Hospital Transformation Consortium Clinical Documentation ...€¦ · specializing in congestive heart failure, cholesterol, hypertension, and the effects of heart disease in women

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Presented by Rae Freeman, HCCS, Dr. James Dunnick, The Dunnick Group

Hospital Transformation ConsortiumClinical Documentation Improvement Series

“Four Key Roles for CDI: CDI Specialist”

July 18, 2017

A PORTION OF THESE MATERIALS WERE PRODUCED PURSUANT TO THE Iowa Small Hospital Improvement

Program (SHIP) Grant FY 17 IA Contract #5888SH01 and the Georgia Small Hospital Improvement Program FY17.

WEBINAR ETIQUETTE

Hospital Transformation Consortium

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WEBINAR RESOURCES


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CONTINUING EDUCATION


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CONTINUING EDUCATION


HTHU provides over 300 courses online, over 100 Webinars a year, and various live training conference and workshops. Accredited Education from the International Association for Continuing Education & Training (IACET). (Who accepts the IACET CEU? Full list at www.iacet.org)

• American Association of Respiratory Therapy• American Board of Medical Microbiology• American Society for Clinical Laboratory Science• American Society for Quality• American Speech-Language-Hearing Association• Board of Certified Safety Professionals• The Child Care Development Associate National

Credentialing Program• Clinician’s View (Occupational, Speech, and Physical

Therapy)• Federal Emergency Management Agency• Georgia, Massachusetts and Ohio Board of Nursing• Georgia Professional Standards Commission• Human Resources Certification Institute (for their

Professional in Human Resource Designation)• National Association of Rehabilitation Professionals in the

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Professional Engineers• The American Association of Integrative Medicine• The American College of Forensic Examiners

Institute• The American Council on Pharmaceutical

Education• The American Psychotherapy Association• The International College of The Behavioral

Sciences• The National Board for the Accreditation of

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Welcome & Introductions Desi Barrett,

HomeTown Health, LLC

Four Key Roles for CDI: The CDI Specialist Rae Freeman, Senior

Manager, Consulting -

HCCS

“Doctor’s Notes: Thoughts from a Physician” Dr. James Dunnick,

The Dunnick Group

Upcoming Events & Resources Annie Lee Sallee,

HomeTown Health, LLC

AGENDAClinical Documentation Improvement Series

Program Goals

Clinical Documentation Improvement Series

A CDI program’s purpose is to improve healthcare records to ensure improved patient outcomes, data quality and accurate reimbursement. This series of continued ICD-10 support with a specific focus on C DI will bring together Physicians, coders, and others that have the ability to increase revenue by coding to t he highest level of specificity.

The goal of this program is to improve hospital financial processes by helping to develop a CDI program within small/rural hospitals through specif ic training to the four main roles within a CDI Progra m: CDI Specialists, Physicians, Nurses and Scribes.

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What You Told Us…


“We have a Clinical Documentation Improvement (CDI) program

in place:”

ConsortiumPre-AssessmentSurvey Results

What You Told Us…


In pursuit of a Clinical Documentation Improvement (CDI) program,

our hospital has: (select all that apply)


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What You Told Us…


Which of the following best describes the training/certification of

your coding/CDI team?


What you Told Us…


What are your hospital's greatest areas of need related to Coding or Clinical Documentation

Improvement? What specifically are you hoping to get out of this program?


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Trainer BiographyClinical Documentation Improvement Series

Rae Freeman, RHIA, CDIP, CCS-PSenior Manager, Consulting at HCCS Healthcare Coding & Consulting Services

Rae Freeman is HCCS’s Senior Manager of Consulting. In this role Rae, an acknowledged HIM expert, performs speaking and education functions in addition to administering HCCS’s consulting services program.

Rae received a Bachelor of Science degree in Health Information Management from Southwestern Oklahoma State University and is an RHIA, a Certified Documentation Improvement Practitioner (CDIP) and a Certified Coding Specialist-Physician based (CCS-P).

Rae has worked in healthcare for 21 years in positions ranging from coder to Physician Office Manager and HIM Director. She is president-elect for the Florida Health Information Management Association and is a past president of the Texas HIM Association as well as the local Southwest Florida HIM Association.

Disclosure of Proprietary InterestClinical Documentation Improvement Series

HCCS does not have any proprietary interest in any product, instrument, device, service, or material discussed during this learning event.

The education offered by HCCS in this program is compensated by the HRSA Small Hospital Improvement Program (SHIP) grant, Iowa FY17-18, Contract #5888SH01 and the Georgia SHIP Grant Program FY17.

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Presented by Rae Freeman RHIA, CDIP, CCS-P Senior Manager Consulting

Healthcare Coding and Consulting Services (HCCS)

CLINICAL DOCUMENTATION IMPROVEMENT SERIES: “Four Key Roles for CDI: CDI Specialist”

Learning Outcome Standard: Based upon

© 2017 Healthcare Coding & Consulting Services

F o u r K e y R o l e s f o r C D I :F o u r K e y R o l e s f o r C D I :F o u r K e y R o l e s f o r C D I :F o u r K e y R o l e s f o r C D I :

Role #1 Role #1 Role #1 Role #1 –––– CDI CDI CDI CDI

SpecialistsSpecialistsSpecialistsSpecialists

Rae Freeman RHIA, CDIP, CCS-P

Senior Manager Consulting

Healthcare Coding and Consulting Services (HCCS)

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Learning OutcomesLearning OutcomesLearning OutcomesLearning OutcomesA t t h e e n d o f t h i s p r e s e n t a t i o n , y o u s h o u l d b e a b l e t o : A t t h e e n d o f t h i s p r e s e n t a t i o n , y o u s h o u l d b e a b l e t o : A t t h e e n d o f t h i s p r e s e n t a t i o n , y o u s h o u l d b e a b l e t o : A t t h e e n d o f t h i s p r e s e n t a t i o n , y o u s h o u l d b e a b l e t o :

Identify benefits of a CDI program in your hospitalIdentify benefits of a CDI program in your hospital

Define the four key roles of CDI and how they work togetherDefine the four key roles of CDI and how they work together

Identify other audiences that need to know and collaborate regarding the CDI programIdentify other audiences that need to know and collaborate regarding the CDI program

Summarize the role of a CDI SpecialistSummarize the role of a CDI Specialist


AgendaAgendaAgendaAgenda

�Four Key Roles in CDI �Four Key Roles in CDI

�Implementing CDI Program�Implementing CDI Program

�Defining CDI Program�Defining CDI Program

�Models for CDI Programs�Models for CDI Programs

�CDI Basics�CDI Basics

When Coding is OutsourcedWhen Coding is Outsourced

�Program Benefits�Program Benefits

�Outpatient CDI�Outpatient CDI

�Positive Impacts�Positive Impacts

�Best Practices�Best Practices

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Four Key Roles in CDIFour Key Roles in CDIFour Key Roles in CDIFour Key Roles in CDI

CDI Specialists

CDI Specialists

PhysiciansPhysicians

NursesNurses ScribesScribes


Working TogetherWorking TogetherWorking TogetherWorking Together

PatientPatient

PhysicianPhysician

CDI Specialist

CDI Specialist

ScribeScribe

NurseNurse

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Implementing a CDI ProgramImplementing a CDI ProgramImplementing a CDI ProgramImplementing a CDI Program

Staffing the programStaffing the program



Physician TrainingPhysician Training

Training Non-Physician Clinicians and CDI Program

Staff

Training Non-Physician Clinicians and CDI Program

Staff

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Physician Queries

Physician Queries

ComplianceCompliance


Defining a CDI ProgramDefining a CDI ProgramDefining a CDI ProgramDefining a CDI Program

MissionMission

GoalsGoals

•Monthly

•Quarterly

•Annually

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Defining a CDI ProgramDefining a CDI ProgramDefining a CDI ProgramDefining a CDI Program

RegulationsRegulationsEthical

StandardsEthical

StandardsWorkflowWorkflow


Models for CDI ProgramsModels for CDI ProgramsModels for CDI ProgramsModels for CDI Programs

SingleSingleHybridHybrid

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EthicsEthicsEthicsEthics

Ethical Decisions

Ethical Decisions


Role of CDI

professional

Role of CDI

professional

DocumentationDocumentation

CDI BasicsCDI Bas icsCDI Bas icsCDI Bas ics

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CDI BasicsCDI Bas icsCDI Bas icsCDI Bas ics

Chart ReviewChart Review

PrioritizingPrioritizing


CDI Program When Coding is CDI Program When Coding is CDI Program When Coding is CDI Program When Coding is

OutsourcedOutsourcedOutsourcedOutsourced

Remote SupportRemote Support

On-site SupportOn-site Support

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CDI Program BenefitsCDI Program BenefitsCDI Program BenefitsCDI Program Benefits

Accurate patient

severity

Accurate patient

severity

POAdocumentation

POAdocumentation



Improves bill hold daysImproves bill hold days

Reduce post-discharge queriesReduce post-discharge queries

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Improves CommunicationImproves Communication

Lessen compliance concernsLessen compliance concerns

Reduce anxiety for auditsReduce anxiety for audits


Outpatient CDIOutpatient CDIOutpatient CDIOutpatient CDI

Plan1

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Review2



Monitor3

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CDI Posit ive ImpactsCDI Posit ive ImpactsCDI Posit ive ImpactsCDI Posit ive Impacts

Documentation

Report Cards

Quality of Care

Financial Benefits


PatientPatient

ComplianceCompliance

QualityQuality

FinancialFinancial

CDI Posit ive ImpactsCDI Posit ive ImpactsCDI Posit ive ImpactsCDI Posit ive Impacts

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CDI Best PracticesCDI Best PracticesCDI Best PracticesCDI Best Practices

VisionVision

Phys Education

Phys Education

P / PP / P QueryQuery

FeedbackFeedback

EducationEducation ToolsTools

TeamworkTeamwork

ACTION ITEMS & COLLABORATIONPUT EDUCATION INTO ACTION ACROSS YOUR SYSTEM

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Action ItemsAction ItemsAction ItemsAction Items

�Schedule meeting with key stakeholders to discuss establishment of CDI program in your facility�Schedule meeting with key stakeholders to discuss establishment of CDI program in your facility

�Decide who will staff the CDI program�Decide who will staff the CDI program

�Schedule training for physicians and for non-physicians�Schedule training for physicians and for non-physicians

�Set program goals �Set program goals

�Schedule start date to begin the CDI program�Schedule start date to begin the CDI program


AHIMA - Clinical Documentation Improvement: Achieving Excellence

• www.ahima.org

• www.hcpro.com

• www.acdis.org

ResourcesResourcesResourcesResources

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Quality

Va

lue

W E W E L C O M E A L L Q U E S T I O N S

239.443.3900

[email protected]

www.hccscoding.com

T H A N K Y O U F O R Y O U R T I M E


Learning OutcomesLearning OutcomesLearning OutcomesLearning OutcomesN o w t h a t y o u h a v e c o m p l e t e d t h i s p r e s e n t a t i o n , y o u s h o u l d b e N o w t h a t y o u h a v e c o m p l e t e d t h i s p r e s e n t a t i o n , y o u s h o u l d b e N o w t h a t y o u h a v e c o m p l e t e d t h i s p r e s e n t a t i o n , y o u s h o u l d b e N o w t h a t y o u h a v e c o m p l e t e d t h i s p r e s e n t a t i o n , y o u s h o u l d b e a b l e t o : a b l e t o : a b l e t o : a b l e t o :

Identify benefits of a CDI program in your hospitalIdentify benefits of a CDI program in your hospital

Define the four key roles of CDI and how they work togetherDefine the four key roles of CDI and how they work together

Identify other audiences that need to know and collaborate regarding the CDI programIdentify other audiences that need to know and collaborate regarding the CDI program

Summarize the role of a CDI SpecialistSummarize the role of a CDI Specialist

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Recommended Resource:

“DOCTOR’S NOTES”Thoughts from a Physician

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Trainer BiographyClinical Documentation Improvement Series

Dr. James Dunnick, MD, FACC, CHCQM, CPC, CMDP The Dunnick Group, LLC

• Dr. James Dunnick is board certified in internal medicine and cardiology. He has 25 years of clinical practice experience specializing in congestive heart failure, cholesterol, hypertension, and the effects of heart disease in women.

• He has authored and published articles, medical textbook chapters and presented original research at national meetings.

• Dr. Dunnick attended IU Bloomington and IU School of Medicine in Indianapolis, where he placed in the Honors Division.

• He is a Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC) and is also certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP).

THE DUNNICK GROUPHelping hospitals meet the demands of cost, care, and compliance.

www.dunnickgroup.com

[email protected]

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COMPLIANCE

Why should I be compliant?

Because the cost of non compliance is much greater than the cost of compliance.

The Physician will always ask, “What’s in it for me?”

The answer is, “Increasing your income and increasing your value to payers.”

WHY BE COMPLIANT

CMS processes approximately 5 million claims Per day

OR

1.8 billion per year

210,000 per hour

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CMS PAYMENTS

2015 Federal Budget

1. MC/MC 24%

1. SS 24%

3. Defense 16%

CMS $Medicare: Medicare spending growth was

projected as 5.0 percent in 2016 and is

expected to average 7.1 percent over the

full projection period 2016-2025.

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Medicare is in Trouble

The Government is not kidding about cost containment.

AAAANNNN AUDITAUDITAUDITAUDIT TESTTESTTESTTEST QUESTIONQUESTIONQUESTIONQUESTIONQuestion: What percent of charges submitted to Medicare are fraudulent?

A. 5%

B. 10%

C. 30%

D. 50%

Answer: C. Medicare believes that 30% of submitted claims are fraudulent.

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ECONOMIC PENALTIES•Civil false claims act:

1. $5,500 – 11,000 per claim

2. Three times the value of each claim

•Criminal false claim act:

1. Felony

2. Up to 5 years imprisonment

3. $25,000 fine

•MC/MC civil monetary penalties law:

1. $10,000 per claim

2. Three times the value of each claim

Other – CIA, Exclusion List

Entity $ Amount Fined

One Hospital 13,000,000.00

Physical Therapist 2,400,000.00

Physiatrist 1,500,000.00

ENT 750,000.00

Family Practice Physician 162,676.00

Dentist 84,00.00

Cardiologist Charged

Coders CIA, Fined

ECONOMIC PENALTIES

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“A 16-count indictment was unsealed in federal court charging a cardiologist, Dr. XX, 55, with performing unnecessary catheterizations, tests, stent insertions and causing unnecessary coronary artery bypass surgeries as part of a scheme to overbill Medicare.”

August 21, 2014, U.S. Attorney Northern District of Ohio Steven M. Dettelbach

THE PHYSICIAN RISK

XX Hospital faces 15 lawsuits over improper heart procedures

Hospital is facing 15 lawsuits and is the subject of a federal investigation over improper interventional cardiology procedures, according to a recent Securities and Exchange Commission filing.

Written by Ayla Ellison (Twitter | Google+) | February 13, 2015

THE HOSPITAL RISK

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HOSPITAL PENALTIES

$13 Million Dollars for incentives for productivity and providing care not supported by documentation.

KKKKNOWNOWNOWNOW TTTTHEHEHEHE RRRRULESULESULESULES

•SOI

•WCC

•W/O CC

•MCC

•W/O MCC

•LOS

•COC

•CMI

•DD

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Three key E/M components

A. History

1. History present illness

2. Past medical family social history

3. Review of systems

B. Physical Exam

1. 1995-Body Parts or organ systems

2. 1997- General or specialty specific

C. Medical Decision Making

1. Problem points

2. Data points

3. Risk

KKKKNOWNOWNOWNOW TTTTHEHEHEHE RRRRULESULESULESULES

DDDDIDIDIDID YYYYOUOUOUOU KKKKNOWNOWNOWNOW

In your HPI:

How many elements do you need for the five billable levels?

How many problem points are needed for a 99203, 99204, 99205?

What happens if you document a 99214 and bill a 99213?

What is the difference between a consult and a referral?

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Physical exam

How many body areas must be examined for any given billing level?

Should you choose the 1995 or 1997 rules?

Which has the greater number of review of systems, 1995 or 1997 guidelines?


The liability of EHR false code level prompts falls on the physician?

The liability of errors by coding staff falls on physicians and hospitals?

What is the difference between a consult and a referral?

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YOU CAN IMPROVE

E/M and ICD 10 CM can be taught from physician to physician. It can be made easier.

You can increase your speed of EHR documentation.

More than just reducing delays and denials, you can increase your value to payers.

COMPLIANCE

The Cost of Non Compliance is Too Much.

Therefore accept the cost of compliance

We must understand the rules; they will be applied.

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WHAT’S COMING?

Title: Why be compliant-what’s in it for me? August 15, 2017

By: The Dunnick Group. www.dunnickgroup.com

With Hometown Health University www.hthu.net

UPCOMING EVENTS & RESOURCESHospital Transformation Consortium

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CONSORTIUM TRAINING

Clinical Documentation Improvement (CDI) Series

presented by HCCS , The Dunnick Group, LLC, & HTHJoin the Coding Team of Trainers for this series on Clinical Documentation Improvement for small hospitals,

including a discussion on the four key roles needed for a successful CDI Program. Training will be provided

for CDI Specialists, Coders, Physicians, Nurses, and Scribes in implementing a program in your hospital.

Webinars held at 10 am CST/ 11 am EST on dates below.

July 18, 2017: Four Key Roles for CDI: Role #1 - CDI Specialist Webinar Training 0.1 CEUs

August 15,2017: Four Key Roles for CDI: Role #2 - Physicians Webinar Training 0.1 CEUs

October 17, 2017: Four Key Roles for CDI: Role #3 - Nurses & Scribes Webinar Training 0.1 CEUs

March 2018: Rural Coding/CDI Specialist Certification Support Course 1 Support Course 0.1 CEUs

Rural Coding/CDI Specialist Certification Support Course 2 Support Course 0.1 CEUs

Rural Coding/CDI Specialist Certification Support Course 3 Support Course 0.1 CEUs

CONSORTIUM TRAINING

Quarterly Coding & ICD-10 Update Series presented by HCCS In order to help hospitals stay on top of the latest changes and ongoing challenges in coding

requirements, experts in the field come together to share their knowledge in the world of coding

and ICD-10. Recommended audience will include: Coders, HIM Managers/Directors, Business

Office Staff interested in the topic.

June 27, 2017: Hitting the Mark on Compliant OB coding in ICD-10 Webinar

Training

Sept. 26, 2017: Annual ICD-10 Updates, Complex Coding ScenariosWebinar

Training

January 30, 2018: CPT 2018 UpdatesWebinar

Training

March 27, 2018: Facility Coding E&MWebinar

Training

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CALENDAR OF EVENTS

View your Program Dashboard

GA/FL: www.hthu.net/htc17

IA: www.hthu.net/iahtcBoth are Password protected: contact Jennie Price at

[email protected] if you need your Dashboard password!

CONSORTIUM RESOURCES

There are on-demand training and certification programs available

in HTHU’s:

• School of Revenue Cycle Management

• PFS/BO Certifications

• School of Coding & Documentation• School of Clinical & Staff Compliance

• School of Physician Office Education

• School of Long Term Care

• School of HIT & Transformation

Questions?

Contact Meghan Williams at [email protected]

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TELL US HOW WE DID!

A survey will launch after this webinar

closes: please take a moment to give us

your feedback on the training, speaker,

content, webinar format, and anything

else you can share!

If there’s something we can help your

hospital with, please let us know!

Questions?

Questions about these resources or Upcoming Events?

Contact:

Annie Lee Sallee

[email protected]

or

Jennie Price, SHIP Program Manager

[email protected]

Documents

Hospital Transformation Consortium Clinical Documentation ...€¦ · specializing in congestive heart failure, cholesterol, hypertension, and the effects of heart disease in women