Clinical Documentation Improvement Summit: Advancing the Documentation Journey. July 31 August 1, 2017 Washington, DC

Transcription

1 AGENDA Clinical Documentation Improvement Summit: Advancing the Documentation Journey July 31 August 1, 2017 Washington, DC MONDAY, July 31, 2017 Time 7:30 8:30 a.m. Registration 8:30 8:45 a.m. Welcome/Opening Remarks Marina Kravtsova, RHIA, CDIP, CCS 2017 CDI Summit Program Committee Co-Chair 8:45 9:45 a.m. Keynote Transforming Query Delivery and Tracking with Mobile Technology for Providers The audience will walk away from this talk with the knowledge of an emerging technology in the CDI and coding space. They will gain perspective on creating faster and easier query workflows supported by technology to enhance provider satisfaction, query response rate, and query response time. Better tracking and reporting of query activity data can enable targeted educational opportunities for both providers and CDI and coding staff. The audience will learn how the role of CDI will evolve with the elimination of query follow-up activities and a stronger focus on targeted education and quality metrics. And finally, they will understand how innovative technology platforms can facilitate seamless collaboration between CDI and coding to ultimately reduce queries to the provider. Dr. Melinda Kantsiper, and Teri Gruenberg, RN, Johns Hopkins Howard County General Hospital 9:45 10:45 a.m. Keynote Clinical Case Studies to Illustrate Documentation Nuances, Query Opportunities, and MS-DRG/APR-DRG Analyses This presentation offers perspectives from a physician and from a coder, with respect to nuances inherent in clinical documentation. Complex clinical case studies encompassing several medical specialties will be utilized as a teaching tool to illustrate the complexity of clinical documentation improvement and the apparent disconnect between the clinical language and the ICD-10-CM/PCS code sets. Each case study will include a discussion of evidence-based queries, as well as an analysis of the working and target MS-DRG, APR-DRG and SOI/ROM scores, in order to illustrate the impact of documentation nuances on inpatient reimbursement. In addition, each case study will include a discussion of capturing appropriate ICD-10-CM and ICD-10-PCS codes, so that the target MS-DRG and APR-DRG can be validated by a third party. Insight will be provided for non-clinically trained coders to effectively analyze clinical documentation and to encourage career expansion into the CDI realm. This interactive presentation will include questions and answers for each clinical case study. This presentation is tailored toward physicians, nurses, clinical documentation improvement 1

2 specialists and coders. 10:45 11:15 a.m. Networking Break Dr. Wilbur Lo, CDIP, CCA, AHIMA-Approved ICD-10-CM/PCS Trainer, Jzanus Consulting, and Melissa Koehler, RHIT, CHDA, CDIP, CCS, CCS-P, AHIMA-Approved ICD-10-CM/PCS Trainer, M*Modal 11:15 a.m. 12:15 p.m. TRACK 1 Program Improvement and Leadership 12:15 1:30 p.m. LUNCH Jumpstarting an Established CDI Program Managers, directors, and executives of CDI will learn how SCL health transitioned to a high-performing, well-respected CDI program. It will offer a perspective on how to approach jumpstarting an existing CDI program by assessing and measuring the various components of a program then leveraging that information to establish strategies. Breaking down the high level strategies into manageable tasks to move the program forward will be discussed including challenges and how they were overcome. Sandy Pearson, MHA, RHIA, CHDA, SCL Health 1:30 2:30 p.m. TRACK 1 Program Improvement and Leadership Building Stronger CDI Leaders across the Enterprise The audience will have the opportunity to build its CDI leadership skills. They will hear about problematic areas where directors should focus their efforts to ensure their CDI programs are effective and efficient. Participants will be able to take usable tools back to their organizations. Judy Moreau, RN, BMA, and Andrea McLeod, RHIT, BAS, Trinity Health 2:40 3:40 p.m. TRACK 1 Physician Documenting to Reduce Denials TRACK 2 Beyond Inpatient CDI Outpatient CDI: Practical Lessons Learned in an ED Assessment Attendees will hear the real-life experiences of experienced CDI consultants as they pioneered a documentation improvement assessment in the emergency department setting. Discussion topics will include pre-assessment expectations, actual findings and review variations between what we expected and what the actual findings revealed. Presenters will discuss challenges to implementing CDI in nontraditional outpatient practice settings and highlight similarities and differences in the use of documentation improvement strategies in alternative settings. Betty Stump, MHA, RHIT, CCS-P, CDIP, CPC, CMPA, and Stephanie Cantin-Smith, RN, MSN, CCDS, Optum360 Consulting TRACK 2 Beyond Inpatient CDI Risk Adjustment and Quality Measures for Outpatient CDI Programs This fast-paced presentation offers new CDI solutions that incorporate technology to enhance critical thinking skills and efficiencies of CDI practitioners. Learn how analysis of your coded data can assist in improving Quality Payment Program performance, provider/cdi/coder education program, reducing the ever-increasing payer denial rates and maintaining and improving the facility A/R and DNFB. Pamela Hess, MA, RHIA, CCS, CDIP, CPC, Himagine Solutions, Inc., and Michael Marron- Stearns, MD, CPC, CFPC, Apollo HIT TRACK 2 Coding/CDI Synergy DRG Reconciliation: Improving Collaboration between CDI and Coding

3 The audience will benefit from the multiple years of CDI and physician-to-physician education provided by Dr. Brundage. Dr. Brundage is a clinician hospitalist in addition to being a CDI expert. The clinical information combined with the ICD-10 coding language as well as action words will improve the physician s understanding of documentation that will reduce the risk of denial at audit. Timothy Brundage, MD, CCDS, Brundage Medical Group A DRG reconciliation program that identifies and resolves inconsistencies in MS-DRG assignment between CDI specialists and coders is critical to achieving revenue cycle success under ICD-10. DRG reconciliation also helps ensure the accuracy of quality outcomes data under value-based care. This presentation will provide an in-depth analysis of DRG reconciliation best practices, including methods for improving collaboration between CDI specialists and coders. Using a case study example of one healthcare system, the presenters will detail an effective approach to pre-bill DRG audits, including discussion of the challenges, organization objectives, process redesign efforts, staff education initiatives and lessons learned. Kristen Bates, MBA, RHIA, CCS, CDIP, University Hospitals Case Medical Center, Audrey Howard, RHIA, 3M Health Information Systems and Susan Belley, MEd, RHIA, CPHQ, 3M Health Information Systems 3:40-4 p.m. Networking Break 4 5 p.m. TRACK 1 Physician Revolutionizing the Clinical Encounter: It s About Time Gain a fact-based appreciation of the impact current EMRs have had on physician practice, the first step to a solution. Consider solutions that match talent and training to the required duties. Identify technology and services that maximize the EMR investment and achieve the true potential of their EMR. Be equipped to demonstrate leadership in their organizations to improve physician and patient satisfaction and reduce accounts receivables. TRACK 2 Coding/CDI Synergy Benefits Realization from Collaboration: Embracing and Integrating the Focus on Clinical Data Integrity This presentation will prepare you to evaluate the critical success factors in your life to bring you and your organization to the next level of preparedness for linking clinical documentation integrity to reimbursement. Bonnie Cassidy, RHIA, nthrive Christina Meyers, RHIA, and Sandra Fuller, MA, RHIA, ecatalyst Healthcare Solutions Day AHIMA CEUS and 6 CNES

4 TUESDAY, August 1, 2017 Time 7:30 8 a.m. Registration 8 9 a.m. Keynote The Doctor and the EHR: Diagnostician or Document Manager A discussion of challenges and solutions for EHR usability from the perspective of a practicing physician will allow the audience insight into how EHRs might better serve the needs of the user and ultimately the patient. Recommendations for team documentation, software, and hardware efficiencies will be discussed. Opportunities to diminish the regulatory burden will be presented. Dr. Marie T. Brown, FACP, American Medical Association, Senior Physician Advisor, Physician Satisfaction and Practice Sustainability 9 10 a.m. Keynote-Clinical Documentation Improvement as a Response to Federal Recoupment Initiatives Attitudes about healthcare delivery are changing, but some attitudes about compliance aren't. This lack of attitudinal change is apparent in some healthcare enterprises that have not embraced the holistic view of clinical documentation improvement as something more than a way to increase revenue by better coding. Effective clinical documentation improvement efforts touch discharge planning, utilization review, revenue cycle, and a healthcare institution's compliance burden. This seminar will weave these various narratives together to make the case for CDI as a key part of a facility's compliance program and why the HIM professionals in the facility need to lead the charge. Barry Herrin, JD, CHPS, FAHIMA, FACHE, Herrin Health Law 10 10:30 a.m. Networking Break 10:30 11:30 a.m. TRACK 1 Physician Medical Residents as Key Players in Documentation Medical residency is the culmination of medical school and the start of one's medical career. It is also the time when medical residents most affect clinical documentation and vice versa. By understanding the challenges of a medical resident experience and being able to work with the resident through these challenges, a partnership is formed between the clinical TRACK 2 Clinical Validation Clinical Validation: What Does It Mean for Coders? With changes to the 2017 Official Guidelines for Coding and Reporting, numerous questions have come up to the meaning and intent of Coding Guideline A.19. The who, what, and where of demonstrating compliance to this new coding guideline are complex. Healthcare providers must continue to optimize clinical documentation integrity with improved strategies. Coders, CDI staff, coding managers, and other staff will benefit from this session by

5 documentation improvement program and the medical residents. Let's take a look at the life of residents and the key players who shape future doctors as well as examine the influence of CDI, which ultimately can affect how they assimilate clinical documentation in their future careers. learning how to validate code assignment with clinical documentation. Six high-risk, highvolume diagnoses are examined with real life examples of clinical validation payer denials and how appeal decisions can be influenced with physician documentation. Emphasis is on the crucial role of coders in this complex but essential undertaking. 11:30 a.m. 12:30 p.m. LUNCH Dr. May Ladrillono, MBA-HM, CDIP, Stanford Healthcare 12:30 1:30 p.m. TRACK 1 Physician Out of the Darkness into the Light: A Surgeon s Perspective on Physician Engagement in the CDI World Studies show that more than 75 percent of clinical documentation specialists surveyed reports that physician engagement is the most pressing need of their CDI program and nearly all reported deficiencies in their provider s documentation. Why is it sometimes so hard to get the providers to be on your side? This presentation from a surgeon who moved into the administration world, and from there into the CDI Physician Consultant arena, will provide insights into what makes a physician feel as they often do and how to turn them around so they perceive the CDS to be an integral member of their team the one who helps them 'get it right' when it comes to using the words that give them credit for what they are already doing. Learn how to gain their interest in accurate and specific documentation and how to leverage that into a partnership that will move your facility to where it needs to be in the world of healthcare documentation and metrics. Dr. Daniel Catalano, SMRT Doc Consulting, Inc 1:40 2:40 p.m. TRACK 1 CDI in Specialty Areas Tale of 2 ACOs: Deploying Centralized CDI Model across ACO Physician Practices Laura Legg, RHIT, CCS, CDIP, AHIMA- Approved ICD-10-CM/PCS Trainer, Healthcare Resource Group TRACK 2 Clinical Validation Clinical Validation: The Real World This session will clarify the confusing, complicated, and controversial subject of clinical validation and how CDI programs can compliantly reconcile the conflict that exists between the 2017 Official Coding Guidelines and statutory/regulatory requirements. Dr. Richard Pinson, FACP, CCS, Pinson and Tang, LLC TRACK 2 Regulatory Hot The Role of Risk Adjustment in Value-based Purchasing

6 Through the learnings of two ACOs case studies, the audience will benefit from discovering the actionable ways in which audience members can integrate a centralized model for clinical documentation improvement within an ACO. Kimberly Hopey, PhD, RN, and Stacey Torturica, CPC, CPMA, CRC, AAPC Fellow, Nuance Communications, Inc. As the Center for Medicare and Medicaid Services rapidly transitions from a fee for service to a value-based purchasing payment model, risk adjustment will have a greater impact on payment and provider cost and quality outcomes and comparisons. From this session, the audience will gain a greater awareness of what risk adjustment is, why it is used, what VBP cost and quality measures are impacted, and how. We will review strategies for leveraging current clinical documentation and coding programs to improve patient risk scores and mitigate compliance risk. The audience will take away the basic operational guidelines to help clinical documentation improvement specialists and coders lead their organizations to success with risk adjustment methodologies across multiple settings, populations and quality and cost measures. Angela Carmichael, MBA, RHIA, CDIP, CCS, CCS-P, CRC, Cache Health Information Management Services 2:40-3 p.m. Networking Break 3 4 p.m. TRACK 1 CDI in Specialty Areas Pediatric Diagnosis Specificity: Distilling Diagnoses to Their Core Attributes Making CDS Communication to Physicians Concise and Consistent CDI professionals and physicians alike are often confronted with the problem of not knowing how much detail is codeable or useful for a given diagnosis. This is especially true in the pediatric space where conflicts between pediatric and adult specificity can create confusion. In this session you will learn how to distill a family of pediatric diagnoses into a concise list of criteria that can be distributed to a wider audience. This session will focus on those pediatric specialties and diagnoses that exhibit the highest opportunity for enhancement and contrast them against those creating adult versus pediatric issues. Attendees can expect to leave with a TRACK 2 Regulatory Hot Coding vs. Auditing: Does It Boil Down to Medical Necessity? CMS states that medical necessity must be the overarching criterion, which means that all individuals that work in the healthcare industry from the data entry clerk to the physician should understand the concepts, principles, and measuring sticks that are necessary to ensure services reflect the needed necessity. This session will not only convey this to the attendees but provide the take-away steps of how to ensure proper development and implementation within their own team. Shannon DeConda, CPC, CPC-I, CPMA, CMSCS, CEMC, CMPM, NAMAS/DoctorsManagement

7 concrete toolkit for diagnosis specificity enhancement in the pediatric space. John Glatthorn, SMRT Doc CDI Consulting Day AHIMA CEUS and 6 CNES Agenda as of 5/23/17