RSSAll Entries Tagged With: "outpatient"

Guest post: Time to learn about HCCs

James S. Kennedy, MD, CCS, CDIP

James S. Kennedy, MD, CCS, CDIP

by James S. Kennedy, MD, CCS, CDIP

Now that you’ve finally mastered coding compliance with DRGs and quality measures, now it is time to learn the new risk-adjustment method, Hierarchical Condition Categories (HCC).

HCCs are to physicians what DRGs are to hospitals and, as such, are subject to government and Recovery Auditor scrutiny. In fact, a whistleblower accused United Healthcare of “upcoding” ICD-10-CM diagnosis codes affecting HCC-derived risk-adjustment factor scores, mentioning that CMS overpaid insurers by $14.1 billion in 2013 alone, according to an article in the New York Times in May. [more]

Q&A: Acceptable documentation for HCCs

Have CDI questions?

Have CDI questions?

Q: What clinical documentation is acceptable to pull Hierarchical Condition Category (HCC) information from for reporting purposes? Would you code from history of present illness, past medical history, active problem list, or the assessment?

A: Follow the coding guidelines when reporting diagnosis codes for HCC purposes. The coding guidelines don’t change with HCCs. As long as the documentation meets the MEAT (monitored, evaluated, assessed, treated) criteria, it can be reported from anywhere in the note. [more]

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

Join us in San Antonio!

Join us in San Antonio!

by Melissa Varnavas

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

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

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Symposium Update: Early bird hotel discount ends August 17

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The ACDIS Symposium: Outpatient CDI is currently sold out!

There are only a couple more days left to get a discounted hotel room rate for the ACDIS Symposium: Outpatient CDI. Reserve your room by Thursday, August 17 to take full advantage of the discount. The symposium takes place from September 18-19 at the Hilton Oak Brook Resort and Conference Center in Oak Brook, Illinois.

When you book your hotel room by August 17, you’ll get the discounted room rate at the Hilton Oak Brook Resort and Conference Center for $159 (tax and fees not included). To book by phone, call 866-275-6295 and mention ACDIS.

Please note that the Outpatient Symposium is sold out. If you have registered and know you won’t be able to attend, please notify customer service to allow others into the event.

 

Note from the Associate Director: Announcing a new outpatient version of the CDI Pocket Guide

R_Hendren

Associate Director Rebecca Hendren

By Rebecca Hendren

Outpatient CDI is a fast-growing area of the profession. So, I’m excited to announce a new resource that will be an incredibly useful tool for those expanding to the outpatient arena. Richard Pinson, MD, FACP, CCS, and Cynthia Tang, RHIA, CCS, authors of the CDI Pocket Guide, are currently finishing their work on a new version focused on Hierarchical Condition Categories (HCC): the 2018 Outpatient CDI Pocket Guide!

One of our guiding principles at ACDIS is to be at the forefront of changes in the industry. We want to provide our members with guidance, information, and resources they can turn to for education and clarification as they venture into new CDI focus areas. We’ve been publishing articles exploring the growing outpatient and ambulatory arena for several years now and will continue to do so as this segment of the profession grows and changes. We want to keep our fingers on the pulse of what’s going on and share that knowledge with our members.

We bring together leading thinkers in the profession who can share their expertise, whether through articles in the CDI Journal, innovative sessions at our annual conference or the new outpatient-focused ACDIS Symposium, or lively discussions in the ACDIS Forum.

I’m delighted that the trusted authors of the CDI Pocket Guide are equally forward thinking and partnered with us to develop a this new resource.

Please continue to let us know what information you need and what resources you would like ACDIS to offer. We really do listen to you and use your feedback to develop our editorial directions.

Editor’s note: Hendren is the associate director of membership and product development at ACDIS. Contact her at rhendren@acdis.org.

Symposium Speaker Highlight: Whitley shares story of ambulatory success

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The ACDIS Symposium: Outpatient CDI takes place Sept. 18-19

Editor’s note: There are only 45 more days left until the first ever ACDIS Symposium: Outpatient CDI, September 18-19, in Oak Brook, Illinois. Last week, we brought you a Q&A with Laurie L. Prescott, MSN, RN, CCDS, CDIP, CRC, in CDI Strategies, but she’s not the only Symposium speaker we got to know recently. Today, we spoke with Yvonne Whitley, RN, BSN, CRCC, CPC, CRC, the supervisor for Novant Health Medical Group’s Ambulatory CDI team, who will present “Novant Health ambulatory CDI—How we’ve grown!” at the event. Please note that this event is filling up fast with limited seats remaining.

Q: Can you explain why you use the term “ambulatory” rather than “outpatient?”

A: The simple answer is that “outpatient” refers more to facilities such as wound care, same day surgery, infusion centers, etc. “Ambulatory,” on the other hand, refers to the provider clinics. Currently we only focus on the ambulatory setting.

Q: What was the biggest challenge you encountered during the implementation of your ambulatory CDI program?

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Guest Post: Expanding the CDI focus to the outpatient arena, part 2

Editor’s note: Crystal Stalter, CPC, CCS-P, CDIP, is the CDI manager for M*Modal in Pittsburgh. She has over 30 years of experience in the healthcare industry, with most of her focus on coding, compliance, and physician documentation. She has spent many of those years as a consultant, working with physicians and hospital HIM departments to improve their workflow processes and revenue cycles. Contact her at crystal.stalter@mmodal.com. Opinions expressed are that of the author and do not represent HCPro or ACDIS. This article was previously published in Briefings on APCs and JustCoding. This is the second part of a two-part series. To read the first part of this article, click here.

There are multiple outpatient places of service the CDI specialist can have an impact. One such place is the ED, where capture of ancillary services, start and stop times (as well as medications and dosages for injection/infusion coding), and evaluation and management (E/M) code (the codes assigned for physician reimbursement) levels often get missed or are incomplete, causing subsequent coding issues.

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Note from the ACDIS Director: It’s time for outpatient CDI to step out on its own

ACDIS Director, Brian Murphy

ACDIS Director, Brian Murphy

By Brian Murphy

We knew it was going to happen.

Eventually, the ACDIS Conference was going to get so big that we couldn’t give every CDI topic justice or the full coverage it deserved. Outpatient CDI was one of those topics. There is so much going on between Medicare Advantage and Hierarchical Condition Categories (HCCs), the complexities of patients admitted versus treated in observation, to outpatient opportunities in the emergency department and in the physician office setting, that the time had come to give outpatient CDI its own event.

Enter the ACDIS Symposium: Outpatient CDI.

This all-new ACDIS event will be held September 18-19 at the Hilton Oak Brook Resort & Conference Center, located just outside of Chicago.

Back when inpatient CDI was still relatively new in 2007, we received large numbers of basic questions, and there was an overwhelming need for nuts and bolts “how to get started” ideas and education. Because we anticipate the same kinds of concerns at the ACDIS Symposium: Outpatient CDI we are accommodating with three specific ideas:

  1. Case studies of how programs have implemented successful outpatient CDI programs. Hear from Cooper University Health Care, Novant Health, Mount Carmel Health System, and others about how they got started, their challenges and their successes.
  2. A “Morning Ideas: Lightning Round” general session on Day 1. This innovative one-hour session combines four to five quick-hit, “here was a problem we had and a solution that worked/here is a process that worked for us and might work for you” ideas from your peers that have worked in the field. This will get your brain working overtime!
  3. A dedicated Q&A panel session to conclude the program. Ask your top questions at this session—and listen to your peers’ questions. Chances are you might have the same questions.

Just like the ACDIS Conference, the Symposium will feature plenty of networking opportunities and idea-sharing over our breakfasts and lunches (food, including breaks, is provided with registration) as well as in our exhibit hall. Come see the many innovative outpatient CDI solutions several vendors are offering in this space.

There is far more on the agenda than I could mention here—sessions on the nuts and bolts of evaluation and management coding (E/M) and how to improve physician E/M billing, a session on the key differences between inpatient and outpatient coding (as taught by our top coding instructor Shannon McCall, RHIA, CCS, CCS-P, COC, CPC-I, CEMC, CRC, CCDS), and much more.

In short, I hope you can make our inaugural ACDIS Symposium. To learn more or to register, please click here.

Editor’s note: If you have specific questions about the Symposium’s content, please send them to ACDIS Associate Director of Membership and Product Development Rebecca Hendren at rhendren@acdis.org. Murphy is the director of ACDIS. Contact him at bmurphy@acdis.org.

Guest Post: Expanding the CDI focus to the outpatient arena, part 1

Editor’s note: Crystal Stalter, CPC, CCS-P, CDIP, is the CDI manager for M*Modal in Pittsburgh. She has more than 30 years of experience in healthcare focused on coding, compliance, and physician documentation concerns. Contact her at crystal.stalter@mmodal.com. Opinions expressed are that of the author and do not represent HCPro or ACDIS. This article was previously published in Briefings on APCs and JustCoding. This is the first part of a two-part series. Please return to the blog next week to read the second part!

The focus for CDI specialists has historically been on the inpatient hospital stay. Reviews of the chart for conditions not fully documented and/or evidence of conditions not documented at all, has been standard practice.

However, with so many changes in the industry facing providers in their outpatient practices, the importance of CDI in places of service such as physician offices, ambulatory clinics, and urgent care clinics is even more vital.

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Symposium update: Early bird pricing ends today

outpatient early bird

Early bird pricing ends today!

Today is the last day to get the Early Bird price for the first ever ACDIS Symposium: Outpatient CDI. Reserve your seat today, July 17, to take full advantage of the discount. The conference takes place from September 18-19 at the Hilton Oak Brook Resort and Conference Center in Oak Brook, Illinois.

ACDIS members receive a $100 discount on their conference tickets, bringing the price down to $805. [more]