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New survey: CDI productivity and program structure

Dear CDI professionals and ACDIS members,

Please take a few minutes to participate in this CDI program structure and productivity survey. In it, we ask questions regarding your CDI program’s reporting structure, the number of record reviews you perform and whether your facility plans to hire new CDI staff to respond to the documentation and training needs associated with ICD-10-CM/PCS implementation. Your responses will illustrate program structure and productivity trends across the country. We hope the results will help you draw meaningful comparisons with other CDI programs across the country and build a case for hiring additional staff.

To participate in the survey, click here.

2013 CDI Salary Survey shows compensation growth

The 2013 CDI Salary Survey released in October shows career growth

The 2013 CDI Salary Survey released in October shows career growth

Of the more than 700 individuals who responded to the 2013 CDI salary survey, most respondents (25.2%) earn $60,000–$69,999 annually. Although that’s down slightly from the 2012 survey results in which 25.9%  reported earning that amount, it’s not bad news. Why? The number of individuals earning $10,000 less ($50,000–$59,999) decreased by 4% while the number of individuals reportedly earning $10,000 more ($70,000–$79,999) increased by nearly the same percentage, illustrating a clear upward shift in salaries.

In addition, this year’s salary survey shows clear growth in CDI career paths and compensation with managers/directors earning more, with those with advanced schooling earning more, and those with advanced certifications earning more as well.

Furthermore, this year’s report provides analysis of CDI salaries by state, region, municipality type.

ACDIS members have complete access to the survey results in the October edition of the CDI Journal.

Free ICD-10 Benchmarking Report available

The Association for Clinical Documentation Improvement Specialist (ACDIS) 2013 ICD-10 Preparation Survey provides a compelling snapshot of where CDI departments stand regarding the impending Oct. 1, 2014 implementation date of ICD-10. More than 180 CDI specialists answered questions on their overall readiness for ICD-10, their biggest areas of concern, their anticipated additional volume of physician queries, and their staff and physician training timetables.

The data in the ACDIS ICD-10 Preparation Survey contains important and surprising results. For example, 61% of respondents indicated they have an ICD-10 implementation committee in place, yet only 39% indicated that their CDI manager/director is a “key leader” in implementation efforts, and only 55% indicated that their facility HIM manager plays such a role.

Non-ACDIS members have limited time access to this special report.

2013 Query benchmarking report available

Please help us by taking a few minutes to respond to the latest physician query survey.

The latest physician query benchmarking report is now available.

It has been three years since ACDIS last surveyed its membership about physician query practices. In 2010, 382 CDI professionals participated. This year’s survey garnered 517 respondents, primarily CDI specialists.

“That’s really a tremendous response rate,” says Drew K. Siegel, MD, CPC, CDI specialist at the University of North Carolina (UNC) Hospitals in Chapel Hill.

The 35-question survey illustrates the importance of the physician query as the primary tool driving CDI efforts, but also demonstrates wide differences regarding query assessment, compliance, and policy review.

“The responses are actually quite varied, so there’s evidence that the query process [across facilities] is clearly not standardized,” says ACDIS Advisory Board member Timothy N. Brundage, MD, CCDS, physician champion at Kindred Hospital North Florida District in St. Petersburg.

That said, the 2013 survey does show some interesting trends, according to fellow ACDIS Advisory Board member Walter Houlihan, MBA, RHIA, CCS, CDI specialist at Baystate Health in Springfield, Mass.

“It is good to know that so many of us have the same challenges and needs when it comes to physician queries,” he says.

Editor’s Note: ACDIS members have access to the complete report in the July 2013 edition of the CDI Journal. The text of the report is available to all under the Featured Article section of the ACDIS homepage through the end of the week, August 23.

CDI Week industry survey open: Participate now

CDI Week

CDI Week

Every year, in honor of the national recognition week for CDI professionals—CDI Week—The Association of Clinical Documentation Improvement Specialists (ACDIS) hosts a comprehensive “Industry Outlook Survey.”

The survey includes more than 30 questions on topics ranging from ICD-10 implementation, physician engagement, electronic health record implementation, and career advancement.

The results of the survey will be posted and publicly available on the CDI Week portion of the ACDIS website.

The third annual CDI Week celebrations take place September 15-21, 2013. Please take a few minutes to complete the 37-question survey by clicking here.

For more information about CDI Week festivities visit:

ACDIS releases ICD-10 CDI benchmarking report

How many records should you review in a day? The answer isn't easy.

Most CDI professionals say they have not begun to query for ICD-10 specificity.

According to the results of the ACDIS 2013 ICD-10 Preparation Survey, 56% of respondents indicated their facilities had performed a formal assessment of their ICD-10 readiness. Considering the back-and-forth debate that took place in late 2011 and early 2012 regarding a possible implementation delay, “that’s pretty good,” says ACDIS advisory board member Susan Belley, M.Ed., RHIA, CPHQ, project manager at 3M HIS Consulting Services in Atlanta.

By this time next year, most facilities will be in the throes of preparation for the transition to ICD-10-CM/PCS. Some liken the challenge to the hype that surrounded Y2K. For those who do not remember that much-publicized event, all the computers all over the world were essentially supposed to stop working at the start of the new millennium due to a glitch in the system. Yet, no doubt because of the behind-the-scenes efforts of countless computer gurus, the world continued on. Similarly, facilities that “turn the clock” on October 1, 2014, and enter the new millennium of ICD-10-CM/PCS will need to rely on the efforts of CDI and coding professionals.

For those who have not started preparations yet, the most important thing to remember is “don’t panic,” says Rebecca “Ali” Williams, RN, BSN, CCDS, senior CDI consultant at United Audit Systems, Inc., in Cincinnati. “Just focus. Go ahead and code some records in ICD-10-CM/PCS and get a feel for it, see what’s different. Over time, with repeated use, coders and CDI staff will begin to feel more comfortable. Over time, it will become second nature,” Williams says.

Editor’s Note: ACDIS members have access to the complete report in the July edition of the CDI Journal.

Q&A: How to determine an appropriate physician query response rate

Ask your question by leaving a comment below.

Ask your question by leaving a comment below.

Q: I enjoyed listening to the ACDIS quarterly conference call in May. Someone on the call stated they have a physician response rate of 95%. That caused me to wonder what the typical time frame for physician response might be; ours is 48 hours after discharge. I have heard some facilities give two weeks and some give up to 30 days, so I am wondering if there is some standard there

A: Different facilities structure their programs differently. Many have no policy in place regarding expectations related to the timing of the physician’s response. That said, the most successful programs do set expectations typically of about 72 hours, and indicate on the query form, itself, that a response is expected within that time frame.

The goal is to have a high query response rate within that 72 hour time frame.  In other words, there is a difference between an organization with a 95% response rate where the queries are closed within 72 hours and one that has a 95% response rate, but the queries are left open indefinitely.  Best practice would be to resolve any open query before billing.

Few organizations will hold a claim for 30 days pending a query response, which can result in a re-billing situation if the query response changes the DRG assignment. An effective CDI department can positively impact bill hold times as they work to resolve open queries so the record is complete for coding within days of discharge.  Most organizations have a bill hold goal of three to five days.  Be sure to address how long a query can remain “open” or awaiting a response  within your CDI program policies and procedures.

One of the most important aspects of tracking physician responses is to determine which physicians need extra support and education regarding the importance of CDI efforts. An internal escalation process (such as the samples recently published in the CDI Journal) may be another way to address habitual non-responders.  Be sure to get hospital and physician leadership support for your deadlines and share them with the medical staff.

Also, you need to know if your organization voids those queries that no longer impact the DRG. For example, if a CDI specialist leaves a query for a CC but a different CC was coded, that query would be “voided” in some organizations. Then, when calculating your response rates you’d also have to void or remove those queries from the calculation so rather than a non-response counting against the query rate, that particular query would be removed from the equation.  Additionally, some organizations “close” a CDI query and “open” a coder query when a patient is discharged if their coding department then follows up on the query so that can impact response rates as well by lowering the CDI response rate.

As you can see, there are a lot of factors to consider when calculating a query response rate so it is difficult to compare organizations without knowing how long queries can remain “open” awaiting a response and what query resolution processes are in place.  Remember the value of the CDI department is in issuing queries to clarify incomplete, vague or missing documentation so query resolution should be a prominent task within the CDI role.

2013 CDI Salary Survey open

In ACDIS’ 2012 CDI Salary Survey, the majority (26%) of respondents earned $60,000–$69,999 annually. However, those earning $70,000–$79,999 rose four percentage points—from 16% to 20%—over previous surveys.

How will pay ranges shift in 2013? There’s plenty of speculation related to remote and travel CDI as well as the increased demand for experienced professionals. Your participation in this year’s survey will provide concrete results. Please take a few minutes to participate and share your experiences. Portions of the data will be provided in CDI Strategies and the full report will be provided to ACDIS members.

Revenue Cycle Institute releases 2013 Recovery Auditor Benchmarking Report

Debbie Mackaman

Debbie Mackaman

by Debbie Mackaman, RHIA, CHCO

We’ve been on quite a ride since the start of the Recovery Auditor (RA) efforts. In 2012, RAs continued to expand. This report examines how providers have adjusted their approach in the past year, and it looks forward to some new initiatives and proposals that could alter the state of RAs as a whole.

The Revenue Cycle Institute’s 2013 Recovery Auditor Benchmarking Survey had 325 respondents, representing both small and large hospitals, from all four RA regions. These respondents represented a number of different departments, including compliance, HIM, PFS, case management, and clinical documentation improvement.

The main theme of this year’s survey is the growing state of the RAs, and the fact that they only seem to be gaining speed.

The percentage of providers that have had recoupments from automated reviews rose by 14% this year. In addition, the amount of providers that have seen record requests for complex or semi-automated reviews has increased from 82% to 91%. This may not be shocking, as CMS continues to approve more issues and the scope of the RAs continues to expand, but it highlights the fact that the audits are ever-changing and will force providers to stay on their toes.

Another item providers need to pay attention to is the arrival of the prepayment RA reviews. As of right now, only two issues have been approved—MS-DRGs 312 and 069—with short inpatient hospital stays looming, and only 11 states are in the prepayment demonstration, but that does not mean that providers are unfamiliar with the prepayment review process. According to our survey, 74% of respondents have seen a prepayment review either from their MAC (52%), their RA (6%), or both (16%). A total of 52% said that they are not specifically changing any internal processes related to prepayment concerns but 33% said they’ve heightened awareness in departments affected by RAs. However, almost half of the respondents have felt the need to revise internal processes to meet auditor scrutiny, which appears to be increasing from year to year. As the RA program expands, providers need to be flexible to adjust to current issues and anticipate upcoming reviews.

Another RA-related demonstration project is the Part A to Part B rebilling demonstration. While only 380 hospitals are participating in this demonstration, 28 responded to the survey. Of these, the majority (62%) have been able to rebill and get reimbursed. Only 14% have not rebilled anything yet, but were planning on doing so in the future. This demonstration project will last three years, and although it could assist facilities in recouping some of their costs for inpatient stays that were deemed not medically necessary, it is certainly not an answer to resolving the daily operational issues facilities face.

The third recent development is the complaint filed by the American Hospital Association (AHA) against RAs. As you all probably know, the AHA, along with several other hospitals, issued a lawsuit against the RAs for unfair Medicare practices. Based on this bold move, I was curious what respondents thought about the initial action. Sixty percent think that something will happen as a result of the complaint, but 43% of those think that it will only involve very minor changes. On the other side, 17% think that nothing will happen, while 25% are just happy to see the RAs being called out on their current practices. This will be an interesting topic to follow and may set a precedent for other audit processes. Although respondents appear to be pessimistic regarding the potential outcome of the lawsuit, the fact that RAs are being challenged should give providers hope for changes going forward.

Editor’s Note: Debbie Mackaman, RHIA, CHCO, is a Regulatory Specialist with HCPro, Inc., and teaches its Medicare Boot Camps. This post is an excerpt from the benchmark report. To read the entire report, visit The Revenue Cycle Institute.

2013 physician query survey open

Please help us by taking a few minutes to respond to the latest physician query survey.

Please help us by taking a few minutes to respond to the latest physician query survey.

In light of the most recent physician query practice guidance released in the February edition of the Journal of AHIMA “Guidelines for Achieving a Compliant Query Practice,” ACDIS wants to know how your query practices have changed or progressed.

Please take a few minutes to participate in this 35-question survey. It asks for input regarding CDI query rates, physician response rates, auditing and tracking efforts, and policy creation. ACDIS will share the results in the featured article section of the website and provide a download to members in the upcoming CDI Journal.

Click here to take the survey.

Editor’s Note: Join query practice brief committee members William E. Haik, MD, FCCP, CDI-P and Cheryl Ericson, MS, RN, CCDS, CDI-P on Monday, March 4, 1-2:30 p.m., eastern for the webcast “Physician Queries: Comply with new ACDIS/AHIMA guidance.”