What to Do Next?Strategies for Approaching Your PPCs

Kristen Geissler, MS, PT, MBA, CPHQ

Strategic Planning & Execution

» Coordination of efforts› Flow and division of

review efforts

» Education & understanding› CMS versus HSCRC

› Clinical versus coding

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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

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Educate

» Education

› Coders/ Concurrent Reviewers

‒ Present on admission

‒ Coding of complications

‒ Compliant querying

› Physicians

‒ Documentation implications

› Leadership

‒ Methodology and strategy

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POA Challenges

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» 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

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

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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, floorPage 7

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

LeadershipPage 8