Presentation is loading. Please wait.

Presentation is loading. Please wait.

Clinical Documentation Improvement

Published byChristian Hicks Modified over 9 years ago

Similar presentations

Presentation on theme: "Clinical Documentation Improvement"— Presentation transcript:

1 Clinical Documentation Improvement
Langley Provider Group Colleen Garry RN, BS Mary Beth Genovese RN, BS, CCS, CCDS

2 JAMA: April 26, 2006 p. 1918 “The era of accountability defined as measured performance with consequences, is rapidly arriving in the US for medical practitioners and health care facilities. Soon, both reputations and incomes of practitioners and health care facilities may well be altered depending on how one scores on a limited set of performance metrics”

3 Hospital Life Today Affordable Care ACT Changes
Decreased reimbursement Bundled payments Pay for Performance/VBP EMR Implementation ICD 10 Pay for Outcomes

4 Deficit Reduction Act of 2005 SECTION 501 c of PL 109-71
Congress authorizes CMS to adjust for Medicare IPPS hospital payments to encourage the prevention of certain conditions (VBP) Requires CMS to choose at two conditions; High volume high cost or both Condition is a cc or MCC Reasonably preventable thru evidenced based guidelines No addition payment when these conditions develop after admission (when condition is the only one to bring to the higher RW tier)

5 Who’s Profiling Physicians?
Federal State and Regulatory agencies Joint Commission CMS Peer Review Organizations Managed Care organizations/Profiling Agencies Prospective Payment Systems Hospitals (one of the major indices is based on SOI)

6 Is your profile accurate?
How complex is the care being delivered? What overall severity is being reported and collected? What risk of mortality is being reflected? How do secondary diagnoses affect reflection of severity and risk? Do I have any control over my profile?

7 WIKIPEDIA DEFINITIONS
Severity of illness (SOI) is defined as the extent of organ system derangement or physiologic decompensation for a patient. It gives a medical classification into minor, moderate, major, and extreme. The SOI class is meant to provide a basis for evaluating hospital resource use or to establish patient care guidelines. The risk of mortality (ROM) provides a medical classification to estimate the likeli-hood of in-hospital death for a patient. The ROM classes are minor, moderate, major, and extreme. The ROM class is used for the evaluation of patient mortality.

8

9

10

11

12

13

14 Flow of Documentation MD DOCUMENTATION Converts into ICD 9 Codes NOW
FEDERAL GOVT. RANKING REIMBURSEMENT MD DOCUMENTATION Converts into ICD 9 Codes NOW And ICD 10 codes OCTOBER 1, 2014 RACS OVERSIGHT RECOVERY TIER STATUS CREDENTIALING INSURANCE COMPANIES HEALTHGRADES LEAPFROG INTERNET PATIENT BALTIMORE SUN

15 Governmental AUDITS NAME OF AUDIT Governmental AGENCY RAC POST BILL
DCS INC. FOR CMS RAC PRE-BILL RAC A to B RE-BILL CMS NGS PRE-BILL AUDIT 1 DAY STAY NGS CMS PART B PHYSICIAN AUDIT

16 RAC’s: YOUR BEST DEFENSE: A GOOD OFFENSE (CDI)
To Assess: Level of Acuity Severity of Illness Clinical Indicators Utilization of resources

17 LANGUAGE INCOMPATABILITIES

18 Clinical Language vs. Diagnostic Statements
CODING LANGUAGE ↓ NA Hyponatremia Fluid resuscitation Dehydration, hypovolemia, hypovolemic shock Enzymes + St elevation V leads Acute anterior MI (STEMI vs. NSTEMI) ↓ HGB transfuse 2 units Acute blood loss anemia Urosepsis Urinary tract infection Sepsis from a urinary source

19 Effective CDI LEADERSHIP SUPPORT DATA TRACKING COMMUNICATION COLLABORATION & ONGOING EDUCATION

20 ACCOMPLISHED BY: CDI team fully trained in CDI (clinical, coding, compliance) Concurrent “real” time record reviews Ensure proper assignment of: DRG/CC/MCC/POA Status/ HAC’s Tracking tool to report on vital data Scheduled reports to CDI Steering Committee with regularly scheduled meetings Continuous feedback to Mid Level Providers and Physicians

21 Benefits of CDI: Regulatory Compliance Improved outcome indicators
Thorough documentation enhances accurate hospital and physician profiles Enhanced support for the patient’s treatment plan LOS and medical necessity are supported by SOI Fewer Denials Added support for E&M coding levels Risk management tool

22 What are the drivers for change?
Accurate and Comprehensive clinical documentation is essential for: Safe, high quality patient care Accurate performance data Appropriate reimbursement revenue Regulatory compliance e.g., MS DRG . POA, HAC’s, Core Measures, PSI’s, RAC ????

23 Critical Success Factors
To ensure accurate comprehensive clinical documentation: Provide Strong Medical and Administrative Leadership Support Communicate and Collaborate Perform Robust Data Tracking Offer ongoing education Implement an effective CDI program

24 Improvement Activities Benchmarking
Regularly monitor performance Determine processes to be studied Identify relevant performance data /gather data Compare discover critical success factors Adopt/adapt successful strategies

25 COUNTDOWN TO ICD 10 502 DAYS 71 WEEKS + 5 days MAY 17, 2013
OCTOBER 1, 2014 MAY 17, 2013

26 CHANGES TO VOLUME ICD-10-CM 68,069 ICD-9-CM 14,025 CODES 3,824
DIAGNOSIS CODES ICD-9-CM 14,025 CODES ICD-10-CM 68,069 PROCEDURE CODES 3,824 ICD-10-PCS 72,589

27

28

29 Thank you QUESTIONS ?

Download ppt "Clinical Documentation Improvement"

Similar presentations

An Essential Tool for Optimizing Clinical Outcomes and Improving Patient Safety: The Administrative and Clinical Standards for Patient Blood Management.

An Essential Tool for Optimizing Clinical Outcomes and Improving Patient Safety: The Administrative and Clinical Standards for Patient Blood Management.
MEDICAL HOME 1/2009 Mary Goldman, D.O., President of MAOFP.

MEDICAL HOME 1/2009 Mary Goldman, D.O., President of MAOFP.
What is this course? This course is designed to provide a basic awareness and understanding of ICD-10 and why it is so critical to our organization.

What is this course? This course is designed to provide a basic awareness and understanding of ICD-10 and why it is so critical to our organization.
THE JOINT COMMISSION PATIENT BLOOD MANAGEMENT PERFORMANCE MEASURES

THE JOINT COMMISSION PATIENT BLOOD MANAGEMENT PERFORMANCE MEASURES
Www.chks.co.uk Epidemiology and benefit to patients from accurate coding Heather Walker CHKS Consultancy and Marketing Director 4 th May 2012.

Epidemiology and benefit to patients from accurate coding Heather Walker CHKS Consultancy and Marketing Director 4 th May 2012.
A Workshop Facilitated by Glenda M. Payne, RN, MS, CNN ESRD Technical Advisor, CMS Regions 4 & 6 Dallas, TX.

A Workshop Facilitated by Glenda M. Payne, RN, MS, CNN ESRD Technical Advisor, CMS Regions 4 & 6 Dallas, TX.
Clinical Documentation Improvement Program Physician Program Overview Our CDI program works to ensure the documentation in the medical record captures.

Clinical Documentation Improvement Program Physician Program Overview Our CDI program works to ensure the documentation in the medical record captures.
1 Medical Necessity Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI Manager Accretive Health.

1 Medical Necessity Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI Manager Accretive Health.
Overview Clinical Documentation & Revenue Management: Capturing the Services Prepared and Presented by Linda Hagen and Mae Regalado.

Overview Clinical Documentation & Revenue Management: Capturing the Services Prepared and Presented by Linda Hagen and Mae Regalado.
Change is Coming in 2014! ICD-10 will replace ICD-9 for Diagnosis Coding.

Change is Coming in 2014! ICD-10 will replace ICD-9 for Diagnosis Coding.
Why it is important and how it affects you as a physician. Jeni Smith, CPC.

Why it is important and how it affects you as a physician. Jeni Smith, CPC.
Physician CDI Preparation for ICD-10

Physician CDI Preparation for ICD-10
Health Center Revenue and Reimbursement Management

Health Center Revenue and Reimbursement Management
Clinical Documentation. Objectives Upon completion of this presentation participants will be able to: Define Clinical Documentation State the purpose.

Clinical Documentation. Objectives Upon completion of this presentation participants will be able to: Define Clinical Documentation State the purpose.
Present on Admission. Requirements of Deficit Reduction Act 2005 CMS and CDC choose conditions that are: High Cost, High Volume, or both. Assigned to.

Present on Admission. Requirements of Deficit Reduction Act 2005 CMS and CDC choose conditions that are: High Cost, High Volume, or both. Assigned to.
Documentation for Acute Care

Documentation for Acute Care
Implementation Chapter 14. 14-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Purposes of Implementation  The implementation.

Implementation Chapter Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Purposes of Implementation  The implementation.
It’s A Success! Achieving Cost-Effective Disease Management in CHF Sherry Shults, RN BSN CIO South Carolina Heart Center.

It’s A Success! Achieving Cost-Effective Disease Management in CHF Sherry Shults, RN BSN CIO South Carolina Heart Center.
INTRODUCTION TO ICD-9-CM

INTRODUCTION TO ICD-9-CM
MEDICAL RECORDS MANAGEMENT IN EYE CARE SERVICES 6.International classification of Disease & Procedures and the method of Indexing data.

MEDICAL RECORDS MANAGEMENT IN EYE CARE SERVICES 6.International classification of Disease & Procedures and the method of Indexing data.

Similar presentations

Ads by Google