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New groups, meetings promote CDI efforts in February

The Las Vegas, NV chapter at its first meeting in June 2011. Pictured above from left to right: Sharon Yens (Centennial Hills Hospital), Kathy Bird (Southern Hills Hospital), Karen Thorsteinson (St Rose Hospital – De Lima), Kathy Hurst (Kindred Hospital – Flamingo), Lori Mejia (Southwest Medical Associates), Sherry Siewers (DDCM Kindred Desert District), Sherry Shariff Hall (St Rose Hospital – Siena), and Marissa Schanbacher (Mountain View Hospital). Taking the photo: Ailsa Kompare (Kindred Las Vegas Market).

New networking groups

Philadelphia: The Philadelphia CDI network has new energy and is planning its first meeting for 2012. For information, contact Judi Bates at Lourdes Health System at 856/757-3161 or e-mail at BatesJ@lourdesnet.org. Or call Debby Dallen at Albert Einstein Medical Center at 856/786-0897 or e-mail dallend@einstein.edu.

Rochester, NY: Ruth Pfrengle, BSN, RN, director of utilization management at the University of Rochester Medical Center, has volunteered to help facilitate networking opportunities in the region. For information, contact 585/273-3816 or e-mail ruth_pfrengle@urmc.rochester.edu.

Texas: Barbara Presley, RN, CDI specialist at the University Medical Center Brackenridge in Austin has volunteered to help professionals from the San Antonio/Austin area to network. For information, contact her at 512/324-7679 or e-mail baPresley@seton.org.

Vermont: Suzanne Schultz, RN, BSN, CCM, CCDS, CDI specialist at the University of Vermont Medical Center in Burlington, has volunteered to connect CDI professionals in the state. For information, contact her at 802/847-2140 or e-mail suzanne.schultz@vtmednet.org.

Washington: The Evergreen ACDIS Chapter of Northwest Washington seeks new volunteers to help lead the group in 2012. For information, contact Jennifer Woodworth, RN, BSN, CCDS, director of CDI at Swedish Medical Center in Seattle by phone at 206/215-2073 or e-mail Jennifer.Woodworth@swedish.org. Or contact Cathie Murphree, LPN, CCDS, Documentation Improvement Specialist/HIM, at St. Joseph Medical Center, in Bellingham, at 360/788-6300 ext. 3429 or e-mail CMurphree@peacehealth.org.

West Virginia: Sheila Harrison, RN, BSN, CDI specialist at the Charleston Area Medical Center, Teays Valley Division, has volunteered to help get networking efforts started in the state. For information, contact 304/389-0689 or e-mail Sheila.Harrison@camc.org.

February meetings

New Hampshire: The next meeting will be held Wednesday, February 8, 1-2:30 p.m., at Elliot Hospital in Manchester. For information, contact Carla A. Heyn at 603/663-3452 or by e-mail at cheyn@Elliot-HS.org

Albany, NY: The Albany (NY) ACDIS Regional Chapter holds its next meeting Wednesday, February 8, 2-4 p.m., at St. Peter’s Hospital. The group will discuss documentation regarding acute renal failure. For information, contact Lois Rubin at 518/525-1081 or e-mail lrubin@sphcs.org.

Virginia: The next Virginia ACDIS Chapter meeting will be held Saturday, February 11, 10 a.m. to 2 p.m., at 1222 Jefferson Park Ave., in Charlottesville. Each attending facility will present/discuss what works well in their facility and what needs improvements. There will also be a teleconference/webinar presentation by ACDIS Advisory Board member Glenn Krauss.

Continuing its “ACDIS gives back” tradition, UVA has decided to donate to The HAVEN, a safe and welcoming place for the homeless in our community. Donations can range from warm items such as gloves, hats, or scarves to nonperishable food. A complete list can be obtained at www.thehavenatfirstandmarket.org/give/. For information, contact Sequana Webb 434/760-4491 or e-mail sck8u@virginia.edu.

Wisconsin: Will hold its winter meeting Saturday, February 18, 9 a.m. to 3 p.m., at Wheaton Franciscan Health Care, in Wauwatosa. Continental breakfast and lunch will be provided. CCDS and AHIMA credits will be offered. The meeting agenda includes:

“A Clinical Perspective on Chart Review and Diagnoses Assignment: A QIO Reviewer’s Perspective,” by Jessica Whitley, MD, MBA, hospitalist and QIO reviewer.
“CDI’s Impact on the Recovery Audit Contractor Initiative: Capitalizing on our Strengths to Minimize Hospital Financial Exposure,” by Diane Draize, RN, CPUR, CCDS, CDI specialist at Ministry Health, and Joan Korn, BSN, RN, CDI specialist at Wheaton Franciscan Health Care.
“What You Don’t Know About Principles of Multiple Significant Trauma is What You Don’t Know!,” by Kathy Thomas, RN, CDI specialist at Wheaton Franciscan Health Care, and Renee Hedtcke, RN, CCDS, at Aurora Summit Medical Center
Open Discussion/Roundtable: Opportunities for CDI Initiatives in the Ambulatory Care environment as well as inpatient setting beyond reimbursement

Deadline to register is Sunday, February 12. Registration is $25 for WI ACDIS members; $50 non-members.

For information, contact Kathy Thomas, RN, at Wheaton Franciscan Health Care, kathleen.Thomas@wfhc.org; Renee Hedtcke, RN, CCDS, at Aurora Health Care, renee.hedtcke@aurora.org; Diane Draize from Ministry Door County Medical Center Sturgeon Bay at diane.draize@ministryhealth.org, Joan Korn from Wheaton Franciscan St. Francis in Milwaukee at joan.korn@wfhc.org, or Glenn Krauss, independent consultant, glennkrauss@earthlink.net.

N. Illinois: The next meeting will take place on Thursday, February 16, from noon to 3:30 p.m., at Northwest Community Hospital in Arlington Heights. The agenda includes:

Participation in the ACDIS Quarterly Conference Call
Presentation by Maralee Gray, BSN, CDI specialist at Rockford Memorial Hospital regarding “CDIS and ICD-10 Crossing Over: How to Safely Make it to the Other Side”
Presentation by Karolee Fill, MSN, APN-CNP, at Northwest Community Hospital regarding “Basic Review of Echocardiography in the Heart Failure population”

For information, contact Nancy R. Ignatowicz at 815/806-2322 or e-mail nancy.ignatowicz@provena.org. Or contact Colleen Stukenberg MSN, RN, CMSRN, CCDS, at 815/599-6820, or e-mail CStukenberg@fhn.org.

California: The California ACDIS Chapter holds its regular meeting the fourth Wednesday of the month, February 22, 9-10 a.m. Those interested in volunteering to help lead the chapter are invited to step forward at this time. For information, contact Dexter D’Costa at 573/529-1791 or e-mail dr_dexterdcosta@yahoo.com.

Maine: The next meeting will be held Thursday, February 23, noon to 4 p.m., at Mid-Coast Hospital in Brunswick. For information, contact Cathy Seluke at 207/872-1796 or e-mail Cathy.Seluke@mainegeneral.org.

New England: The next New England Regional ACDIS Chapter meeting will be held Tuesday, February 28, 2-4 p.m., at Tufts Medical Center, Stearns Auditorium. Janet Cavagnac from Baystate will review ICD-10 coding in 3M software. Participants should bring a 3M equipped laptop if possible. Volunteers are needed to schedule future meeting and help lead the group. For information, contact Kelley Sears at 508/954-7432 or e-mail Kelley.Sears@steward.org.

Georgia (Southeast): The next Southeast ACDIS meeting will be Wednesday, February 29, 10 a.m. to 2 p.m., at Parkridge Medical Center in Chattanooga, TN. For information, contact Bonnie I. Epps at 404/712-4550 or e-mail Bonnie.Epps@emoryhealthcare.org. Or visit the Southeast Regional ACDIS Chapter Facebook page for meeting announcements and other information.

Upcoming events

New Jersey: The next NJ meeting will take place Friday, March 2. For information, contact Deborah Gardner-Brown at 732/238-4511, or e-mail Deborah@RRA-INC.com.

Tennessee: The next TN-ACDIS meeting will be held at Baptist Hospital in Nashville on Friday, March 16, 9 a.m. to 1 p.m. For information, contact Sherri Clark at 865/804-6561 or e-mail SClark@mc.utmck.edu.

Long Island, NY: St. Francis Hospital hosts the next networking meeting on Tuesday, March 6, 3-5 p.m. For information, contact Adelaide M. La Rosa at 516/562-6229 or e-mail Adelaide.LaRosa@chsli.org.

Mid-West Regional: The Michigan, Wisconsin, and Minnesota state ACDIS networks’ mid-west regional conference, has been postponed.

Meeting minutes

The following minutes and/or presentations have been made available from the following chapters:

February 01, 2012 | Melissa Varnavas | Comments 1

August meetings have agendas full of education and enrichment

North Carolina

The NC ACDIS Chapter meets Friday, Aug. 5, 8 a.m. to 2 p.m., at Sapona Country Club, in Lexington. The agenda includes:

8-9 a.m.: Registration and reception with continental breakfast
9-10:30 a.m.: Keynote Speaker-Steve Robinson, MS, RN, PA, CPUR, Sr. Director, Clinical Documentation Improvement Solutions at Maxim Health Information Services “Current/Upcoming CMS Mandates and Concurrent Review.” Robinson will discuss:
- Appropriate MS-DRG assignment
- RAC preparedness
- POA coding
- Core Measures Coordination
- 2012 IPPS proposal and pending final rule
- ICD-10 impact on CDI
10:45-11:30 a.m.: NC ACDIS business meeting
11:30 a.m. to 12:30 p.m.: Lunch
12:30-2 p.m.: Closing Speaker-Nicole Greer, PPCC, founder of Vibrant Coaching and lead trainer for Laurie Beth Jones Inc. National Training Team “Engaging the Elements of Success: A Highly Intuitive Tool for Communication, Growth, and Success!”

Attendees are asked to register by Friday, July 29. Cost is $25 per person and includes breakfast, lunch, CEUs, and door prizes. For information, contact Leah Taylor via e-mail at Leah.Taylor@iredellmemorial.org or by phone at 704/878-7436; or Brenda Harris via e-mail at Brenda.Harris@carolinashealthcare.org or by phone at 704/863-6378; or visit http://ncacdis.org/

NC ACDIS members are asked to participate in a short, three question survey prior to the meeting.

Central Ohio

The ACDIS Central Ohio Chapter meets Thursday, Aug. 18, 1:30-3 p.m., at the James Cancer Hospital. The topic for discussion will be ICD-10 and CDI. RSVP to sheri.blanchard@osumc.edu.

NY/PA

NY/PA Regional Network meets at The Robert Packer Hospital in Sayre, PA, in its Patterson Auditorium, Friday, Aug. 19, 8 a.m. to 4 p.m. We also have video conferencing available for seven more facilities, so sign up soon. (Please allow time to complete a video trial before the conference day.)

We have been approved by ACDIS for four credits towards the Certified Clinical Documentation Specialist (CCDS) certification. We will have four guest presentations including:

Jonathan Elion, MD: Dr. Elion has 40 years of experience in computing and more than 25 years of experience in medical computing and information standards, and is the founder of ChartWise Medical Systems. He will be speaking about ethical practices in CDI and the importance of quality documentation.
Mario A. Perez, III, RHIA, RHIT, CCS, CCS-P: Perez is the Director, Coding and Documentation Compliance for J.A. Thomas & Associates, Inc. He will be speaking about why facilities need CDI programs, how to makes them successful, and how justify CDI efforts to the larger facility stakeholders.
Glenn Krauss, BBA, RHIA, CCS, CCS-P, C-CDIS, CCDS, independent consultant based in Madison, WI, will discuss the future of CDI.
Jean Elsener, RN CPUR, CRN-C, CRN-A CCDS, CDI specialist, Quality Management, will discuss writing concise, standardized, and non-leading queries.

For information, contact Susan Tiffany RN, CCDS, supervisor CDI, Guthrie Healthcare System, Robert Packer & Corning Hospitals at 570/887-6094 or by e-mail at tiffany_susan@guthrie.org

New Jersey

The NJ ACDIS Chapter holds a “summer outing” Friday, Aug. 19, 1:30-4 p.m., at RRA, Inc., Meeting Annex, 385 West Ferris St., East Brunswick. The meeting will include tasty frozen drinks and yummy appetizers and door prizes. It also features an opportunity to share CDI best practices and trouble areas, explore ways to achieve physician compliance, and preview of Quadrameds ICD-10 Simulator and CDI Tracking software. For information contact, Deborah Gardner-Brown at 732/238-4511, or e-mail Deborah@RRA-INC.com

Florida

FLACDIS Quarterly Meeting is set for Saturday, Aug. 20,9 a.m. to 3:30 p.m., at Sacred Heart Medical Center, 5151 N Ninth Ave., Pensacola. The agenda has changed slightly:

Three CEU’s awarded for CCDS renewal including:
- Virginia Bailey/Dr. Dragut – Coding Quiz
- Trivia Contest-Kimberly Richert
- Dr. Michelle Dragut (E-mail topic requests to Virginia.bailey@baycare.org)
- Katherine (Kitty) Novak, Director FTI Consulting presenting on principal diagnosis selection
Raffles, even a 50/50 one this time!
Corn dogs, candy apples, cotton candy!
Opportunity to network with your peers
Blue Ribbon Pie Contest

RSVP by August 10 to pcassady@csg-hs.com. For more information, visit the FLACDIS website or the Florida ACDIS Chapter’s Facebook page.

California

ACDIS-CA chapter meets via teleconference Wednesday, Aug. 24, 9-10 a.m. For information, contact Dexter D’Costa by e-mail at dr_dexterdcosta@yahoo.com.

Multiple meetings being held across the US help CDI professionals chill out the summer season with educational offerings.

Planning ahead

Georgia

The next meeting of the Southeast Chapter will be at Medical Center Central Georgia in Macon, Sept. 9, 10 a.m. to 2 p.m. RSVP to james.doster@emoryhealthcare.org. Attendance is $10 for non-members; annual membership dues are $25.

Maine

The next Maine ACDIS meeting is scheduled for Sept. 20. For information, contact Theresa Davis BSN, RN, CCDS, by e-mail at tdavis@emh.org.

Michigan

The MI ACDIS Chapter has postponed its July meeting and will hold its next teleconference on Thursday, Oct. 20, noon to 1 p.m. The meeting features an in-depth look at how ICD-10 affects CDI program practices with MI member Sue Haley. For information contact, Janet Gentle, at 231/487-3564 or by e-mail at jgentle@northernhealth.org.

South Carolina

The first SC ACDIS Chapter kickoff was a huge success, so save-the-date for the next meeting slated for Friday, Nov. 11, 10:30 a.m. to 2:30 p.m., at Providence Hospital, in Columbia. For information, contact Rebecca “Ali” Williams at 864/560-5701 or by e-mail at rawilliams@srhs.com.

August 04, 2011 | Melissa Varnavas | Comments 3

Mark your calendars and let ACDIS Chapters meetings fill up your summer schedule

Don't let your summer schedule fill up without making time for local CDI networking events.

July

New Orleans

The New Orleans ACDIS Chapter meets Tuesday, July 12, 4-6 p.m., at Semolinas Restaurant at Clearview Mall in Metairie. For information, contact Royceann Brechtel Fugler by phone at 504/456-5186 or by e-mail at rfugler@ejgh.org.

Indiana

The Central Indiana ACDIS Chapter meets tomorrow Wednesday, July 13, at the IU Health Bloomington Hospital. The agenda features a presentation by ACDIS Advisory Board member Glenn Krauss regarding strategies to communicate with difficult physicians.

The Central Indiana Chapter recently named new Advisory Board members including:

Kathy Wilson, first year member, Community Hospital North, e-mail her at KWilson4@ecommunity.com.
Wendy Wilson, first year member, IU Health, Bloomington Hospital, e-mail her at WWilson4@iuhealth.org.
Lena Wilson, second year member, IU Health Network/HIM, e-mail her at lwilson9@iuhealth.org.
Susan Bradford, second year member, Riverview Hospital, e-mail her at sbradford@riverview.org.

For more information, contact Susan Bradford by phone 317/776-7285 or by e-mail at sbradford@riverview.org

Kansas City, Missouri

The KC MO ACDIS Chapter holds its next meeting, Wednesday, July 27, 2:30-4:30 p.m., at Shawnee Mission Medical Center, in Shawnee Mission, KS. The meeting agenda will include topics as determined by members of the group. Those interested in attending should contact Joann Agin at jagin@carondelet.com.

To read the minutes of the April KC MO ACDIS meeting click here.

Virginia

The next Virginia ACDIS Chapter meeting will be held Saturday, July 30, 10 a.m. to 2 p.m., at August Health in Fisherville. To RSVP, contact Bea Benson, RN, BSN at bbenson@augustahealth.com.

August

So. Nevada

The Southern Nevada ACDIS Chapter meets the first Wednesday of every month at 5:30 p.m. (August’s meeting will be held on Wednesday, Aug. 3) at Kindred Hospital Flamingo Campus (Classroom), 2250 East Flamingo Road, Las Vegas. For information, contact ailsa.kompare@kindredhealthcare.com.

North Carolina

The NC ACDIS Chapter meets Friday, Aug. 5, 8 a.m. to 2 p.m., at Sapona Country Club, in Lexington. The agenda includes:

8-9 a.m.: Registration and reception with continental breakfast
9-10:30 a.m.: Keynote Speaker-Steve Robinson, MS, RN, PA, CPUR, Sr. Director, Clinical Documentation Improvement Solutions at Maxim Health Information Services “Current/Upcoming CMS Mandates and Concurrent Review.” Robinson will discuss:
- Appropriate MS-DRG assignment
- RAC preparedness
- POA coding
- Core Measures Coordination
- 2012 IPPS proposal and pending final rule
- ICD-10 impact on CDI
10:45-11:30 a.m.: NC ACDIS business meeting
11:30 a.m. to 12:30 p.m.: Lunch
12:30-2 p.m.: Closing Speaker-Nicole Greer, PPCC, founder of Vibrant Coaching and lead trainer for Laurie Beth Jones Inc. National Training Team “Engaging the Elements of Success: A Highly Intuitive Tool for Communication, Growth, and Success!”

NC ACDIS members are asked to participate in a short, three question survey prior to the meeting.

NY/PA
The NY/PA Regional ACDIS Network holds its next meeting Friday, August 19, 8 a.m. to 4 p.m., at the Robert Packer Hospital in Sayre, PA. The event is free. Video conferencing is available to the first 10 registrants who require it. The agenda includes guest speakers:

Jonathan Elion, MD, founder of ChartWise Medical Systems, who will discuss ethical practices in CDI and the importance of quality documentation.
Mario A. Perez, III, RHIA, RHIT, CCS, CCS-P, director of coding and documentation compliance at J.A. Thomas & Associates, Inc., who will discuss CDI programs, why they are needed, how to make them successful and how to justify implementation.
Glenn Krauss, BBA, RHIA, CCS, CCS-P, C-CDIS, CCDS, independent consultant who will discuss the future of CDI programs, understanding the value of CDI beyond financial reimbursement.
Jean Elsener, RN CPUR, CRN-C, CRN-A CCDS, who will discuss how to craft concise, standardized, and non-leading queries.

Each presenter will speak for an hour, with time for questions and discussion. There will also be time to network, visit with exhibitors, and sign up for raffles.

For information, contact Susan Tiffany RN, CCDS, at 570/882-6094, pager #465; or by e-mail at tiffany_susan@guthrie.org.

New Jersey

The NJ ACDIS Chapter holds a “summer outing” Friday, Aug. 19, 1:30-4 p.m., at RRA, Inc., Meeting Annex, 385 West Ferris St., East Brunswick. The meeting will include tasty frozen drinks and yummy appetizers and door prizes. It also features an opportunity to share CDI best practices and trouble areas, explore ways to achieve physician compliance, and preview of Quadrameds ICD-10 Simulator and CDI Tracking software. For information contact, Deborah Gardner-Brown at 732/238-4511, or e-mail Deborah@RRA-INC.com

Florida

The next FLACDIS Chapter meeting will be held Saturday, Aug. 20, 9 a.m. to 3:30 p.m., at Sacred Heart in Pensacola. Although the meeting agenda is still under construction the theme for the first meeting of the “panhandle” region is “Meet Me at the ClinDoc Fair.” The event will feature state-fair corn dogs, sausages and peppers, cotton candy, and even a best-pie contest. Non-FLACDIS members can attend for free for the first time, with a $10 charge to receive CEUs. Visit the FLACDIS Chapter on Facebook, at the web site www.flacdis.org, or download the latest newsletter. To attend the upcoming meeting, RSVP to pcassady@csg-hs.com.

Planning ahead

Michigan

The MI ACDIS Chapter has postponed its July meeting and will hold its next teleconference on Thursday, Oct. 20, noon to 1 p.m. The meeting features an in-depth look at how ICD-10 affects CDI program practices with MI member Sue Haley. For information contact, Janet Gentle, at 231/487-3564 or by e-mail at jgentle@northernhealth.org.

South Carolina

The first SC ACDIS Chapter kickoff was a huge success, so save-the-date for the next meeting slated for Friday, Nov. 11, 10:30 a.m. to 2:30 p.m., at Providence Hospital, in Columbia. For information, contact Rebecca “Ali” Williams at 864/560-5701 or by e-mail at rawilliams@srhs.com.

July 12, 2011 | Melissa Varnavas | Comments 1

NJ ACDIS meeting next week, more March events

Maryland

The Maryland CDI group meeting takes place Friday, March 18, 1:30 p.m., at the Maryland Hospital Association in Elkridge, MD. Contact Christine Mobley, RN, director of clinical documentation at Prince George’s Hospital Center, at christine.Mobley@dimensionshealth.org or 301/618-6507.

Long Island

The Long Island New York ACDIS Chapter meets at Stony Brook University Medical Center, Tuesday, March 22, 3-5 p.m. For information, contact Adelaide M. La Rosa, RN, director of clinical documentation improvement at St. Francis Hospital in Roslyn by phone at 516/562-6229 or by e-mail at Adelaide.LaRosa@chsli.org.

Northeast Regional

The next New England CDI networking meeting will be held at Brigham and Women’s Hospital in Boston Tuesday, March 22, 1-3 p.m. For information, contact Patty Spry and Kelley Sears, co-chairs at pattyspry2@yahoo.com or sears.kelley@yahoo.com.

New Jersey

The NJACDIS quarterly education meeting will be held Friday, March 25, from noon to 4:30 p.m. at 385 West Ferris

The arrival of EMR may seem like some distant ship on the horizon but next week the New Jersey ACDIS Chapter has your ship-to-shore lifeline ready by offering a hands-on workshop with an EMR provider.

Street Suite E, in East Brunswick, NJ. The event features an electronic medical record (EMR) simulation from medical billing company MTBC and presentation “Meaningful Use and Patient Centered Medical Home (PCMH): Integrating the CDI professionals in ambulatory care.” The simulation provides:

an overview of the three stages of Meaningful Use
a look at patient portal
an examination of the architecture of the EMR
an opportunity to view how CDI professionals can be supportive in the transition of the EMR, PCMH and Meaningful Use-driven Incentives

The event agenda includes:

Registration noon to 12:30 p.m.
Lunch 12:30-1:30 p.m.
Presentation 1:30-2:45 p.m.
Break 2:45-3 p.m.
Presentation 3-4:15 p.m.
Questions/announcements 4:15-4:30 p.m.

Registration is $27 for members, $24 for additional participants from the same facility, $30 for non-members, $27 for additional non-member participants from the same facility, $20 for AHIMA or nursing students.

To register, visit http://www.knowledgeconnex.com/RRA/register.htm.

For information, contact Deborah Gardner-Brown, RHIT, CCS, C-CDI, at 732/238-4511, or e-mail Deborah@RRA-INC.com, or contact Melanie Halpern, RN-BC, MBA, CCDS, CCRA, Clinical Documentation and Coding Integrity Supervisor at University of Medicine and Dentistry of New Jersey in Newark, NJ, at melanie.halpern@gmail.com.

Minnesota

The next Minnesota ACDIS Conference call will be held Wednesday, March 23, 1-2 p.m. Send meeting agenda items to Sue Baklarz, RN, Clinical Documentation Specialist at St. Cloud Hospital, by Thursday, March 17 BaklarzS@centracare.com. For information, contact Mark LeBlanc, RN, MBA, CCDS, at Park Nicollet Health Services by phone at 952/993-5692 or by e-mail at mark.leblanc@parknicollet.com.

Tennessee

Jennifer Turner, RN, CDI specialist at Erlanger Health System in Chattanooga hopes to gather CDI professionals in the state for local networking meetings. The first meeting will be Thursday, March 31, 1-4p.m., at Erlanger East/ Women’s East Pavilion, in Chattanooga. Contact her at Jennifer.Turner@erlanger.org or by phone at 423/778-9225.

Nevada

In Las Vegas, Ailsa Kompare, RN, BS, ACM, CCDS, clinical documentation improvement specialist for Kindred Hospitals, is planning a networking meeting. The first meeting will be Wednesday, May 11, 6 p.m., at Kindred’s Flamingo Campus. General networking is on the agenda as well as a presentation “Clinical Documentation Integrity: It’s not just about reimbursement,” by Sherry Siewers, RN, Desert District Director of Case Management for Kindred Healthcare, which has been approved by Nevada State Board of Nursing for 1.0 Continuing Education Hours. Contact her at ailsa.kompare@kindredhealthcare.com or by phone at 702/343-7232.

March 16, 2011 | Melissa Varnavas | Comments 0

November CDI networking meetings scheduled

New Jersey

Meets Friday, November 5, from noon to 4 p.m., at the New Jersey Hospital Association Conference Center in

Pick a state. There's lots of local meetings to chose from in November.

Princeton. The meeting features the presentation “Forensic CDI: Are you missing clues in the operative care or the post-op care?” by guest speaker Sue Fitzgerald, RN, MAS. Fitzgerald has more than 30 years experience in emergency, adolescent psych, PACU, cardiac transport, bronchoscopy nursing, and as a surgical clinical reviewer NSQIP. To register, visit http://www.knowledgeconnex.com/RRA/register.htm.

Northern Ohio

Meets Wednesday, November 10, 11 a.m., at Genesis Healthcare System. For information, contact Kristine Cilona, RN, at Mercy Medical Center 330/489-1111 ext. 3157 or by e-mail at Kristine.Cilona@cantonmercy.org.

Minnesota

Meets Wednesday, November 10, at St. Luke’s Hospital in Duluth. For information, contact Heidi Hillstrom MS, MBA, RN, CCDS, Clinical Documentation Management by phone at 218/249-5461 or e-mail hhillstrom@slhduluth.com.

Connecticut

Meets Thursday, November 11, 9-10:30 a.m., at The Hospital of Central Connecticut, Bradley Memorial Campus. For information, contact MaryAnn Shanley by phone at 860/224-5900 ext., 2168 or by e-mail at mshanley@THOCC.org.

Georgia

The Southeast Regional ACDIS Chapter (which includes Georgia, Alabama, South Carolina, and other states in the Southeast) holds its next meeting Friday, November 12, 10 a.m. to 2 p.m., at Emory University Hospital in Atlanta, GA. The meeting comes after the CDI Boot Camp visited the area, so meeting planners anticipate a good discussion of lessons-learned from Boot Camp attendees. A CCDS exam preparation session is also planned. For information, contact Bonnie Epps, MSN, RN, by e-mail at bonnie.epps@emoryhealthcare.org or by phone at 404/712-4550.

Kentucky

The Northern KY/Southern IN Chapter meets Thursday, November 18, 1-4 p.m., at Jewish Hospital in Louisville, KY. For information, contact Dee Schad, RN, BSN, CCDS, by phone at 502/361-6492 or by e-mail at deanna.schad@jhsmh.org.

Pennsylvania

The Southwestern CDI networking group tentatively plans to meet for November 19, at the Monvalley Hospital in Monongahela. For information, contact Josie Pearson, BSN, RN, CDIS, at Memorial Medical Center in Johnstown, via e-mail at jozierp@comcast.net.

Long Island, NY

The next Long Island New York ACDIS Chapter meeting will be held Tuesday, November 30, 3-5 p.m., at South Nassau Communities Hospital. For information, contact Adelaide M. La Rosa, RN, by phone at 516/562-6229 or by e-mail at Adelaide.LaRosa@chsli.org.

December/January meetings

Northern IL CDI Networking meeting is tentatively planned for December 7, at Provena St. Joseph Medical Center in Joliet. For information, contact Colleen Stukenberg MSN, RN, CMSRN, CCDS, by phone at 815/599-6820, or by e-mail CStukenberg@fhn.org.

The “start-up” of the Southern California ACDIS Chapter is tentatively planned for Wednesday, January 26, 2011, with an evening 6-8 p.m. meeting at Kindred Westminster. Planned speakers include Hassan Alkhouli, MD, CCS, CDI physician adviser and Paryus Patel, MD, both experienced CDI physicians. For information, contact Wendy De Vreugd, RN, BSN, PHN, FNP, CCDS, by phone at 714/899-5020 or by e-mail at wendy.devreugd@kindredhealthcare.com.

November 03, 2010 | Melissa Varnavas | Comments 1

15 different groups plan CDI networking opportunities

Join the CDI community at one of 15 events taking place this fall.

October meetings

The New Hampshire CDS Chapter meets Thursday, October 7,1-3 p.m., at St Joseph’s Hospital in Nashua. The speaker, Sandra Egan, RN, C-CDI, nurse auditor from Exeter Hospital will present, “CDI and its proactive role in RAC activities: How what you do affects the outcomes later.” For information, contact Carla Heyn, RHIT, BS, Clinical Documentation Specialist, at Elliot Hospital in Manchester, at 603/663-3452 or by e-mail at cheyn@Elliot-HS.org.

The Central Indiana ACDIS Chapter meets Wednesday, October 13, 10 a.m. to noon, at the Hughes Board room at Clarian’s Methodist campus. In addition to the main topic, “RAC Impact on CDI Programs” by Kathy Bennett from Bloomington Hospital, the group will discuss chapter organization with regard to the length of service for executive team members, and topics for future meetings, speakers, etc. For information, contact Susan Bradford, RN, BSN, CDI specialist at Riverview Hospital in Noblesville, IN, at 317/776-7285 or by e-mail at sbradford@riverview.org.

The New England ACDIS Chapter meets Wednesday, October 13, noon to 2 p.m., at the Miriam Hospital in Providence, RI. Lunch will be provided. For information, contact Karen M. DiMeglio, by phone at 401/444-9393 or by e-mail at KDiMeglio@Lifespan.org.

Maine State CDI Local Chapter meeting will be held on Tuesday, October 19, 1-5 p.m., at the Harold Alfond Cancer Center in Augusta and feature guest speaker Glenn Krauss on expanding the role of CDI’s. Other agenda items include:

CDMP Guide Demo
Blastgroups
Update on CDI No Response Action Plan

For information, contact Theresa Davis, RN, clinical documentation specialist at Eastern Maine Healthcare Systems in Bangor, at 207/735-8340 or by e-mail at tdavis@emh.org.

The Oregon/Southwest Washington Chapter of ACDIS meets Friday, October 15, 10 a.m., at Oregon Health & Science University in Portland. For information, contact Eileen Pracz, RN, at 503/418-4023 or by e-mail at pracze@ohsu.edu.

The Florida ACDIS Chapter holds a Halloween masquerade meeting, Saturday, October 23, from 8 a.m. to 5 p.m., at the Morton Plant Northbay Hospital in New Port Richey. The meeting, dubbed “The Unmasking of Clinical Documentation” features:

Election of 2011 officers
ICD 10 with Gayl Kirkpatrick
E/M Billing with Jonathan Becker
Out patient CDI-a new frontier with Carolyn Rader
A CSI approach to physician education with Sylvia Hoffman
Four CEU’s toward CCDS renewal
Four CME’s for physicians
Contests, giveaways, raffles

For information, contact Virginia Bailey by phone at 727/859-4880 or by e-mail at Virginia.bailey@baycare.org.

November meetings

The first meeting of the Texas ACDIS Chapter takes place Wednesday, November 3, 10 a.m. to 4 p.m., at the offices of KPMG in Dallas. For information, contact TexasACDIS@gmail.com or call Melinda Fleet at 214/840-2295.

The New Jersey ACDIS quarterly education meeting will be held Friday, November 5, from noon to 4 p.m., at the New Jersey Hospital Association Conference Center in Princeton. The meeting features the presentation “Forensic CDI: Are you missing clues in the operative care or the post-op care?” by guest speaker Sue Fitzgerald, RN, MAS. Fitzgerald has more than 30 years experience in emergency, adolescent psych, PACU, cardiac transport, bronchoscopy nursing, and as a surgical clinical reviewer NSQIP. To register, visit http://www.knowledgeconnex.com/RRA/register.htm.

The Northern Ohio ACDIS Chapter meets Wednesday, November 10, 11 a.m., at Genesis Healthcare System. For information, contact Kristine Cilona, RN, at Mercy Medical Center 330/489-1111 ext. 3157 or by e-mail at Kristine.Cilona@cantonmercy.org.

The Minnesota ACDIS Chapter meets Wednesday, November 10, at St. Luke’s Hospital in Duluth. For information, contact Heidi Hillstrom MS, MBA, RN, CCDS, Clinical Documentation Management by phone at 218/249-5461 or e-mail hhillstrom@slhduluth.com.

The Connecticut ACDIS group gathers, Thursday, November 11, 9-10:30 a.m., at The Hospital of Central Connecticut, Bradley Memorial Campus. For information, contact MaryAnn Shanley by phone at 860/224-5900 ext., 2168 or by e-mail at mshanley@THOCC.org.

Southeast Regional ACDIS Chapter (which includes Georgia, Alabama, South Carolina, and other states in the Southeast) holds its next meeting Friday, November 12, 10 a.m. to 2 p.m., at Emory University Hospital in Atlanta, GA. The meeting comes after the CDI Boot Camp visited the area, so meeting planners anticipate a good discussion of lessons-learned from Boot Camp attendees. A CCDS exam preparation session is also planned. For information, contact Bonnie Epps, MSN, RN, by e-mail at bonnie.epps@emoryhealthcare.org or by phone at 404/712-4550.

The Northern KY/Southern IN Chapter meets Thursday, November 18, 1-4 p.m., at Jewish Hospital in Louisville, KY. For information, contact Dee Schad, RN, BSN, CCDS, by phone at 502/361-6492 or by e-mail at deanna.schad@jhsmh.org.

December/January meetings

October 05, 2010 | Melissa Varnavas | Comments 1

Four new local groups, August meetings announced

I am excited to welcome the efforts of those in New Hampshire, Tennessee, Texas, and Hawaii who recently expressed interest in starting CDI networking groups in those states.

Gather 'round the table, there's some upcoming CDI networking to be done!

New Hampshire

I’ll start with New Hampshire since it’s closest geographically to me here in Marblehead, MA. Actually, CDI specialists from the “Granite State” have been meeting for some months now but Carla A. Heyn, RHIT, BS, Clinical Documentation Specialist, at Elliot Hospital in Manchester, just faxed over the group’s official ACDIS local chapter membership form.

Anyone can form a group of CDI specialists for networking purposes. ACDIS does not require official affiliation. But to steal the line from the American Express advertising campaign: “membership has its benefits.” Those who chose to become official ACDIS chapters may:

use the ACDIS logo
have their meeting information posted to the blog
receive complimentary products to help facilitate local educational sessions
receive complimentary CCDS CEU credits—a $75-$150 value
receive discount membership for local chapter members on national membership

Anyone interested in joining the Granite State ACDIS Chapter should contact Carla at 603/663-3452 or e-mail cheyn@Elliot-HS.org.

Tennessee

Although Judy Rochelle, RN, CCDS, CCM. CPHM, CPUR, CDI Manager at Erlanger Health System in Chattanooga, TN, only just moved there she’s certainly taking her new home’s namesake to heart. Judy recently “volunteered” to kick start a CDI group in the “Volunteer State,” so feel free to contact her at 423/778-4225 or by e-mail at Judith.Rochelle@erlanger.org

Texas

Perhaps they stole some mojo from Tennessee but two staff member from KPMG have volunteered to organize the first CDI networking meeting in the state of Texas. To join the roster of those interested in local meetings contact Melinda Fleet, manager at KPMG in Dallas at 214/840-2295 or by e-mail mfleet@kpmg.com or Kathryn Schulze, RN, OCN, CCDS, Director, KPMG, in Houston, at 713/295-0073 or by e-mail at kschulze@kpmg.com. We understand the obstacle of geographic location to the facilitation of local networking options so feel free to voice your opinion as to the best method of meeting organization to either Melinda and Kathryn or to myself here on the blog or by e-mail at mvarnavas@cdiassociation.com.

Hawaii

We also heard this week from two volunteers located in Hawai’i. They already planned to host a get-together this week with other CDI from their immediate area and wrote to see if they could invite others to join them. Of course we were excited to accept their generosity. So if you live in those gorgeous islands feel free to contact Elsa L. D. Honma, Project Manager at Hawaii Pacific Health in Honolulu, at 808/535-7127 or by e-mail at elsa.honma@kapiolani.org or feel Eleu Zane, RN, BS, BSN, C-CDI, at Pali Momi Medical Center (a part of Hawaii Pacific Health) at 808/485-4281 or e-mailcherlyn.zane@kapiolani.org.

August Meetings

There are few upcoming meetings that I also wanted to be sure to tell you about.

Tomorrow, Thursday, August 12, 1- 4 p.m., the Kentucky ACDIS Chapter meets at the Baptist East Hospital in Louisville. Chapter leader Dee Schad, RN, BSN, CCDS, manager at Jewish Hospital & St. Mary’s HealthCare expects upwards of 50 guests to attend the meeting. For information, contact her at 502/361-6492 or e-mail deanna.schad@jhsmh.org.

On August 20, from 8 a.m. to 2:30 p.m., the NJACDIS group presents a CDI round table session, at the New Jersey Hospital Association, Princeton. Every attendee is asked to submit a de-identified medical record and the CDI staffers will discuss the record for coding, medical necessity, and query opportunities. The meeting includes a continental breakfast, outdoor barbecue for lunch, and door prizes but is limited to only 35 attendees.

To register, visit www.Knowledgeconnex.com, select the education portal, select meetings, and scroll down to the date 8/20/2010. Select the NJACDIS meeting and begin registration.

The California ACDIS State-Wide teleconference meeting takes place Wednesday, August 25, 9-10 a.m., the meeting features ACDIS Advisory Board Member Wendy De Vreugd, RN, BSN, PHN, FNP, CCDS, senior director of case management of Kindred Healthcare Hospital Division, West Region, who will discuss the importance of engaging physician champions and strategies for doing so.

For information, contact California ACDIS state chapter leader Dexter D’Costa MBBS, MHA, CPHIMS, Manager, Clinical Documentation Program at Stanford Hospital & Clinics at 650/723-5343 or by e-mail at dd’costa@stanfordmed.org

The Connecticut Chapter will meet Thursday, September 9, at 9 a.m., at The Hospital of Central Connecticut, Bradley Campus. For information, contact MaryAnn Shanley, RN, clinical documentation specialist by e-mail at mshanley@THOCC.org or call 860/224-5900, ext. 2168.

The next meeting of Maine CDI is tentatively planned for September 14 at Maine General Medical Center. For information, contact Theresa Davis, RN, clinical documentation specialist at Eastern Maine Healthcare Systems in Bangor, at 207/735-8340 or by e-mail at tdavis@emh.org.

The Minnesota group holds its next meeting on Wednesday, September 22, 2-3:30 p.m. For information, contact Michelle L. Callahan, RN, CDI lead specialist at Hennepin County Medical Center in Minneapolis by phone at 612/873-9376 or e-mail her at Michelle.Callahan@hcmed.org.

The next Northern Illinois meeting will also be in September. To join the group, contact Nancy R. Ignatowicz, RN, MBA, CCDS, System Manager, Clinical Documentation, at Provena Health in Frankfort by pohne at 815/806-2322 or by e-mail at nancy.ignatowicz@provena.org. Or contact Colleen Stukenberg MSN, RN, CMSRN, CCDS, by phone at 815/599-6820, or by e-mail CStukenberg@fhn.org.

August 11, 2010 | Melissa Varnavas | Comments 0

July meetings slated for NC, IN, LA, MD, MN; Maine and New Jersey offer updates

North Carolina

The NC ACDIS Chapter holds its next meeting on Friday, July 9, 8 a.m. to 1:15 p.m., at Carolinas Healthcare System Airport Training Facility. The event features Pamela P. Benson, MD, MS, FACEP, who will speak on the role of CDI in the emergency department and Tiffany M. Murriel, BSN, RN, from Navigant Consulting, Inc., who will speak on the role of CDI in the transition from ICD-9 to ICD-10.

The cost is $20 at the door. To register, contact meeting hosts Judith Rochelle by e-mail at Judith.Rochelle@carolinashealthcare.org or by phone at 704/582-1226; or Wendy Shedd via e-mail at Wendy.Shedd@carolinashealthcare.org or by phone at 704/355-3189.

For additional information about the North Carolina group contact NC ACDIS President Leah Taylor, RN, CCDS, by e-mail at leah.taylor@novanthealth.org or by phone at 704/402-9656.

Central Indiana

The Central Indiana ACDIS group holds its next meeting on Wednesday, July 14, 10 a.m. to noon, at Community Hospital North. The agenda includes:

Developing Diagnosis Specific Queries with Sandy Beatty from Columbus Regional Hospital
Group Sharing: Query process for staging pressure ulcers, POA and query forms for wound debridement and physician documentation of surgical debridement
Report from ACDIS Advisory Board: Lena Wilson, from Clarian Health will talk about the board’s decision to support the recent release of AHIMA’s CDI Practice Brief

The Central Indiana ACDIS Chapter currently includes more than 30 CDI specialists from facilities as far north as Elkhart to as far south as Columbus. It’s April meeting attendance included 14 participants who traveled to Bloomington Hospital along with six others who attended by audio conference.

For information, contact Susan Bradford, RN, BSN, Clinical Documentation Specialist at Riverview Hospital by phone at 317?776-7285 or by e-mail at sbradford@riverview.org.

New Orleans

The Greater New Orleans Chapter of CDI has a meeting July 14, from 4-6 p.m., at Serranos Restaurant, in the Clearview Mall, in Metairie. For information, contact Royceann Brechtel Fugler, RN, BC, MHA, Clinical Documentation Specialist, at East Jefferson General Hospital by phone at 504/456-5186, or Melissa Mayer at melissamayer@ejgh.org

Maryland

The Maryland Hospital Association Clinical Documentation Improvement Workgroup meets bimonthly, the third Friday of the month, July 16, 1:30–3 p.m., at the Maryland Hospital Association Headquarters in Elkridge. Contact Christine Mobley, RN, director of clinical documentation at Prince George’s Hospital Center, at christine.Mobley@dimensionshealth.org, for information.

Minnesota

The Minnesota ACDIS Chapter holds its next meeting on July 28, 1-2:30 p.m., at Hennepin County Medical Center in Minneapolis. For information, contact Michelle L. Callahan RN, BSN, CCDS, Clinical Documentation Supervisor by phone at 612/873-9376, or by e-mail at Michelle.Callahan@hcmed.org.

Maine

The Maine ACDIS Chapter Meeting has started a “blastgroup” as a means to communicate with its members regarding upcoming meetings and local events. It’s next meeting will be September 14. To learn more, contact Theresa Davis RN, BSN, CCDS Clinical Documentation Specialist by e-mail at tdavis@emh.org or by phone at 207/973-5178

New Jersey

The NJACDIS holds its next meeting Friday, August 20, 8 a.m. to 2:30 p.m., at the New Jersey Hospital Association in Princeton. The meeting will focus on a CDI coding round table. Participants will each receive a portfolio of four de-identified medical records for review one week prior to the meeting and during the session will share various methods about how to best clarify and code for the care provided to the patient. The records will be reviwed for medical necessity, coding, and query opportunities.

There will be a continental breakfast, an outdoor BBQ with all the fixins, and door prizes. Register online www.Knowledgeconnex.com, select the eduation portal, meetings, and scroll down to the date 8/20/2010. Select the NJACDIS meeting, and begin your registration. The meeting will be limited to 35 attendees. For additional information, contact Deborah Gardner-Brown, RHIT, CCS, C-CDI, at 732/238-4511, or e-mail Deborah@RRA-INC.com, or Melanie Halpern, RN-BC, MBA, CCDS, CCRA, Clinical Documentation and Coding Integrity Supervisor at University of Medicine and Dentistry of New Jersey in Newark, NJ, at melanie.halpern@gmail.com.

July 01, 2010 | Melissa Varnavas | Comments 0

May meetings in OH, GA, IL, PA, MD, NJ, CA, NY

Northern Ohio

The Northern Ohio ACDIS networking group meets Tuesday, May 4, at Elyria Memorial Hospital. (Note: RSVPs were due by Monday, April 26.) For information, contact Kristine Cilona, RN, Documentation Specialist at Mercy Medical Center, 330/489-1111 ext. 3157 or by e-mail at Kristine.Cilona@cantonmercy.org

Georgia

Southeastern ACDIS Meeting will be held on Friday, May 7, 10 a.m. to 2 p.m., at the Macon Marriott. For information, contact Bonnie Epps, MSN, RN, Clinical Documentation Improvement manager at Emory Healthcare, at bonnie.epps@emoryhealthcare.org or by phone at 404/712-4550.

Northern Illinois

The next Northern Illinois Regional CDI meeting will be held Friday, May 14, 1-3 p.m., at Northwest Community Hospital, 800 W. Central Road, Arlington Heights, IL. For information, contact Nancy Ignatowicz at Nancy.Ignatowicz@provena.org or Colleen Stukenberg at 815/599-6820 or by e-mail at CStukenberg@fhn.org.

Pennsylvania/New York

The next meeting of Pennsylvania/New York CDI takes place May 14, 8 a.m. to 4 p.m., at the Robert Packer Hospital School of Nursing living room in Sayre, PA. The packed agenda includes:

8–11 a.m.: Meet and greet, with discussion. For those who have a distance to drive, no formal agenda will be made for this time. Coffee will be served and we will have the opportunity to network and get to know each other.
11 a.m. to noon: Lunch will be provided
noon to 1 p.m.: Guest speaker Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, CCDIS, Revenue Cycle Consultant at Memorial Hospital Towanda will offer a lecture regarding Recovery Audit Contractors and the role of the CDIS in denials management process improvement.
1:15-2:15 p.m.: “Processes initiated by CDS’s”, a presentation by Paula Frost from the Reading Hospital and Medical Center
2:15-3:15: Where are we going from here? Topics for discussion include:
- Clinical Documentation Specialist Certifications. CCDS professionals should come prepared to share their experiences with the exam and the exam process.
- Do we become a ACDIS network? ACDIS is now offering CCDS credits for local chapter education sessions
- Clinical Integration Specialist (CIS): Emerging role for CDS
3:30-4 p.m.: Open discussion, planning for future events

For information or to RSVP, contact Susan Tiffany RN, CDS, Supervisor Clinical Documentation Program at Robert Packer Hospital & Corning Hospital at 570/882-6094 pager 465 or by e-mail at Tiffany_Susan@guthrie.org

Maryland

MD CDS Workgroup meeting will be held Friday, May 21, 1:30–3 p.m., at the Maryland Hospital Association Headquarters in Elkridge. For information, contact Christine Mobley, RN, director of Clinical Documentation at Prince George’s Hospital Center at 301/618-6507 or by e-mail at Christine.Mobley@dimensionshealth.org.

New Jersey

The New Jersey local CDI networking group NJACDIS holds its next quarterly education meeting on Friday, May 21, 2-4:30 p.m., at RRA, Inc. Corporate Offices in East Brunswick, NJ. Discussion will focus on a review of the AHIMA CDI Tool Kit. E-mail Deborah to register, or call 732/238-4511.

Long Island, NY

The next LI/NY Local Chapter Meeting will be Monday, May 24 at New Island Hospital in Betthpage, NY. For information, contact Adelaide M. La Rosa, RN, by phone at 516/562-6229 or by e-mail at Adelaide.LaRosa@chsli.org.

California

California CDI hold a teleconference meeting Wednesday, May 26, 9-10 a.m. For information, contact Adriana van der Graaf, MBA, RHIA, CCS, CHP, at 805/402-9839 or by e-mail at avandergraaf@irminconline.com.

April 30, 2010 | Melissa Varnavas | Comments 0

NJ ACDIS offers summary of special guest event

by Melanie Halpern, RN-BC, MBA, CCDS, CCRA

Juanese Williams spoke to the NJACDIS meeting in March.

Editor’s note: The New Jersey ACDIS group brought healthcare fraud investigator Jua’nese L. Williams, PhD, MBA, BS, CPUR, IQCI, C-CDI, CPC, to its meeting in March at the New Jersey Hospital Association, in Princeton, NJ. In response to Williams’ lecture “Integrating Clinical Documentation and Medical Necessity to Successfully Navigate the 18 Federal Auditing Agencies and Contractors,” Halpern offers the following summary. Halpern is the supervisor of clinical documentation and coding integrity at UMDNJ–The University Hospital, in Newark, NJ. Contact her at 973/972.3236 or by e-mail at halperme@umdnj.edu.

Dr. Williams was very knowledgeable. With Florida as her home state and the backdrop to the largest CMS fraud investigations in the country, if you need someone to give a convincing argument about the realities of recovering CMS funds to hospitals and physicians, she’s really good.

I thought her way of responding to participants’ questions was especially effective. With a look of endearment and tilt of her head, when asked things like, “We’re a comprehensive stroke center, and our protocols…” She would nod and say…”po? time to go!” (in other words, if your fancy protocol includes protocols for medications CMS auditors may not consider that administration a medical necessity).

We learned a lot of other valuable information, as well.

1. NINN (non-coverage) letters: Starting April 1, 2010, as a CMS Condition of Participation, facilities need to give patients NINN (non-coverage) letters to alert them that CMS will not pay for procedures that fail the medical necessity litmus test. This topic was positioned as a community oOutreach education opportunity. According to Williams, that means facilities need to also educate the state QIO authority/arbiter, as well as hospital staff and patients.

2. Medicaid Integrity Contractors (MIC): The MICs’ scope of work is to oversee item #1 above as it relates to Medicaid claims. The MIC has authority to deny full claims, for which there is no federal appeal process for their decision. Hospitals would only be able to appeal the state portion of Medicaid payment, through a state-level proceeding. The MIC contractors are looking at 2005-2007 cases onsite (so there’s no opportunity to ‘pull together’ the records, and/or send/submit materials that may be missing).

In addition, MICs are looking at inpatient/outpatient claims, who then use that data mining to review physicians’ data. The MIC, if/when they suspect inconsistent documentation/treatments, are required by law to turn over the cases to OIG’s Healthcare Fraud prevention and Enforcement Action Team (HEAT). Williams described such OIG investigations as “not a social visit.”

3. Medicare Administrative Contractors (MAC): They control the dollars, Williams says. A MAC scope of review includes discrepancies between Part A and Part B, as it relates to Medicare whereas the MICs concentrate on Medicaid. MACs also focus on the documentation specificity to/from office to hospital. MAC can impose “prepayment” holds to providers (based on a bell curve, not necessarily any wrong doing). First MACs review the inpatient and office claims, then they determine the payment to provider, says Williams. NJ’s MAC is HighMark.

4. Audits related to Medical Necessity Claims: Hospitals should require pre-certification for elective surgeries (ie: when the doctor wants to schedule operating room time). Before a surgery date and time are set, facilities should require physicians to submit the patient’s office medical record to the hospital, so it can become part of the in-patient medical record. This is the only way a hospital can defend the medical necessity.

Specifically, AICD, TKR, and THR implants are the focus of this fraud investigation. The patient’s care and treatment plan leading up to the supposed requirement of an implant must meet CMS specifications (ie, 30 second VT for AICD implant; failed NSAID treatment with bone pathology and significant ADL limitations for total knee and hip replacements). Otherwise the hospital is not able to defend the medical necessity for the elective surgery, and the full claim can be denied (or only ancillary services will be paid).

5. Audits concerning the “72 hour rule (window)”: There was a healthy discussion about hospital’s “billing rules” as being non-compliant either through bundling services that should be billed separately, over services that should be “carved out”. Williams recommended extreme caution for attempting to resubmit unbundled claims stating that such actions draw auditors’ focus to the entire case. From there, additional concerns regarding issues of medical necessity and DRG validation will become new focus of claim(s) reviews.

6. Audits of claims for observation vs. inpatient status: Medicare’s inpatient definition has two key parts, Williams’ says. They include the severity of the signs and symptoms exhibited by the patient at the time of admission and the medical predictability of something adverse happening to the patient. Williams cautions that InterQual’s definition may not be good enough, for CMS to “capture data from the first 12 hours of admission to support inpatient…”

7. The CDI role in discharge documentation: Clinical documentation education efforts should include the discharge planning process: This point related to HINN letter for non-coverage, which specifically targets 30-day re-admissions to any facility. Williams stressed that documentation about the disposition facility (LTAC, SNF, etc) is vital.

The discharge plan must clearly be documented, including the need for continued therapeutic treatments, Williams says. If the family/patient disagrees with the plan or physician feels that by discharging patient there could be a safety issue, that needs to be well documented. Williams emphasized that this documentation should not be about the patient’s payment disposition, but about the quality of the care for the patient and the risk to patient by noncompliance. With such documentation provided then it is up to the QIO to argue the patient’s payment issues, or lack of non-acute care services available in the state.

8. PEPPER Reports: Williams suggested that these reports are very important to clinical documentation programs, because it specifies the top 10 DRGs the government identified as at high risk. CDI programs should review at least the last two PEPPER reports (Q3 ’09, published 2/25/10, and Q4 ’09, published 3/25/10) and compare the reports with their own facility data, Williams suggested.

9. The “bottom line” clinical documentation query: Williams suggested that the essential physician query as submitted by a CDI specialists should ask, “What is the medical necessity of this admission, and by what standards are you basing your judgment?”

10. Healthcare Integrity Triad: During her presentation, Williams included a slide which showed a triangle with the word “compliance” in the middle and at each corner the words: “clinical documentation,” “coding,” and “medical necessity.”

April 29, 2010 | Melissa Varnavas | Comments 2