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