ICD-10 Updates

Icd-10-cm/pcs changes Precise coding of claims will now be expected.

Poll question Have you confirmed that your systems are updated with the ICD-10-CM and PCS 2017 code sets?

Designing an effective audit Identify deficiencies that may impact revenue and data quality by focusing on: Incorrect coding Data abstraction errors Gaps in provider documentation “Auditing ICD-10 Through the Lens of Education” How can you accomplish this? Well, you can establish a CDI program designed to improve documentation to support medical necessity and demonstrate quality care.

CDI in Critical Access Hospitals CDI staff can improve documentation in the inpatient setting, and also in the ER and observation areas, as a part of the transition from outpatient to inpatient status. Multiple hats: quality abstraction, utilization reviews, and case management Solid documentation that supports medical necessity and demonstrates quality care is essential regardless of the type of setting or reimbursement methodology. With that said, I wanted to briefly mention critical access hospitals and the role that CDI or clinical documentation improvement, can have within them. Critical Access Hospitals are not paid under the MS-DRG for its inpatients, although non-Medicare patients may be paid based on DRGs. For CAHs, CDI can take on more of a regulatory focus. It may be hard to understand the return on investment since Critical Access Hospitals are paid on a cost reimbursement basis. However, if the CDI program is looked at in terms of improving documentation to support medical necessity and demonstrate quality care, then the CDI needs of Critical Access Hospitals really aren’t much different from those of a short-term acute care facility. CDI staff can improve documentation in the inpatient setting and also in the ER and observation areas as a part of the transition from outpatient to inpatient status. A CDI professional in a critical access hospital can also wear multiple hats. One CDI professional can perform quality abstracts, utilization reviews, and become involved with case management. It really can be a compliance component for your type of hospital. CAHs really should monitor their case mix index, as well as consider quality reporting of physicians to help drive goals, efforts, and reviews. If the case mix index is low, then it may not demonstrate the true level of care being provided to the patient population and thus total reimbursements will fall short of the actual cost. Improved documentation will result in improved coding and thus a more accurate case mix index.

Key Performance Indicator Case Mix Index (CMI): relative value assigned to a diagnosis-related group of patients in a medical care environment. The CMI value is used in determining the allocation of resources to care for and/or treat the patients in the group. A hospital's CMI = (Sum of DRG weights for all discharges)/(total number of discharges) Case Mix Index is a relative value assigned to a diagnosis-related group of patients in a medical care environment. This value is used in determining the allocation of resources to care for and/or treat the patients in the group. A hospital's CMI represents the average diagnosis-related group (DRG) relative weight for that hospital. It is calculated by summing the DRG weights for all discharges and dividing by the number of discharges for the same time period. A high CMI means the hospital performs high dollar services and therefore receives more money per patient.  

Do you have a CDI program in place? Poll question Do you have a CDI program in place?