2015 ACDIS Conference

Transcription

1 4:00 p.m. 8:00 p.m. 6:00 p.m. 8:00 p.m. Monday, May 18, 2015 Attendee pre-registration (West Registration, Street Level) By pre-registering you will avoid waiting in line in the morning! Welcome reception, sponsored by Elsevier Clinical Solutions (Exhibit Hall A, Street Level) 7:00 a.m. 8:00 a.m. Tuesday, May 19, 2015 DAY 1 Registration (West Registration, Street Level) and continental breakfast (Exhibit Hall A, Street Level) 8:00 a.m. 8:30 a.m. 8:30 a.m. 9:30 a.m. 9:45 a.m. 10:45 a.m. A Matter of Life or Death: CDI Impact on Mortality Risk Adjustment Allison Q. Clerval, RN, BSN, CCDS; Kathleen M. Shindle, RN, BSN, CCDS Utilization Review Revitalizing a CDI Program and CDI: A Physician Coding Clinic Update for CDI for Physician Engagement Advisor s Perspective James S. Kennedy, MD, Karen Chase, MS, RN, CCS, CDIP Stephanie Lee Ciccarelli, MD, BSN, CCDS FACP; Rhonda West-Haynes, MHA, BSN, RHIA, CCDS This session is a must for anyone that is trying to start a new CDI program, revamp an existing program, engage physicians, or prove to administration that CDI can make a difference in both quality and reimbursement. It will include metrics and methodologies for improvement. - from 3M Health Information Systems: Coach TM purse Welcome remarks, ACDIS update, and 2015 awards presentation, Brian Murphy, ACDIS Director (Ballroom A, Street Level) General Session: Analyzing the Realistic Impact of ICD-10 on APR-DRGs, Donna Smith, RHIA (Ballroom A, Street Level) This session will demonstrate a step-by-step analysis that can be used to determine the areas and service lines with the greatest exposure under ICD-10, along with mitigation opportunities using documentation specificity. Presenter Donna Smith will give real-world examples of the reimbursement impact for organizations paid under APR-DRGs. Variations in DRG calculations will be reviewed and specific clinical examples provided. This session will describe the role of Coding Clinic and its impact on documentation and coding integrity. It will review recent Coding Clinic advice for which queries are indicated and offer strategies for using Coding Clinic in audit defense. A relatively new term being discussed among CDI professionals is risk adjustment. Learn how Thomas Jefferson University Hospital utilizes the University HealthCare Consortium (UHC) risk model variables to benchmark patient outcomes and accurately reflect expected patient mortality. Level : Basic Level : Intermediate Level : Intermediate Level : Intermediate This case study will show the evolution of a full-time hospitalist to a full-time physician advisor, with part-time responsibilities for appeals and medical necessity reviews. It will include overall and program goals and incorporating an EHR into the CDI program, demonstrating how electronic queries and alerts led to an increase in response rates. 10:45 a.m. 11:15 a.m. from MedeAnalytics: $50 Visa gift card from HCQ Consulting and ImplementHIT: The 2015 CDI Pocket Guide Page 1 of 7

2 11:15 a.m. 12:15 p.m. Coding and Physician Self-Defense: Engaging Docs in CDI William E. Haik, MD, FCCP, CDIP, AHIMA-Approved ICD-10- CM/PCS Trainer Eliminating Documentation Opportunities With PSI 15 and 90 Is No Accident Mary Kay Brooks, RN, MSN, CPHQ CDI and Core/Quality Measures: Creating Impact Beyond the DRG Amy R. Herndon, RN, BSN, CCDS; Dawn R. LaRoque, RN, BSN, CCDS, CPHQ Introducing CDI to the Simulation Lab Residency Program Eileen Finnin, RN, BS Attend a live presentation to the general medical staff regarding why and how physicians should be involved in the documentation of the health record, interrupted by staged comments and questions from the audience as well as an open microphone. During the presentation, the three Ps of how physicians are impacted by coding, and how they should involve themselves in the documentation process, will be presented to the medical staff. When addressing documentation opportunities with PSI 15 (Accidental Puncture and Laceration), do not underestimate the power of one for a sustainable outcome. This session will teach different strategies to address documentation opportunities and standardize processes for improvement for both PSI 15 and PSI 90. Historically, most of the data related to core measures has been collected retrospectively. This session will provide you with the tools needed to implement a concurrent core measures program, allowing you the opportunity to intervene and avoid misses, and more importantly ensure that your patients receive the best care at the right time. This can improve publicly reported data and avoid financial losses by increasing Value-Based Purchasing scores. Level : Intermediate Level : Basic Level : Advanced Level : Intermediate 12:15 p.m. 1:30 p.m. 1:30 p.m. 2:30 p.m. CDI Success: Keys to Healthy CDI and Medical Provider Relationships Jennifer M. Conroy, RN, BSN; John R. Houskamp, MD Diagnostic Criteria 101: Criteria to Diagnose 15 Common Hospital Medicine Diagnoses Timothy N. Brundage, MD, CCDS Completing the Circle: The Importance of CDIS Participation in the Denial Management Process Sarah C. Mendiola, Esq., LPN, CPC Create good documentation habits from day one with this innovative approach to communicate with and engage physicians. Presented by a speaker who spearheaded the incorporation of CDI into her facility s simulation lab, this session will discuss the lab and its simulated scenarios, along with a statistical analysis of documentation to assess improvement. It will also include limitations and ideas for future improvement. Through the Looking Glass: Examining APR-DRGs in the Pediatric Population Karen L. Bridgeman, MSN, RN, CCDS; Tina H. Smith, BSN, RN, CCDS Gundersen Health System s high response rate is a sign of its strong relationship with medical providers and is a key to the success of its CDI department. This session will describe how the system achieved this high level of engagement and the strategies it employed. It is presented by Gundersen s CDI physician leader, who is also a practicing hospitalist with firsthand knowledge of the multitude of factors that can cause a medical provider to become disengaged with documentation integrity. Boxed lunch - provided (Exhibit Hall A, Street Level) from Novia Strategies Inc.: $100 Nordstrom gift card This session will provide the clinical criteria for the top 15 medical diagnoses for hospitalized medical patients, presented by a board-certified internal medicine MD who practices clinically and provides documentation education. Learn the evidence-based medicine, as well as the references for these clinical criteria, to support your documentation improvement efforts. This interactive session is conducted by an associate attorney whose work focuses on appeal of denied claims by CMS contractors. She will present actual examples of costly denials that could have been prevented with CDIS intervention. These include 2-midnight rule denials, medical necessity for major joint replacement (as outlined by CMS), and justification of MCCs that are difficult to support clinically while maintaining compliance guidelines. It will also provide a sample of and explain the impact of a Corporate Integrity Agreement on the CDIS and your organization. Level : Intermediate Level : Basic Level : Intermediate Level : Advanced This presentation will examine the nuances in the pediatric population, from neonates through adolescents. Join us through the looking glass to learn the ins and outs of the APR-DRG system on the pediatric population, and enhance your pediatric CDI practice with an in-depth discussion and practical applications. 2:30 p.m. 3:15 p.m. Page 2 of 7

3 3:15 p.m. 4:15 p.m. Doc for Docs: Giving The Talk to Physicians Jonathan L. Elion, MD, FACC ICD-10-PCS Code Assignment: Uncovering Missing Documentation Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS; Laurie L. Prescott, RN, MSN-Ed, CCDS, CDIP CDI for Risk Adjustment Coding Adele L. Towers, MD, MPH, FACP Leading Your CDI Program to Become a Strategic Force Within Your Organization Karen M. DiMeglio, RN, MS, CPC, CCDS; Ann M. Kashmanian, MBA, CPA How do you give "the talk" to a new crop of house staff that need training, or to a reluctant physician? This presentation takes the form of a "talk within a talk": It provides a presentation that is ready to be given to physicians while also supplying commentary about the presentation, along with examples, tips, and stories about the challenges of this important task. ICD-10-PCS includes key elements that must be present in the documentation for accurate code assignment there are no characters that stand for the documentation doesn t say. There are specific codes for all aspects of a procedure, which may necessitate the clinical knowledge of the CDI team to assist in ensuring clear, supportive documentation. This session is not for ICD-10 beginners but will be lots of fun! Risk adjustment coding is not just for insurance companies anymore. Physicians, ACOs, and healthcare and physician groups need to understand the risk adjustment model and the different opportunities it presents. This session will discuss the effectiveness of an automated CDI process in risk adjustment coding. CDI specialists will learn best methods to leverage their expertise to manage automated processes and network flows that will greatly improve coding documentation. Level : Intermediate Level : Intermediate Level : Advanced Level : Advanced 4:15 p.m. 4:15 p.m. 5:15 p.m. 7:00 a.m. 8:00 a.m. 8:00 a.m. 9:00 a.m. Sessions adjournment Join us for dedicated poster session viewing (Exhibit Hall A, Street Level) Wednesday, May 20, 2015 DAY 2 Continental breakfast (Exhibit Hall A, Street Level) CDI programs are uniquely positioned to be the driving force behind improving quality metrics and positioning hospitals to receive recognition for high-quality care and accurate reimbursement. This presentation will provide critical knowledge and strategies to lead your program. It will focus on developing a high-performance team, translating data into actionable reports, utilizing a multifaceted approach to communication, selecting initiatives to improve hospital metrics, and identifying opportunities for collaboration to ensure success. 7:15 a.m. 7:45 a.m.: Meet the ACDIS/HCPro boot camp instructors at the ACDIS booth #100 from The Claro Group: Garmin TM watch Keynote Session : Caring for Your Caregivers, Will Miller, MD (Ballroom A, Street Level) Healthcare corporations and organizations fully understand the vital role being played by their caregivers: the nurses, physicians, technicians, and first responders. If you are thinking about a great way to honor and thank them, Dr. Will Miller has an answer. A nationally recognized expert on coping with stress and living a high quality of life, Dr. Miller has 25 years experience as a psychotherapist, teacher, and author. In addition, Will was a nationally touring headline stand-up comedian for 17 years in New York City. His presentation is rich in content based on the latest social science research, and has practical application but also brings the fun! 9:15 a.m. 10:15 a.m. The Impact of a Targeted CDI Intervention on the Documentation Patterns of Surgery Residents: Can They Improve? David R. Jeffcoach, MD; Trey A. La Charité, MD Clinical Evidence Queries: Tips, Tricks, and Caveats Millie G. Alexander, RN, BS, CCDS Reviewing PSI 90: The Untold Story Mark LeBlanc, RN, MBA, CCDS; Sherri Wacha, RN, CCDS Welcome to Munchkin Land: The World of Pediatric CDI Tamara Ashley Hicks, RN, BSN, MHA, CCS, CCDS, ACM, AHIMA- Approved ICD-10-CM/PCS Trainer; Melinda B. Matthews, RN, BSN, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer Page 3 of 7

4 Resident physicians, especially surgery residents, are an untapped resource in many institutions. Often, these physicians productivity is limited not by a lack of desire but a lack of education and experience in CDI. At the conclusion of the presentation, attendees will be able to describe a training model that yields impressive results and can be reproduced within their own institutions. This session will include an in-depth look at how to write clinical evidence queries. The speaker is a former RAC auditor with experience denying diagnoses based on lack of clinical evidence, and a Potentially Preventable Condition (PPC) consultant with the goal of validating conditions POA, not POA, and not clinically supported. CDI has always been the concurrent reviewer of inpatient charts, and CDI specialists are thus often asked to add more work to their review besides accurate coding capture. This session will show how PSI/HAC review can be incorporated into the review process with little impact on productivity but a huge effect on the bottom line. This session will discuss successful strategies for implementing a pediatric CDI program as developed at a children s hospital designated as a level one pediatric trauma center. The discussion will include how to adjust an adult CDI program and transform it into a successful pediatric-focused program; tools to establish, improve, and maintain physician buy-in; and meaningful metrics to demonstrate successful implementation. Level : Basic Level : Intermediate Level : Intermediate Level : Intermediate 10:15 a.m. 11:00 a.m. 11:00 a.m. 12:00 p.m. EHR Documentation and CDI: What to Expect and How to Successfully Handle the Transition Sam Antonios, MD, FACP, FHM, CCDS from MedeAnalytics: $50 Visa gift card Go After the Truth, the Clinical Truth That's What Matters at the End of the Day! Kelli A. Estes, RN, CCDS; Cesar A. Limjoco, MD Motivating Your Medical Staff: Leveraging the Medicare Physician Value- Based Payment Modifier Richard D. Pinson, MD, FACP, CCS Expansion of CDI Into the Postacute Setting Timothy N. Brundage, MD, CCDS; Wendy De Vreugd, RN, BSN, PHN, FNP, CCDS, MBA; Genevir del Mundo, CDIP, CCS, AHIMA- Approved ICD-10-CM/PCS Trainer; Kimberly A. Klem, RN, MSN, NE-BC Going to electronic documentation in your EHR? Get ready it's a new world. This session will explain what to expect, how to prepare, and how you will benefit from the opportunities of EHR while overcoming its challenges. Included are best practices for managing the problem list and the diagnosis list, copy-paste and cloned notes, and available vocabularies such as ICD-9, SNOMED, and IMO. This session is intended to encourage an alignment between CDI specialists and coders to understand the need for capturing conditions based on the clinical truth instead of jumping at indicative numbers. This session will employ clinical examples and consider circumstances that do not necessarily support clinical conditions such as ABLA, hyponatremia, malnutrition, or AKI. Medicare has implemented both hospital and physician value-based initiatives that reward or penalize based on quality of care provided; these initiatives are highly dependent on accurate and complete documentation. This session will provide the learner with knowledge of Medicare's physician VBPM to successfully leverage physician motivation to provide complete and precise documentation terminology. Level : Intermediate Level : Intermediate Level : Intermediate Level : Advanced 12:00 p.m. 1:30 p.m. 12:30 p.m. 1:30 p.m. CDI is expanding beyond the short-term acute care environment into postacute settings. Hear from a representative of a long-term acute care hospital (LTACH), a physician, and a CDI in an inpatient rehab facility (IRF) about their interdisciplinary approach to documentation integrity and CDI across the spectrum of care. This session will include discussion on the postacute benefits of a CDI program, the reimbursement methodologies of the LTACH and IRF settings, and targeted CDI opportunities in each. Boxed lunch - provided (Exhibit Hall A, Street Level) from Addison Group: Coach TM purse from FTI Consulting Health Solutions: Gift basket of wine and gourmet foods, plus a copy of AHIMA s book, Clinical Documentation Improvement: Achieving Excellence Join us for dedicated poster session viewing (Exhibit Hall A, Street Level) Page 4 of 7

5 1:30 p.m. 2:30 p.m. Revenue Cycle: Overview and Its Relationship to CDI Adelaide M. La Rosa, RN, BSN, CCDS, AHIMA-Approved ICD-10- CM/PCS Trainer and Ambassador; J. Peter Savini, BA, MHA The Emergency Department: How CDI in the ED Is Crucial to a Successful CDI Program Victor Freeman, MD, MPP Creating and Using an Effective Pre-Billing Review to Identify PSIs Mary McGrady, MSN, RN, CCDS; Murali K. Nagarajan, CCS, MB, BS Pediatric Surgical Documentation Specificity for the ICD-10-Enabled Organization: How to Minimize the Effects of ICD-10-PCS John P. Glatthorn, BSBA CDI specialists need to learn how to talk the talk not only with the clinical team but also the financial team to further advance their role in the healthcare industry. This session will define key roles and components of the revenue cycle and CDI s place within it, as well as opportunities for performance improvement and working in tandem with denial management. Hear the lessons learned from a CDItrained physician who spent four days researching CDI issues in an ED in order to teach effective documentation to ED physicians. Included in the session are an explanation of the need for evidence-based diagnostic criteria in the ED, why sepsis, acute renal failure, and acute respiratory failure are so poorly documented in the ED, and why capturing these diagnoses is critical for ensuring/promoting diagnosis capture in the rest of the record. This session is a detailed case study on using CDI to recognize potential PSIs during concurrent review. Participants will gain an understanding of inclusion and exclusion criteria for PSIs and a process for partnering CDI with quality initiatives; they ll also develop tactics for writing queries related to PSI clarification. Level : Basic Level : Intermediate Level : Intermediate Level : Intermediate 2:30 p.m. 3:15 p.m. 3:15 p.m. 4:15 p.m. Problems Solved! Using the EMR to Improve Accuracy and Obtain Supporting Documentation With the Problem List Mary Kay Brooks, RN, MSN, CPHQ Did You Take All of That Out? : Preparing Surgeons for ICD-10-PCS Documentation Requirements Cheree A. Lueck, RN, BSN; Gwen S. Regenwether, BSN, RN Panel Session : Quality and CDI Moderator: Shelia A. Bullock, BSN, MBA, CCDS, CCS, CAHIMS, CCM This session will focus on how to leverage your EHR when reviewing and amending operative notes to meet ICD- 10-PCS needs. While most lectures of this sort focus exclusively on root operations and their effectiveness in pediatrics, this talk explores the root operations as they relate to the coderclinician language barrier in the pediatric space, and how you may not be as far from a PCS code as you might think. A Full-Time Physician Advisor Program From Zero to Sixty: Exploration, Development, Test, and Execution Donald A. Butler, RN, BSN; Vaughn M. Matacale, MD An inaccurate and nonspecific problem list can result in headaches for coders, nurses, and physicians. The University of Iowa embarked on a project to establish guidelines and structure for its inpatient problem list that resulted in improved documentation and coding for these conditions. from Optum360: Two drawings each for a Tiffany & Co. necklace from Harmony Healthcare: ipad This session describes how ICD-10- PCS implementation can impact your facility s cash flow. You will be able to pinpoint your vulnerabilities, organize an educational plan of action for your surgical staff, and collaborate with coding professionals and interdisciplinary team members. You ll return to your facility with the tools to create accurate procedural documentation and billing. This special panel session includes a roundtable discussion on CDI and its overlap with quality improvement initiatives and its impact on quality metrics, followed by an extended Q&A session with the audience. A moderator will lead the discussion with six panelists. Level : Intermediate Level : Intermediate Level : Intermediate Level : Basic This session will describe the development, trial period, analysis, model proposal, and execution for a fulltime physician advisor (PA) program at a tertiary medical center. It includes what one can expect from a PA program, how to build the case for approval, and how to go about getting it done. Page 5 of 7

6 4:15 p.m. Sessions adjournment 4:30 p.m. 5:30 p.m. 7:00 a.m. 8:00 a.m. 8:00 a.m. 9:00 a.m. No Orientation Manual Needed Oh Wait, That s Not True: The Struggle and the Triumph of Orienting a New CDS Natalie Esquibel, RN, BSN, CCDS; Rachel Mack, BA, RN, MSN, CCDS, CDIP Coding of Complications: Past, Present, and Future Kyra E. Brown, RHIA, CCS, AHIMA-Approved ICD-10-CM/ PCS Trainer Prepayment Review: Is Your Organization Prepared? Mark Michelman, MD, MBA Medical Necessity: What CDI Departments Need to Understand About Patient Status Kimberly A. H. Baker, JD, CPC; Cheryl E. Ericson, RN, MS, CCDS, CDIP, AHIMA-Approved ICD-10-CM/PCS Trainer You ve hired a new CDS now what? Boot camp? On-the-job training? Good luck, figure it out? This session will detail the benefits of having a CDI educator instruct a new CDS one on one with an orientation manual to get him or her on track to high performance within three months of hire. Understanding the issues related to coding and documentation of complications can be a challenge. This session will address issues that lead to high complication rates and will focus on documentation tips to assist in physician, coding, and CDI staff education and promote accurate complication rates. It will include AHRQ and Coding Clinic references. Prepayment review is a CMS eightstate pilot that allows your fiscal intermediary up to 60 days to review a claim for payment. If the hospital payment is denied, any physician payment will be recouped. This speaker has two years of experience with the pilot and will provide strategies to promote collaboration between hospitals and their respective medical staffs. Level : Basic Level : Intermediate Level : Advanced Level : Intermediate 9:15 a.m. 10:15 a.m. Special Session : CCDS FAQ (Room 204, Concourse Level) This session is an informational opportunity for people to learn more about the CCDS exam and the associated requirements and qualifications. All who are interested in pursuing certification are welcomed. Thursday, May 21, 2015 DAY 3 Continental breakfast (Exhibit Hall A, Street Level) from ACDIS: CDI Boot Camp from ACDIS: Loyal Listener Library 6-pack of webcasts from ACDIS: 1 seat to the 2016 ACDIS Conference from CDI Search Group: Surprise giveaway from ChartWise Medical Systems Inc.: Apple Watch TM from ACS: $100 gift card Many organizations struggle with the changing regulations differentiating an inpatient claim from an outpatient/observation claim, which can lead to medical necessity denials when billed incorrectly. This session will review the key elements required to support an inpatient admission as well as the impact of provider documentation, which affects principal diagnosis assignment and can make a claim more vulnerable to medical necessity denials. Pediatric CDI: Medicare Risk Using Metrics and Data Lessons Learned From How Do Quality Adjustment, the New Payment Analytics to Support CDI a Tertiary, Freestanding Factors Really Affect Methodology: What Your Current and Future States Children's Hospital Hospital Payments? Physicians Need to Know Andrea J. Eastwood, RHIT, BAS; Jodi P. Carter, MD; Mary Ellen Kimberly A. H. Baker, JD, CPC Trey A. La Charité, MD; Lynn H. Judy Moreau, RN, MBA Fee, RN, CCDS; Nancy C. Rush, Lowery, CPC, CFPC RN, BSN, CCM Page 6 of 7

7 This case study will take you on a journey of standardization and consolidation, utilizing benchmarks and metrics to drive CDI performance across a healthcare system. The speakers will share their vision of the role of CDI and their preparations for migrating from a fee-for-service to a population health payment model. It will also discuss the speakers use of technology and lessons learned to improve CDI productivity and effectiveness. This session will demystify the quality provisions that affect hospital payment, with a focus on understanding how the provisions operate and the actual dollar impact they have on payment at a hospital. A case study will be used to demonstrate the free government pricing tool, including how it can be used to calculate payments and see the impact of the quality adjustments, or changes to the DRG, for specific cases at your hospital. Healthcare reform is rapidly changing. Payers increasingly want to reimburse providers for outcomes of care as opposed to fee for service. Primary care physicians now need to be the focus of your CDI efforts in the outpatient setting. This session will include HCC reporting and missed opportunities for capturing HCCs with strategies for success. The Phoenix Children's Hospital CDI program began in 2011 and has since become nationally recognized for its successes. After attending this session, learners will be able to describe topperforming pediatric queries, understand queries unique to the pediatric surgical and ICU populations, and identify opportunities to increase pediatric SOI and ROM. Level : Intermediate Level : Basic Level : Intermediate Level : Intermediate 10:15 a.m. 10:45 a.m. 10:45 a.m. 11:45 a.m. Outpatient CDI: Tools to Get Started Lisa A. D. Lanier, BS, CCS Beyond the Numbers: What Laboratory Values Mean for CDI Specialists Verona A. Lodholz, DC, MT(ASCP), CPC, CCDS Coming to a Hospital Near You: UHC Mortality Reviews Based on Actual Events Jennifer Roberts Love, RN, BA, CCDS, CDIP Panel Session : CDI and the Revenue Cycle Moderator: Walter Houlihan, MBA, RHIA, CCS, FAHIMA If you are interested in expanding your traditional inpatient CDI program into the outpatient side, this session will help get you started with takeaway tools and common areas of focus. You ll leave with a better understanding on how to determine the need for OP CDI at your facility and the components of an OP CDI program. The session will cover ensuring medical necessity for common outpatient services, including improving documentation to secure diagnoses needed to support diagnostic tests and procedures performed in the ED and clinic setting. from MedeAnalytics: $50 Visa gift card Understanding laboratory results enhances the CDS's ability to provide concise and accurate queries and increases confidence when interacting with providers. The session will review the various laboratory sections and case studies, allowing participants to test their understanding of the materials presented. Lab sections covered will include hematology, coagulation, transfusion services, chemistry, and microbiology. UHC mortality reviews are a new and interesting area where CDI professionals can make an impact. This presentation will discuss common diagnoses seen in mortality reviews. The speaker shares how to capture this documentation while entertaining and captivating you with personal stories related to the case studies provided. Level : Basic Level : Intermediate Level : Intermediate Level : Basic This special panel session features a roundtable discussion on how CDI fits into the hospital revenue cycle, including best practices for CDI integration and positioning, followed by an extended Q&A session with the audience. Coding, compliance, and CDI representatives will be on the fivemember panel. 11:45 a.m. Conference adjournment Obtain your CEUs online In order to receive your continuing education certificate(s), you must complete the online evaluation at within two weeks of the program. Page 7 of 7