What to Do Next? Strategies for Approaching Your PPCs

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Presentation transcript:

What to Do Next? Strategies for Approaching Your PPCs Kristen Geissler, MS, PT, MBA, CPHQ

Strategic Planning & Execution Finance Quality Physicians HIM Coordination of efforts Flow and division of review efforts Education & understanding CMS versus HSCRC Clinical versus coding

Review for data quality BEFORE reviewing for clinical quality Case Review Review of historical PPC cases Consider a sample of top 10 PPCs with cases higher than expected value and driving most financial impact/weight Review for data quality opportunities: Documentation Coding Present on admission Review for data quality BEFORE reviewing for clinical quality

Educate Education Coders/ Concurrent Reviewers Present on admission Coding of complications Compliant querying Physicians Documentation implications Leadership Methodology and strategy

POA Challenges Limited training during initial rollout Very limited early feedback on accuracy of POA data Encoder limitations on alerts or edits Early adoption of internal ‘policies’ difficult to change Inherent challenges in assigning POA indicator for codes that drive PPCs Copyright © NCI 2009 Confidential and proprietary, shall not be transferred or distributed

Case Review Review of live PPC cases starting 7/1/09 Identification of cases with PPCs prior to submission deadlines Review before final tape submission to HSCRC Review for potential errors in Documentation Coding Present on admission Identify process for review and remediation Consider targeting top 10-15 with highest financial impact Review for data quality BEFORE reviewing for clinical quality

Factors Affecting Rank Factors to consider Are diagnoses documented appropriately and timely? Documentation of condition present on admission Are you accurately coding PPC-driver codes? Review coding clinics associated with complication codes Are you accurately coding POA? Re-educate staff on POA assignment Audit records for ‘N’ and ‘U’ Query and educate physicians Are you coding all secondary diagnoses? Some secondary diagnoses may provide exclusions for some PPCs What’s the drill down on clinical quality? Commonalities in service, physician, floor

MHAC Checklist Organize team to include at least: Finance, HIM, Quality, Physician Review historical PPC cases and identify opportunities for improvement in Documentation Coding POA Assignment Quality/coordination of care Develop process for identifying live PPC cases (‘pre-tape’) Develop review process and flow for PPC cases Develop process to remediate data quality errors Develop education plan for key stakeholders Coders/Concurrent reviewers Physicians Leadership