Hospital Transformation Consortium Clinical Documentation Improvement Series Four Key Roles for CDI: CDI Specialist

Transcription

1 Hospital Transformation Consortium Clinical Documentation Improvement Series Four Key Roles for CDI: CDI Specialist Presented by Rae Freeman, HCCS and Dr. James Dunnick, The Dunnick Group 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.

2 Hospital Transformation Consortium WEBINAR ETIQUETTE All attendees are in Listen Only mode Questions or comments? - Open Questions pane in dashboard. - Type in comments or questions. - Comments & questions will be monitored and addressed!

3 Hospital Transformation Consortium WEBINAR RESOURCES This webinar will be recorded and ed to you to share with others on your team. Handouts are available for download in the Handouts pane and will posted on your Dashboard

4 Hospital Transformation Consortium CONTINUING EDUCATION 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. In order to obtain these units, you must: Attend webinar/view recording in its entirety within 30 days Pass online quiz with 80% or better. Complete webinar evaluation. Following this webinar, all attendees who have viewed the recording in its entirety will receive an with a link to the quiz and evaluation. Anyone that misses the webinar can view the recording online, posted on the program Dashboard, for CEUs.

5 Hospital Transformation Consortium 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 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 Private Sector National Association of Social Workers National Board for Certification in Occupational Therapy, Inc. (NBCOT) National Council for Therapeutic Recreation Certification National Registry of Emergency Medical Technology (EMT) National Registry of Microbiologists National Society of Professional Engineers Society for Human Resources Management State of Georgia, FL and Iowa Board of 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 Occupational Therapy (NBCOT)

6 Hospital Transformation Consortium ACTION ITEM: GROUP PARTICIPATION Are you on this webinar with a group? If so, please enter: first/last names and addresses of those in attendance with you in the Questions Pane.

7 Clinical Documentation Improvement Series AGENDA 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

8 Clinical Documentation Improvement Series Program Goals 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.

9 Clinical Documentation Improvement Series What you Told Us We have a Clinical Documentation Improvement (CDI) program in place: Consortium Pre-Assessment Survey Results

10 Clinical Documentation Improvement Series 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

11 Clinical Documentation Improvement Series What you Told Us Which of the following best describes the training/certification of your coding/cdi team? Consortium Pre-Assessment Survey Results

12 Clinical Documentation Improvement Series 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

13 Clinical Documentation Improvement Series Trainer Biography Rae Freeman, RHIA, CDIP, CCS-P Senior 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.

14 Clinical Documentation Improvement Series Disclosure of Proprietary Interest 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.

15 CLINICAL DOCUMENTATION IMPROVEMENT SERIES: Four Key Roles for CDI: CDI Specialist Presented by Rae Freeman RHIA, CDIP, CCS-P Senior Manager Consulting Healthcare Coding and Consulting Services (HCCS) 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).

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 Consulting Healthcare Coding and Consulting Services (HCCS) 2017 Healthcare Coding & Consulting Services 16

17 Learning Outcomes 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 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 2017 Healthcare Coding & Consulting Services 17

18 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 2017 Healthcare Coding & Consulting Services 18

19 Four Key Roles in CDI CDI Specialists Physicians Nurses Scribes 2017 Healthcare Coding & Consulting Services 19

20 Working Together Physician Nurse Patient CDI Specialist Scribe 2017 Healthcare Coding & Consulting Services 20

21 Implementing a CDI Program Staffing the program 2017 Healthcare Coding & Consulting Services 21

22 Implementing a CDI Program Physician Training Training Non-Physician Clinicians and CDI Program Staff 2017 Healthcare Coding & Consulting Services 22

23 Implementing a CDI Program Physician Queries Compliance 2017 Healthcare Coding & Consulting Services 23

24 Defining a CDI Program Mission Goals Monthly Quarterly Annually 2017 Healthcare Coding & Consulting Services 24

25 Defining a CDI Program Regulations Ethical Standards Workflow 2017 Healthcare Coding & Consulting Services 25

26 Models for CDI Programs Single Hybrid 2017 Healthcare Coding & Consulting Services 26

27 Ethics Ethical Decisions 2017 Healthcare Coding & Consulting Services 27

28 CDI Basics Role of CDI professional Documentation 2017 Healthcare Coding & Consulting Services 28

29 CDI Basics Chart Review Prioritizing 2017 Healthcare Coding & Consulting Services 29

30 CDI Program When Coding is Outsourced Remote Support On-site Support 2017 Healthcare Coding & Consulting Services 30

31 CDI Program Benefits Accurate patient severity POA documentation 2017 Healthcare Coding & Consulting Services 31

32 CDI Program Benefits Improves bill hold days Reduce post-discharge queries 2017 Healthcare Coding & Consulting Services 32

33 CDI Program Benefits Improves Communication Lessen compliance concerns Reduce anxiety for audits 2017 Healthcare Coding & Consulting Services 33

34 Outpatient CDI 1 Plan 2017 Healthcare Coding & Consulting Services 34

35 Outpatient CDI 2 Review 2017 Healthcare Coding & Consulting Services 35

36 Outpatient CDI 3 Monitor 2017 Healthcare Coding & Consulting Services 36

37 CDI Positive Impacts Documentation Report Cards Quality of Care Financial Benefits 2017 Healthcare Coding & Consulting Services 37

38 CDI Positive Impacts Patient Quality Compliance Financial 2017 Healthcare Coding & Consulting Services 38

39 CDI Best Practices Vision Education Tools Phys Education Feedback Teamwork P / P Query 2017 Healthcare Coding & Consulting Services 39

40 ACTION ITEMS & COLLABORATION PUT EDUCATION INTO ACTION ACROSS YOUR SYSTEM

41 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 2017 Healthcare Coding & Consulting Services 41

42 Resources AHIMA - Clinical Documentation Improvement: Achieving Excellence Healthcare Coding & Consulting Services 42

43 Value Quality T H A N K Y O U F O R Y O U R T I M E WE W E L C O M E ALL Q U E S T I O N S info@hccscoding.com Healthcare Coding & Consulting Services 43

44 Learning Outcomes 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 : 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 2017 Healthcare Coding & Consulting Services 44

45 DOCTOR S NOTES Thoughts from a Physician

46 Clinical Documentation Improvement Series Trainer Biography 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).

47 THE DUNNICK GROUP Helping hospitals meet the demands of cost, care, and compliance.

48 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.

49 WHY BE COMPLIANT CMS processes approximately 5 million claims Per day OR 1.8 billion per year 210,000 per hour 49

50 CMS PAYMENTS 2015 Federal Budget 1. MC/MC 24% 1. SS 24% 3. Defense 16% 50

51 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

52 Medicare is in Trouble The Government is not kidding about cost containment. 52

53 AN AUDIT TEST QUESTION Question: 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

54 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

55 ECONOMIC PENALTIES Entity $ Amount Fined One Hospital 13,000, Physical Therapist 2,400, Physiatrist 1,500, ENT 750, Family Practice Physician 162, Dentist 84,00.00 Cardiologist Coders Charged CIA, Fined

56 THE PHYSICIAN RISK 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

57 THE HOSPITAL 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

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

59 KNOW THE RULES SOI WCC W/O CC MCC W/O MCC LOS COC CMI DD 59

60 KNOW THE RULES Three key E/M components A. History 1. History present illness 2. Past medical family social history 3. Review of systems B. Physical Exam Body Parts or organ systems General or specialty specific C. Medical Decision Making 1. Problem points 2. Data points 3. Risk

61 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 and bill a 99213? What is the difference between a consult and a referral?

62 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?

63 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?

64 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.

65 COMPLIANCE The Cost of Non Compliance is Too Much. Therefore accept the cost of compliance We must understand the rules; they will be applied.

66 WHAT S COMING? Title: Why be compliant-what s in it for me? August 15, 2017 By: The Dunnick Group. With Hometown Health University

67 UPCOMING EVENTS & RESOURCES Hospital Transformation Consortium

68 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).

69 CONSORTIUM TRAINING Clinical Documentation Improvement (CDI) Series presented by HCCS, The Dunnick Group, LLC, & HTH Join 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

70 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 Sept. 26, 2017: Annual ICD-10 Updates, Complex Coding Scenarios January 30, 2018: CPT 2018 Updates March 27, 2018: Facility Coding E&M Webinar Training Webinar Training Webinar Training Webinar Training

71 CALENDAR OF EVENTS View your Program Dashboard GA/FL: IA: Both are password protected: contact Jennie Price at if you need your Dashboard password!

72 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

73 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!

74 Questions? Questions about these resources or Upcoming Events? Contact: Annie Lee Sallee or Jennie Price, SHIP Program Manager