hospital transformation consortium clinical documentation ... transformation consortium clinical...

Presented by Rae Freeman, HCCS and

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


As an IACET Authorized Provider, HomeTown Health, LLC offers

CEUs for its programs that qualify under the ANSI/IACET

Standard. HomeTown Health, LLC is authorized by IACET to

offer 0.1 CEUs/1 credit hour for this program.

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Anyone that misses the webinar can view the recording online, posted on the program Dashboard, for CEUs.

CONTINUING EDUCATION


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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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

Occupational Therapy (NBCOT)

ACTION ITEM: GROUP PARTICIPATION


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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 CDI will bring together Physicians, coders, and others that have the ability to increase revenue by coding to the 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 specific training to the four main roles within a CDI Program: CDI Specialists, Physicians, Nurses and Scribes.

What you Told Us…


“We have a Clinical Documentation Improvement (CDI) program in place:”

Consortium

Pre-Assessment

Survey Results

What you Told Us…


In pursuit of a Clinical Documentation Improvement (CDI) program, our hospital has: (select all that apply)

Consortium

Pre-Assessment

Survey Results

What you Told Us…


Which of the following best describes the training/certification of your coding/CDI team?

Consortium

Pre-Assessment

Survey Results

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?

Consortium

Pre-Assessment

Survey Results

Trainer BiographyClinical Documentation Improvement Series

Rae Freeman, RHIA, CDIP, CCS-PSenior Manager, Consulting

HCCS - Healthcare Coding & Consulting Services

Rae is an acknowledged HIM expert who 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.

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 guidance published by American Health Information

Management Association (AHIMA) as well as the Association for Clinical Documentation

Improvement Specialist (ACDIS).

© 2017 Healthcare Coding & Consulting Services 16

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

Role #1 – CDI Specialists

Rae Freeman RHIA, CDIP, CCS-P Senior Manager ConsultingHealthcare Coding and Consulting Services (HCCS)


Learning 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 :

Identify benefits of a CDI program in your hospital

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

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

Summarize the role of a CDI Specialist


Agenda

Four Key Roles in CDI

Implementing CDI Program

Defining CDI Program

Models for CDI Programs

CDI Basics

When Coding is Outsourced

Program Benefits

Outpatient CDI

Positive Impacts

Best Practices


Four Key Roles in CDI

CDI Specialists

Physicians

Nurses Scribes


Working Together

Patient

Physician

CDI Specialist

Scribe

Nurse


Implementing a CDI Program

Staffing the program



Physician Training

Training Non-Physician Clinicians and CDI Program

Staff



Physician Queries

Compliance


Defining a CDI Program

Mission

Goals

•Monthly

•Quarterly

•Annually


Defining a CDI Program

RegulationsEthical

StandardsWorkflow


Models for CDI Programs

SingleHybrid


Ethics

Ethical Decisions


Role of CDI

professional

Documentation

CDI Basics


CDI Basics

Chart Review

Prioritizing


CDI Program When Coding is Outsourced

Remote Support

On-site Support


CDI Program Benefits

Accurate patient

severity

POAdocumentation



Improves bill hold days

Reduce post-discharge queries



Improves Communication

Lessen compliance concerns

Reduce anxiety for audits


Outpatient CDI

Plan1


Outpatient CDI

Review2


Outpatient CDI

Monitor3


CDI Posit ive Impacts

Documentation

Report Cards

Quality of Care

Financial Benefits


Patient

Compliance

Quality

Financial

CDI Posit ive Impacts


CDI Best Practices

Vision

Phys Education

P / P Query

Feedback

Education Tools

Teamwork

ACTION ITEMS & COLLABORATIONPUT EDUCATION INTO ACTION ACROSS YOUR SYSTEM

http://d.pr/11oyA


Action Items

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

Decide who will staff the CDI program

Schedule training for physicians and for non-physicians

Set program goals

Schedule start date to begin the CDI program


AHIMA - Clinical Documentation Improvement:

Achieving Excellence

• www.ahima.org

• www.hcpro.com

• www.acdis.org

Resources

http://www.ahima.org/

http://www.hcpro.com/

http://www.acdis.org/


Quality

Valu

e

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 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 a b l e t o :

Identify benefits of a CDI program in your hospital

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

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

Summarize the role of a CDI Specialist

“DOCTOR’S NOTES”Thoughts from a Physician

http://d.pr/11oyA

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]

mailto:[email protected]

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

49

CMS PAYMENTS

2015 Federal Budget

1. MC/MC 24%

1. SS 24%

3. Defense 16%

50

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.

51

Medicare is in Trouble

The Government is not kidding about cost containment.

52

AN AUDIT TEST QUESTIONQuestion: 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.

53

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

54

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

“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

http://phx.corporate-ir.net/phoenix.zhtml?c=88004&p=irol-SECText&TEXT=aHR0cDovL2FwaS50ZW5rd2l6YXJkLmNvbS9maWxpbmcueG1sP2lwYWdlPTEwMDY0NTIwJkRTRVE9MCZTRVE9MCZTUURFU0M9U0VDVElPTl9FTlRJUkUmc3Vic2lkPTU3

https://twitter.com/@bhr_ayla

https://plus.google.com/u/0/116407004021217686831/posts

HOSPITAL PENALTIES

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

KNOW THE RULES

•SOI

•WCC

•W/O CC

•MCC

•W/O MCC

•LOS

•COC

•CMI

•DD

59

Three key E/M components

A. History1. History present illness2. Past medical family social history3. Review of systems

B. Physical Exam1. 1995-Body Parts or organ systems2. 1997- General or specialty specific

C. Medical Decision Making1. Problem points2. Data points3. Risk

KNOW THE RULES

DID YOU KNOW

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?

DID YOU KNOW

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?

DID YOU KNOW

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?

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.

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

http://www.dunnickgroup.com/

UPCOMING EVENTS & RESOURCESHospital Transformation Consortium

http://d.pr/11oyA

Recommended Resource:Pre-Program Resource Course on HTHU.net: “Developing & Maintaining a CDI Program for Small Hospitals” (Course Link)

This course explains what clinical documentation improvement is, defines the purpose of a CDI program, and explains how CDI efforts can positively affect an organization’s key performance indicators, balancing quality measures and reimbursement. Specific case examples are provided to illustrate how CDI can affect the reimbursement of a given admission. Additionally, real life scenarios are provided from several hospitals to support the impact of a strong CDI program within a hospital. Lesson II provides details on how to develop and operate a CDI program within an organization. Whether you already have existing CDI efforts in place or you are starting from scratch, you will gain understanding on how to run a CDI program based on organizational goals. Clinical documentation improvement efforts both large and small can help to improve documentation and thus quality measures and reimbursement.

Learning Outcomes Upon completion of this course, you will be able to:• Recall how a clinical documentation improvement (CDI) program will impact key performance indicators for your hospital.• Recognize the importance of a CDI program.• Describe necessary components of formalizing a CDI program.

Learning Outcomes Standard:Based upon guidance published by American Health Information Management Association (AHIMA) as well as the Association for Clinical Documentation Improvement Specialist (ACDIS).

https://lms.hthu.net/oltpublish/site/program.do?dispatch=showCourseSession&id=5b88bd71-1d38-11e6-807c-0cc47a352510

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

(“Why be compliant-what’s in it for me?”)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

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]

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]

hospital transformation consortium clinical documentation ... transformation consortium clinical...

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