
  • Necessary
  • Required
  • Inherent
  • Routinely expected

Patient safety queries and documentation integrity education will bring focus towards a greater understanding of the impact these specified diagnostic terms hold. A diagnosis identifying the condition as part of the post-operative and medical care will then also prevent a coded error.

In addition, PSI exclusions, as noted in the Agency for Healthcare Research and Quality (AHRQ) Quality Indicators Enhanced Version 5.0 reference, provide insight into diagnoses that do not meet PSI definition if combined with other acuity indicators. To learn more about quality and safety documentation and reporting, click here. You’ll find great material for provider education as well.

Editor’s note: Murray is a senior CDI consultant for HIM services at ComforceHealth. Her subject matter expertise includes consultative CDI services, training and education, and implementation of new programs. The opinions expressed do not necessarily reflect those of ACDIS or its Advisory Board. Advice provided is general. Contact Murray at jocelyn.murray@comforcehealth.com.

 

Guest Post: The CDI buzz about CMI: What your facility metrics mean

What's your case-mix index?

What’s your case-mix index?

Jocelyn Murray

Jocelyn Murray

By Jocelyn E. Murray, RN, CCDS

There’s no question of the financial sustenance facility case mix index (CMI) provides. An elevated CMI level indicates an increased severity (or acuity weight) in surgical and life sustaining levels of medical care. Facility budgets are formed around the CMI, it is the acuity weight representing the average facility case and therefore reflects upon reimbursement. It makes perfect sense that this marker is a strong point of reference in the financial revenue department and a CFO focus. CMS.gov gives the following description of the CMI:  the average DRG weight relative weight calculated by summing the DRG weights for all Medicare discharges and dividing by the number of discharges.

We know our financial leaders focus on the CMI on an ongoing basis, but is it a true indicator of our CDI operational assessment and program productivity?

In my opinion, the CMI is a good tool to compare area hospital performance at a similar acuity level for medical and surgical care. We know a comparable facility with a much lower CMI can be a direct reflection on missed documentation and lower acuity weighted diagnostic codes. CDI intervention then consists of a provider education plan to improve documentation and capture the severity. Pre-billed audits ensure the acuity is also captured in final coding. Both are standard elements of the CDI process and program interventions.

It can also be a useful tool to help identify how outpatient CDI focus programs in the ED, short-stay surgery, and observation practice levels help ensure CMI accuracy. The DRG for a patient admission that does not meet medical necessity, indicates the patient’s care could have been provided on an outpatient basis. It could also have a critical impact on the CMI.

The lower weight CMI, as reflected by the DRG in this case, is tossed into the bucket as part of the calculated averaged acuity level for the site. One or two occurrences of low CMI weighted inpatient cases may not be a concern, but a handful of cases would certainly have a detrimental overall effect.

In my first years of CDI program implementation, the facility had a significant drop in the CMI over a couple of months during the summer. I dug into the metric further and discovered the top two acuity case surgeons in both neuro and orthopedic were away on vacation. A significant drop in surgeries occurred, and a small number of high-acuity procedure cases were performed and made available in the in that period’s calculation. Of course, the surgeon’s absence had nothing to do with our CDI program productivity efforts. And yet, the CMI drop was brought to my attention by the chief financial officer (CFO) who questioned the cause as CDI productivity. Together, we reviewed my identified findings and took the opportunity to bring forward critical information to the leadership team. The CMI changes had no reflection on the CDI program impact in the absence of surgical caseloads available during that time period.

CDI programs (CDI) are working at more advanced levels in 2017 and need to focus on understanding how their CMI metrics are effected and how the program responds. One key performance of the CDIP is identification of the root cause with any metric change.  Only then can you can establish a responsive goal and develop an individualized action plan for intervention.

In my case, a report identified the absence of two key surgeons and the effects of their absence on revenue for the facility. It was then up to the executive leadership and chief medical staff to strategize on how to prepare, plan, and focus actions for this type of revenue impact in the future.

Editor’s Note: Murray is a senior CDI consultant, HIM services, at ComforceHealth. Her subject matter expertise includes consultative CDI services, training and education, and implementation of new programs. She has expertise both in program assessment and enhancement to improve the quality, productivity, and effectiveness of CDI programs within an organization. The opinions expressed do not necessarily reflect those of ACDIS or its Advisory Board.  Contact her at jocelyn.murray@comforcehealth.com.

 

 

Guest post: Querying for clinical validity

by Erica E. Remer, MD, FACEP, CCDS

Some clinicians may interpret a query as an affront to their clinical judgment. This is not your intent. You are trying to determine whether a condition was present and whether it should compliantly be coded or not.

Here is an example of how a coder would provide the clinical indicators in the affirmative for the clinician to answer the query in regards to an intimated diagnosis:

Dear Dr. So and So,

The SCr was 3.4 and two days ago it was 1.4. You documented “renal dysfunction likely due to contrast.” Is there a diagnosis that corresponds to this?

You can also provide the physician with the documented diagnosis and the clinical indicators which make you skeptical:

Dear Dr. So and So,

You documented that this patient had pneumonia in the history and physical assessment. Over the course of the next three days, the repeat chest x-rays were read by the radiologists as “no infiltrate,” the sputum and blood cultures did not grow any organism out, and antibiotics were discontinued. However, the impression list continues to list “pneumonia.” Based on this information, please confirm the patient’s condition and your medical decision making, clinical support for the diagnosis in the medical record. If pneumonia was ruled out, please amend the assessment and plan, diagnosis list.

If a physician advisor supports the coding and CDI departments involve him or her in the process. The physician advisor can help create internal clinical guidelines to help providers ward off CVDs by standardizing criteria.

Make sure your providers see coders and CDI professionals as an ally, not an adversary, and that goal of CDI efforts is to protect both the physician and the facility from unnecessary denials.

Become educated

The last step is education—both for the CDI staff and for the physician.

Physicians often don’t know about clinical validations denials. When they occur, share them with providers. Point out what could have prevented them. Reinforce the good habit of documenting their thought process and explaining why they are doing what they are doing to and for the patient. Don’t accept responses to queries with only diagnoses and no clinical evidence supporting them.

Educate CDI and coding teams. If you have regular staff meetings, you can discuss topics which seem to be eliciting clinical validation denials. Changing clinical criteria may herald impending denials. Crowdsource best approaches to specific clinicians and specific conditions. Have joint discussions between coders and the CDI staff.

Clinical validation denials require time, energy, and resources to revisit patient encounters coded in the past. Concurrent clinical validation practices can prevent future denials by shoring up clinical support of valid diagnoses and eliminating others. An ounce of prevention is worth a pound of cure.

Editor’s note: This article, written by Erica E. Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc., Consulting Services, first appeared in its entirety, in JustCoding. Advice given is general. Readers should consult professional counsel for specific legal, ethical, clinical, or coding questions. Contact her at icd10md@outlook.com.

 

 

Note from Associate Editorial Director: What’s your query metric?

Melissa Varnavas

Associate Editorial Director Melissa Varnavas

Although many CDI program directors wish for national standards for calculating CDI productivity (e.g., a set number of new reviews and re-reviews per CDI specialist per day), “frequent regulatory changes and broad diversity within the industry prohibit a one-size-fits-all approach,” the ACDIS Advisory Board wrote in a White Paper released in December.

While that fact may be indisputable—new CDI staff simply cannot be expected to be as productive as those with multiple years’ experience and programs with expanded record review scopes cannot be expected to turn over as many records as those simply looking for a lone CC/MCC—CDI programs can take advantage of polling research conducted by ACDIS over the years to help establish baseline metrics and program goals.

For example, a 2014 ACDIS website poll indicated that productivity expectations ran the gamut:

  • 32% review 1–10 records per day
  • 25% review 11–15 records per day
  • 18% review 16–20 records per day
  • 13% review 21–25 records per day
  • 6% review 26–30 records per day
  • 6% review more than 30 records per day

The productivity survey conducted in association with December’s White Paper release found 85% of respondents review 6–15 new patient reviews—only 7% reviewed less and only 5% reviewed 16 new records or more per day.

Ultimately, judging from the data, the Advisory Board suggested that “16–24 total reviews per day (new reviews and re-reviews) is an average range for a CDI specialist, with 20 daily reviews being an acceptable goal to account for variability in review focus,” as noted later in the survey.

The latest survey out from ACDIS probes at a number of additional questions related to CDI physician query practices, including:

  • Do you query for clinical validation, i.e., to confirm presence of a documented diagnosis lacking clinical support?  To date, 85% of the more than 200 respondents do.
  • Does your facility have standard query policies and procedures? More than 75% do.
  • Does your facility have an electronic query system either as part of your EHR or another software system? Only 17% don’t.

The survey which will remain open through March 1, also asks important questions about query auditing and monitoring, resources used to craft query policies, and about respondents’ perceptions regarding the effectiveness of electronic systems.

As I often say, ACDIS thrives on membership participation and we need yours to ensure the data revealed in this 2017 physician query assessment represents the true benchmarks of our industry. Won’t you take a few minutes to share your thoughts?

Click here to take the survey. And thanks!