by Katy Rushlau

It’s hard to believe that CDI Week has come and gone. The week-long event is something we work on for months—selecting the theme, planning activities, creating graphics and materials, and spreading the word on social media to get CDI professionals excited for the celebration. I personally spend most of my summer preparing the materials and events, and, while it’s a relief when it’s over and everything has gone smoothly, it’s still a little sad knowing I’ll have to wait another year to celebrate with you all again. 

I am always amazed at how engaged our community is during CDI Week. Dozens of facilities and local chapters organized their own celebrations and recognitions. One facility hosted a team party complete with ACDIS-colored cupcakes and a photo booth. Another facility handed out “ring pops” (lollipop rings) with little notes that said “thank you for your engagement.” It’s incredible to see how our local members and CDI communities come together to mark the occasion and embrace our theme, CDI in Concert: Your Ticket to Collaboration.

Numbers-wise, this year’s CDI Week was one for the record books.

• The ACDIS website was viewed more than 42,000 times
• 7,800 engaged with us on Facebook
• 2,000 people attended our free webcast
• 100 people entered our social media giveaway
• 50 teams submitted their photos

If you haven’t already, be sure to download a free copy of our Industry Overview Survey and our daily Q&As. I want to thank you all for celebrating with us and making last week so much fun. And special congratulations to our contest winners Kim Seery, Kristin Haley, Tamara Kicks, Claudine Hutchinson, Jeanne Jacobs, Cara Belnap, and Betty Bogda. 

by Brian Murphy

One of the (many) great things about our ACDIS members is their level of passion and commitment for their profession and this association. If you’ve ever been to an ACDIS conference, read one of our popular “Meet a Member” profiles in the CDI Journal, or attended a local ACDIS chapter meeting, you’ve certainly experienced that energy and enthusiasm first-hand.

Many members are looking for the next step and hoping to get involved on a deeper level with ACDIS, to make changes that have an effect not just on themselves professionally, or even locally, but on a broader, national level.

I’m pleased to say that the opportunity is in front of you, should you choose to accept it. ACDIS has several openings for boards and committees. We are seeking passionate volunteers who want to make a difference by serving the ACDIS membership and helping to improve the broader CDI profession. Take a look at our opportunities below, find the best fit, and apply!

ACDIS Advisory Board: The ACDIS Advisory Board is responsible for providing leadership, expertise, and an industry voice for the ACDIS membership. It is ACDIS’ most prestigious board. Click here to view its qualifications, responsibilities, and the nomination/election process.

Please note that for 2017 we will accept RN-credentialed candidates only for four openings. MDs, HIM/coding, and other applicable candidates are welcome to apply in subsequent years. The ACDIS Advisory Board is a multidisciplinary group and we are striving to make sure its composition accurately reflects that of our membership.

Candidates must meet the qualifications outlined in the above link. Applications will be reviewed by a Nominating Committee and all final selections for the ACDIS Advisory Board are made by a popular vote of the ACDIS membership.

To volunteer for the ACDIS Advisory Board, please complete the application form here: http://app.keysurvey.com/f/1066032/10ff/. The application period closes end of day Monday, October 3.
 
CDI Practice Committee: The CDI Practice Committee is a brand-new group which will be responsible for defining and publishing best practice for the CDI profession and providing commentary to the appropriate coding authorities and/or medical specialties. Click here to view its purpose, composition, and scope of work.

For 2017 we are seeking a maximum of 12 volunteers of all backgrounds (RN, HIM, MD, quality, case management, and other CDI related backgrounds) who also possess the CCDS certification. Candidates should be regular readers of AHA Coding Clinic for ICD-10-CM/PCS and Medicare rules and regulations.

To volunteer for the CDI Practice Committee, please complete the application form here: http://app.keysurvey.com/f/1066908/7c4f/. The application period closes end of day Monday, October 3.

ACDIS Forms & Tools Library Committee: The Forms & Tools Library Committee meets regularly (typically monthly) for roughly an hour to review materials donated to the ACDIS community for compliance and effectiveness prior to publishing under the Resources tab of the ACDIS website. The group also conducts semi-annual audits of existing materials to ensure that the Resources (such as sample queries, policies and procedures, and education materials) contain the most recent clinical and coding information. To volunteer, email Associate Editorial Director Melissa Varnavas at mvarnavas@acdis.org.

Local Chapter Advisory Board (CAB): The Local Chapter Advisory Board is a group of past and present local chapter leaders who serve as liaisons to the volunteers who run more than 40 local chapters across the country. They meet regularly (typically monthly) for roughly an hour to share best practices and brainstorm solutions to chapter leadership challenges. They also review materials within the local chapter toolkit to provide best practices for chapter development and education. volunteer, email Associate Editorial Director Melissa Varnavas at mvarnavas@acdis.org. 

The Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations’ (QIOs) resumed patient status reviews of short stays in acute care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities on September 12, 2016, according to a statement published by CMS.

BFCC-QIOs began conducting patient status reviews to determine the appropriateness of Part A payment for short stay hospital claims back in October 2015 but by May 2016, CMS suspended the reviews in order to review policies and retrain its auditors.

The BFCC-QIOs will now begin to examine records for compliance with 2-midnight rule and other short-stay Medicare requirements and will follow the same guidelines implemented before the temporary pause when reviewing claims for patient status, according to CMS. Twice a calendar year, the BFCC-QIOs will conduct patient status reviews using a provider sample from claims paid within the previous six months. BFCC-QIOs will request a minimum of 10 records in a 30-45-day time period from hospitals. The maximum number of record requests per 30 days will be 30 records. BFCC-QIOs will develop detailed results letters for all providers, including individualized, claim-by-claim denial rationales and clinical details. Additionally, one-on-one provider education must be completed by the BFCC-QIO within 90 days. A complete list of guidelines is available on the CMS website.

In light of new coding guidelines and increased scrutiny on 2-midnight rule compliance, CDI professionals will need to become more involved with diagnosis validation, says Allen Frady RN-BSN, CCDS, CCS, CDI education specialist for BLR Healthcare in Middleton, Massachusetts. For example, coding guidelines no longer require linking language in provider documentation to assign a combination code or mandatory multiple code, which may lead to medical necessity denials. CDI specialists will need to be vigilant in anticipating potential problems and query for correct diagnostic language to best match the complete clinical picture of the patient.

“This will present its own special set of problems when looking at medical necessity in relation to the expectation that a patient may, or may not, require care crossing two midnights in the eyes of the auditor,” says Frady.

CMS will continue to oversee BFCC-QIO reviews and will re-review a sample of completed claim reviews each month. The agency will also monitor provider education calls and respond to individual provider inquires and concerns. CMS encourages providers to send questions to its Open Door Forum Mailbox at ODF@cms.hhs.gov.

With Affordable Care Act and Hospital Readmissions Reduction Program efforts, 49 states and the District of Columbia have seen a drop in readmission rates, according to CMS. Since 2010, Medicare 30-day readmissions rates declined by more than 10% in 11 states and by more than 5% in 43 states. Nationally, from 2010 to 2015 Medicare readmission rates have decreased by 8%, says CMS. In 2015, hospitals avoided 100,000 readmissions, reaching a grand total of 565,000 avoided readmissions since 2010.

While CMS emphasizes readmissions reductions in its efforts, researchers and physicians at Johns Hopkins Hospital challenge the notion of readmissions as an accurate measure of quality care. In the study published this month in the Journal of Hospital Medicine, hospitalist Daniel J. Brotman, MD, and his colleagues examined nearly 4,500 acute-care hospitals’ readmission rates and compared them with those hospitals mortality rates in six areas used by CMS—heart attack, pneumonia, heart failure, stroke, chronic obstructive pulmonary disease (COPD), and coronary artery bypass.

Researchers found that hospitals with the highest rates of readmission were more likely to show better mortality scores in patients treated for heart failure, COPD, and stroke. The results indicate that patients treated at hospitals that had more readmitted patients had a fractionally better chance at survival than patients who were cared for at hospitals with lower readmission rates.

“When we did deep dives into causes of readmissions for individual patients, sometimes we saw situations in which providing more comprehensive, detailed, or sophisticated care was leading to readmissions,” said Brotman in an interview with HealthLeaders Media.  “The defects that lead to readmissions are usually not related to the care provided during the hospitalization.”

CMS Star Ratings ranks readmissions similarly to mortality, which is a particular concern in that the agency seems to be using readmissions as a quality metric, Brotman says. “Certainly readmissions are a measure of how much care a patient is getting in the inpatient setting to some extent, but are they a measure of quality or do they measure something else?”

One of the ways to prevent a readmission is to keep someone out of the hospital at all costs, which is not always good for patient care, says Brotman. Readmissions, like length of stay, should be a utilization measure, not a quality measure, he says.

“We shouldn't admit patients who don't really need to be in the hospital,” says Brotman. “But we also shouldn't be incentivizing hospitals to do their best to turn away patients who do need hospitalization regardless of whether they've recently been hospitalized.”

by Melissa Varnavas

I just got off a planning call with half-dozen members of chapter leadership from the “show-me” state and, believe me, they’ve got something to show-off at their upcoming, first-annual, full-day conference on Saturday, October 15, at Boone Hospital Center in Columbia.

They have an amazing line-up of speakers, including ACDIS Advisory Board member Sam Antonios, who’ll be discussing physician advisor’s role in CDI, Jennifer Grub who’ll discuss CDI in recovery auditor denial prevention, and Rebekah May who’ll discuss severity of illness/risk of mortality, among other great presentations. Click here to learn more about the agenda.

They’ve also done fantastic work, including establishing an umbrella non-profit state-wide association, opened a bank account, a Google account, and a Square account, all to ensure that attendees can sign up for the event hassle-free. Committee members reached out to a variety of vendors who’ll be exhibiting at the conference, many of whom will also donate raffle items for attendees.

The group knows that networking remains a huge part of the benefit of these events, so they’ve got a number of additional surprise items up their sleeves. If you’re interested in attending they still have room for about two dozen more possible attendees, so pop over to their page on the ACDIS website to learn more.

September

• The Massachusetts ACDIS Chapter celebrates CDI Week at Bar Louie Rooftop at Patriot Place in Foxboro, Thursday, September 29, 7p.m. to 10 p.m. Come have a drink, appetizer, water, and network with other clinical documentation specialists throughout the Mass chapter. Cash bar. For information, contact Aimee Van Balen, at AVANBALEN@Lifespan.org.
• The ACDIS NW Oregon Chapter meets bi-annually. The next meeting will take place on September 30 in Medford. For information, contact Karen Gray at Karen.Gray@salemhealth.org.

October

• The Florida ACDIS Chapter meets Saturday, October 1, 7:45 a.m. to 4:30 p.m., at Orlando Health. For information, contact Jose.Gonzales at Jose.Gonzalez2@orlandohealth.com.
• The Washington ACDIS Chapter meets Thursday, October 6, at Swedish Medical Center in Seattle. For information, contact Nora Tiffany at Nora.Tiffany@providence.org.
• The Michigan ACDIS Chapter meets Saturday, October 8, 7:30 a.m. to 4:30 p.m., at the Amway Grand Hotel in Grand Rapids. The chapter currently seeks volunteer presenters and is looking for members to help plan events for the 2017 calendar. For information, contact Susan Haley at shaley@theclarogroup.com.
• The Illinois ACDIS Chapter meets Thursday, October 13, 1 p.m. to 4 p.m., at Morris Hospital. For information, contact Colleen Stukenberg at CStukenberg@fhn.org.
• The Suffolk County Long Island New York ACDIS Chapter meets Friday, October 14, at SBUH. Elections will be held for new chapter officers during the meeting. For information, contact scacdis@gmail.com.
• The Wisconsin ACDIS Chapter meets Saturday, October 15, at Wheaton Franciscan in Wauwatosa. For information, contact Teri Ryan at teri.ryan@aurora.org.
• Three Missouri ACDIS chapters join together for their first state-wide full-day event on Saturday, October 15, at Boone Hospital Center in Columbia. For information, contact Karen Elmore at kelmore@bjc.org.
• The Virginia ACDIS Chapter meets Saturday, October 15, 10 a.m. to 3 p.m., at Chesapeake (VA) Regional Medical Center Lifestyle Center. For information, contact Shelly McBrayer at Shelly.mcbrayer@chesapeakeregional.com.
• The Philadelphia Pennsylvania/New Jersey ACDIS Chapter meets Thursday, October 27, at 8 a.m., at Cooper University Hospital, in Camden, New Jersey. For information, contact Gina Stewart atgstewart@e4-services.com.  
• The Puerto Rico ACDIS Chapter meets Thursday, October 27, to discuss frequently asked questions about CDI. For information, contact Carmen Ibarrondo at cibarrondo@picconsultantspr.com.

November

• The North Carolina ACDIS Chapter meets Friday, November 4, at UNC Lenoir Healthcare in Kinston. For information, email ncacdis@gmail.com. 
• The Westchester County New York networking group meets Tuesday, November 15, 4p.m. to 6 p.m., at Northern Westchester Hospital in Mount Kisco. Bring a snack or pot-luck item for the group. For information, email Kerry Seekircher, westchesteracdis@yahoo.com. 

Those applying to take the CCDS exam or recertify will no longer have to write their applications by hand. We recently got some new applications in the form of editable PDFs, which you can complete on your computer.

The new forms are now available on the ACDIS website for exams, re-exams, and for recertification. Visit the ACDIS site and go to the Certification section. Click on “How to Apply” or “Recertification,” locate the form you need, and click on the link. Or just click the appropriate a link below:

• To apply for the exam
• To apply for a re-exam
• To submit your recertification

Save the form to your desktop using the format indicated at the top of each form, such as CCDS_EXAM_PRICHARDS (use your first initial and last name—the example uses my name).

Fill out the application with your information, save it again, and then email it to ccdsapp@acdis.org.

Do not provide payment information on any of the forms. Instead, click the link on the second page of the application and pay through our secure online store. If you prefer, we will call you for your credit card information. You can indicate in the body of your email that you wish a call. You may also print the completed application and mail it to us with a check.

The new process is really easy and a first step to an online certification and recertification processes.

As always, contact Penny Richards at prichards@hcpro.com if you have questions.

by Rebecca Hendren

ACDIS has a number of training and educational materials and it can be hard to decide which program best fits your needs. Our members often ask me to recommend a program for them, so I thought I’d share my short answers to help you figure out which program is best for you.

Our boot camps are our most popular option, covering the basics of the CDI role to more advanced concepts and CDI expansion. Our classes are offered live with our fabulous CDI instructors or online so you can complete the modules at your convenience. Currently we have courses covering the following topics:

• Clinical Documentation Improvement Boot Camp
• CDI for Quality Boot Camp
• Risk Adjustment Documentation and Coding Boot Camp
• ICD-10-PCS for CDI Online Boot Camp

We also have a comprehensive e-learning library, CDI Essential Skills, which is perfect for any new CDI specialist or CDI department onboarding new staff. The online format is engaging and interactive, and covers basic coding and documentation concepts, techniques for provider engagement, and much more.

Finally, I receive a number of inquiries about preparation for the Certified Clinical Documentation Specialist (CCDS) exam. While none of these boot camps are designed to be a credentialing prep class, we do find that the Clinical Documentation Improvement Boot Camp is helpful for those who are interested in the CCDS credential. It covers much of the information that CDI professionals need to master to successfully pass the CCDS exam. Please note, completion of our boot camps does not automatically qualify you to sit for the exam—you must have at least two years’ experience and meet additional requirements.

Stay tuned for more information on our brand new CCDS exam preparation class that is in development for 2017.

Please contact me at rhendren@hcpro.com if you’d like more information on any of these programs.  

The U.S. District Court for the District of Columbia denied the Department of Health and Human Services’ claim to delay proceedings in an appeals backlog case until September 30, 2017, according to a civil action notice released by the Court.

In 2014, the American Hospital Association asked the court to issue a writ of mandamus to compel the HHS to process their long-pending claim-reimbursement appeals in accordance with statutory timelines. The Court denied the AHA’s request, believing the matter best left to the political process. However, the Court of Appeals disagreed, holding that the Court has jurisdiction to grant mandamus relief.

In response, the HHS filed a motion to stay the proceedings to allow the department to “move forward on various administrative and legislative efforts designed to tackle the backlog of reimbursement appeals.” Once again, the Court was reluctant to intervene, but the backlog and delays have only worsened in two years—for the federal fiscal year (FY) ending September 2015, more than 884,000 Medicare claims were awaiting adjudication before Administrative Law Judges, according to an article released by the Office of Medicare Hearings and Appeals (OMHA). Therefore, the Court ultimately decided to deny the HHS’s motion.

U.S. District Judge James Boasberg reviewed the two categories of actions presented by HHS:

1. Administrative actions including estimates of the effect on the backlog
2. Legislation to reform the appeals process and provide the agency with additional funding

The HHS’s proposed administrative fixes would result in 50% fewer backlogged OMHA appeals in fiscal year 2020, according to Boasberg. However, the OMHA backlog will continue to grow every year between FY 2016 and FY 2020, from roughly 757,090 to 1,003,444 appeals, according to the Court statement.

“Significant progress toward a solution cannot simply mean that things get worse more slowly than they would otherwise,” says Boasberg. 

The Comprehensive Error Rate Testing (CERT) program received a new assignment this summer. On August 16, CMS awarded CERT Review Contractors work to AdvanceMed, an NCI company, eliminating the existing CERT Documentation Contractors effective October 13, 2016, according to a statement published by CMS.

The CERT program is a post-payment auditing function and focuses on billing errors that result from no or insufficient provider documentation, medical necessity, incorrect coding, and other issues, such as duplicate claims or non-covered services. The CERT contractor performs this function by randomly selecting a statistically valid sample of processed Medicare claims and requesting the associated medical documentation from the provider. Once the records are received, the CERT professional audits the chart to determine whether the claim was paid appropriately.

Using the audit information from the CERT contractor, CMS then calculates a national improper payment rate and uses it to measure the performance of Medicare Administrative Contractors (MACs) to gain insight into the causes of errors. CMS publishes the results of these reviews annually, which CDI leadership may use to pinpoint areas of risk related to documentation and coding.

The work currently performed by CERT Documentation Contractors will be transitioned to the Review Contractors and fully operational on October 14, 2016. October 6 is the last day that the current CERT Documentation Contractor will be receiving medical records and CERT inquiries at their location.

Beginning on October 7, the CERT Provider Website and the CERT Documentation Portal (which will eventually become the CERT Claim Status website) will undergo updates to add new features and additional functionality. Providers will not be able to update their contact information for the CERT program until after October 13.  

Physicians often ask why documentation matters to them. Last week, CMS sent out a reminder regarding the importance of complete and accurate documentation related to physician evaluation and management (E/M) codes.

In a 2012 study report, the Office of the Inspector General (OIG) noted that a number of physicians increased their billing of higher level, more complex and expensive E/M codes. Many providers submit claims coded at a higher or lower level than the medical record documentation supports. The following resources can be used to bill correctly for E/M services:

• OIG Report: Coding Trends of Medicare E/M Services
• Medicare Claims Processing Manual: Chapter 12, Section 30.6
• E/M Services Guide
• 1995 Documentation Guidelines for E/M Services
• 1997 Documentation Guidelines for E/M Services
• Frequently Asked Question on Use of 1995 and 1997 Guidelines

CDI specialists should review the requirements and guidance to prepare themselves when providers come to them and ask for help. 

The Cooperating Parties made revisions to the 2017 ICD-10-CM Official Guidelines for Coding and Reporting to explain how bilateral conditions should be reported when the two sides are treated during separate encounters, as well as what codes would be appropriate once one side has been treated. The easiest way to explain how this works is to show an example of the new guidelines. Consider the following:

Patient has bilateral age-related nuclear cataracts that necessitate surgical repair. The patient will undergo two surgeries during separate encounters—one for each eye— to allow time in between for complete healing of the first eye.

For the first encounter to treat the right eye (i.e., first side), use a bilateral diagnosis code for the cataracts (H25.13 [age-related nuclear cataract, bilateral]) because the patient still has cataracts in both the right and left eyes.

For the second encounter to treat the left eye (i.e., second side), use the unilateral code for the left eye cataract because the right eye no longer has a cataract. However, a cataract extraction status code may be reported to identify the right eye has already been treated. Coders should report:  

• Diagnosis: Age-related nuclear cataract, left eye (H25.12)
• Cataract extraction status, right eye (Z98.41)
  
  • Please see the instructional note stating “If an intraocular lens implant was placed in right eye, use additional code Z96.1.”

The exception to the reporting above would be if the treatment on the first side did not completely resolve the condition. In that case, the bilateral code would still be appropriate.

Another practical example of when this guideline could apply is with patients with severe degenerative joint disease of both knees, requiring bilateral total knee replacements performed during separate encounters.

Editor’s Note: This article was written by Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, and was originally published in JustCoding. McCall is the director of HIM and coding for HCPro, a division of BLR, in Danvers, Massachusetts. For more information regarding CDI Boot Camps offered by HCPro, visit www.hcprobootcamps.com. 

Our local chapters joined in the fun of our sixth annual CDI Week, hosting meetings and other get-togethers. Colorado, Pennsylvania, and Maine hosted educational meetings; our pediatric network group held a conference call; and California and Massachusetts Chapters got together with entertaining after-hours events to network and spend time with one another. We’re so pleased that so many of our local chapter members had a chance to connect.

We were lucky enough to get our hands on a few photos from last week’s activities. Please enjoy this little slideshow that we put together.

October

• The Washington ACDIS Chapter meets Thursday, October 6, at Swedish Medical Center in Seattle. For information, contact Nora Tiffany at Nora.Tiffany@providence.org.
• The Michigan ACDIS Chapter meets Saturday, October 8, 7:30 a.m. to 4:30 p.m., at the Amway Grand Hotel in Grand Rapids. The chapter is seeking volunteer presenters and is looking for members to help plan events for the 2017 calendar. For information, contact Susan Haley at shaley@theclarogroup.com.
• The Illinois ACDIS Chapter meets Thursday, October 13, 1 p.m. to 4 p.m., at Morris Hospital in Morris, Illinois. For information, contact Colleen Stukenberg at CStukenberg@fhn.org.
• The Suffolk County Long Island New York ACDIS Chapter meets Friday, October 14, at Stony Brook University Hospital in Stony Brook, New York. . Elections will be held for new chapter officers during the meeting. For information, contact scacdis@gmail.com.
• The Wisconsin ACDIS Chapter meets Saturday, October 15, at Wheaton Franciscan in Wauwatosa. For information, contact Teri Ryan at teri.ryan@aurora.org.
• Three Missouri ACDIS chapters join together for their first state-wide full-day event on Saturday, October 15, at Boone Hospital Center in Columbia. For information, contact Karen Elmore at kelmore@bjc.org.
• The Virginia ACDIS Chapter meets Saturday, October 15, 10 a.m. to 3 p.m., at Chesapeake (VA) Regional Medical Center Lifestyle Center. For information, contact Shelly McBrayer at Shelly.mcbrayer@chesapeakeregional.com.
• The Philadelphia Pennsylvania/New Jersey ACDIS Chapter meets Thursday, October 27, at 8 a.m., at Cooper University Hospital, in Camden, New Jersey. For information, contact Gina Stewart at gstewart@e4-services.com.  
• The Puerto Rico ACDIS Chapter meets Thursday, October 27, to discuss frequently asked questions about CDI. For information, contact Carmen Ibarrondo at cibarrondo@picconsultantspr.com.

November

• The North Carolina ACDIS Chapter meets Friday, November 4, at UNC Lenoir Healthcare in Kinston. For information, email ncacdis@gmail.com. 
• The Westchester County New York networking group meets Tuesday, November 15, from 4 p.m. to 6 p.m., at Northern Westchester Hospital in Mount Kisco. Bring a snack or pot-luck item for the group. For information, email Kerry Seekircher, westchesteracdis@yahoo.com. 

This special edition/added show features a look at the new CDI Pocket Guide Digital Editions, an ebook and app package of the popular CDI Pocket Guide. Special guests include Richard Pinson, MD, FACP, CCS; and Cynthia Tang, RHIA, CCS, authors of the CDI Pocket Guide.

To learn more about these products please visit our HCMarketplace store.

by Penny Richards

Those applying to take the CCDS exam or recertify no longer have to write their applications by hand, since ACDIS implemented new editable PDF applications, candidates can complete electronically, on their computer. 

The new forms are now available on the ACDIS website for exams, re-exams, and for recertification. Visit the ACDIS site and go to the Certification section. Click on “How to Apply” or “Recertification,” locate the form you need, and click on the link. Or just click the appropriate a link below:

• To apply for the exam
• To apply for a re-exam
• To submit your recertification

Save the form to your desktop using the format indicated at the top of each form, such as CCDS_EXAM_PRICHARDS (use your first initial and last name—the example uses my name).

Fill out the application with your information, save it again, and then email it to ccdsapp@acdis.org.

Do not provide payment information. Instead, click the link on the second page of the application and pay through our secure online store. If you prefer, we will call you for your credit card information. You can indicate in the body of your email that you wish a call. You may also print the completed application and mail it to us with a check.

The new process is really easy and a first step to an online certification and recertification processes.

As always, contact me at prichards@hcpro.com if you have questions.

Nearly 5,000 member hospitals, health systems, and other healthcare organizations say they are on board for CMS’ Cardiac and Comprehensive Care for Joint Replacement (CJR) Bundled Payment Model proposed rule. Groups expressed concern, however, about the  pace of change, and CMS’ ability to accurately track and process the outcomes of its increasingly complex alternative payment models, according to a letter written by the American Hospital Association (AHA) to Andrew Slavitt, acting administrator for CMS.

As CMS transitions from volume to value-based payments and alternative payment models, including bundled payment models, it set  the goal to have 30% of payments tied to APMs by 2016, and 50% of its payments tied to APMs by 2018, according to Cheryl Ericson, MS, RN, CCDS, CDIP, manager of clinical documentation services with DHG Healthcare, who spoke on the subject in a recent edition of ACDIS Radio. Bundled payments fall under two categories:

1. elective/voluntary
2. mandatory

Initially, the Bundled Payments for Care Initiative (BPCI), launched in 2013, was a voluntary program (hospitals could sign up to participate). However, participation wasn’t as high as CMS anticipated, so , the agency implemented mandatory bundled payments, including CJR. CMS picked 67 metropolitan statistical areas and required hospitals in those regions not involved in a BCCI to participate.

In its letter, the AHA urged CMS to refrain from expanding mandatory bundled payment models to other geographic areas or clinical conditions before conducting an assessment of lessons learned under existing models. AHA expressed particular concern with CMS’ proposed cardiac bundled payment model, which came less than four months after the CJR program began and with measures almost exactly the same as the CJR. CMS does not have any complete episode data and has not been able to effectively evaluate how bundled payments are working, says the AHA.

The proposed cardiac rule sets at least 75 different target prices for different combinations of cardiac diagnoses and procedures, posing challenges for providers and other clinicians. CMS should move at a more deliberate pace and simplify the rule, and perhaps consider including only coronary artery bypass grafts (CABGs) in the cardiac model to start, the AHA wrote.

In addition, the AHA does not support CMS’s proposal to expand the CJR program to include surgical hip and femur fracture treatment (SHFFT) episodes, or to require certain CJR hospitals to also implement the cardiac bundled payment model. Hospitals do not have an unlimited capacity to implement bundled payment models, and individual organizations need an opportunity to see how bundled payments effect their facilities, says the AHA. 

Hospitals continue to appeal Recovery Audit Contractor (RAC) claim denials, according to the latest report from the American Hospital Association’s quarterly RACTrac survey.

Hospitals reported appealing 45% of all RAC claim denials, and 60% of claims reviewed in the second quarter of 2016 had no overpayment. Hospitals also reported that RACs cite “inpatient coding errors” as the most common reason for complex claim denials.

Three in four claims appealed to an administrative law judge took longer than the statutory limit of 90 days to provide a determination to the hospital, according to the report.

The AHA RACTrac survey collects data from hospitals on a quarterly basis to assess the effect of the Medicare RAC program on hospitals nationwide. The AHA developed RACTrac in response to the lack of data and information provided by CMS on the effect of the RAC program on providers.

Hospital representatives are invited to attend a webinar October 18 at 2 p.m. eastern to review the survey results and recent RAC policy developments. The free, web-based survey helps AHA monitor the impact of RACs and advocate for needed changes to the program. All hospitals can submit their third quarter data to the RACTrac survey through Oct. 21. 

The new system outlined in the Medicare Access and CHIP Reauthorization Act (MACRA) represents the most significant change to Medicare in a generation, says Andrew Gurman, MD, president of the American Medical Association, in an October 5 conference call with news media.

Under MACRA, providers must choose from one of two paths beginning in 2017. They can either participate in an alternative payment model (APM), such as an accountable care organization, or they can join in the Merit-Based Incentive Payment System (MIPS), which requires doctors to submit quality-reporting data to Medicare.

To help providers navigate the impending changes, the AMA is offering three free tools to both its member and non-member organizations. (Users may have to register to access the free tools.)

• Interactive "Payment Model Evaluator," which allows providers to input information about their practice and assess which APM represents the best fit for them, or if they should consider MIPS instead.
• MACRA-specific modules for the AMA's "Steps Forward" practice improvement program, which focus on specific challenges providers may face through the transition. The modules offer providers continuing medical education credit.
• A seven-episode podcast series, "Inside Medicare's New Payment System" featuring interviews with AMA and CMS staff. 

Click here for more information. 

The Washington Evergreen ACDIS Chapter had more than two dozen CDI specialists converge on Swedish Medical Center in Seattle last Thursday, October 6.

“The accommodations were great, the cafeteria was great, and the presentation was fabulous,” says past-chapter leader Susan Browne, who recounted how Swedish CDI staff discussed reviews focused on patient safety indicators, hospital acquired conditions, and hospital readmission reduction.

The entire team did a great job pulling everything together, Browne says, adding that the next in-person event will take place in Spokane next April.

Michigan’s chapter event last Saturday included more than 50 participants and six speakers at the lovely Amway Grand Hotel in Grand Rapids.

“The venue was beautiful, the food and service fantastic,” says local chapter leader Susan Haley. “Our speakers delivered some great information on current industry trends. We had some great sponsors and vendor support, and we have received a lot of great feedback from the audience.”

The first Maryland ACDIS Conference held in September welcomed more than 80 attendees and was filled to capacity for the inaugural event, according to the chapter’s newsletter recap from Olga Firstbrook.

An email from Karen Walleck at Anne Arundel Medical Center sums the day up.

“What a wonderful conference! You all did an awesome job! The conference packets were super and appreciated (I like taking notes). Excellent choice of speakers! I found each presenter to be extremely knowledgeable and their content very pertinent. If there were any ‘hitches’ during the day they were not apparent to me,” Walleck wrote.

Coming up this week we’re excited about events in Illinois, Long Island and New York City, Wisconsin, Missouri, Virginia, and Alabama.

October

• Illinois ACDIS meeting takes place Thursday, October 13, 12:30-4 p.m., at Morris Hospital. Reservations required to Betty Bogda at bbogda@morrishospital.org.
• The Suffolk County Long Island New York ACDIS Chapter meets Friday, October 14, at Stony Brook University Hospital in Stony Brook, New York.  Elections will be held for new chapter officers during the meeting. For information, contact scacdis@gmail.com.
• The Wisconsin ACDIS Chapter meets Saturday, October 15, at Wheaton Franciscan in Wauwatosa. For information, contact Teri Ryan at teri.ryan@aurora.org.
• Three Missouri ACDIS chapters join together for their first state-wide full-day event on Saturday, October 15, at Boone Hospital Center in Columbia. For information, contact Karen Elmore at kelmore@bjc.org.
• The Virginia ACDIS Chapter meets Saturday, October 15, 10 a.m. to 3 p.m., at Chesapeake (VA) Regional Medical Center Lifestyle Center. For information, contact Shelly McBrayer at Shelly.mcbrayer@chesapeakeregional.com.
• The Alabama ACDIS Chapter meets via teleconference on Wednesday, October 19, noon (central) to discuss chapter endeavors. For information, contact
• The New York City Five Boroughs (NYC5B) ACDIS Chapter meets at NYU Langone Medical Center on Wednesday, October 19, at 5 p.m. For information, email NYC5B.ACDIS@gmail.com.
• The Arizona ACDIS Chapter meets Wednesday, October 26, 5:30 p.m., at HonorHealth Scottsdale Osborn Medical Center, with guest speaker Kaitlyn Crowther, RHIA, on “Utilizing Innovative Speech Recognition and Natural Language Understanding.” RSVP by noon October 24, by email to debra22@cox.net.
• The Philadelphia Pennsylvania/New Jersey ACDIS Chapter meets Thursday, October 27, at 8 a.m., at Cooper University Hospital, in Camden, New Jersey. For information, contact Gina Stewart atgstewart@e4-services.com.  
• The Puerto Rico ACDIS Chapter meets Thursday, October 27, to discuss frequently asked questions about CDI. For information, contact Carmen Ibarrondo at cibarrondo@picconsultantspr.com.

November

• The North Carolina ACDIS Chapter meets Friday, November 4, at UNC Lenoir Healthcare in Kinston. For information, email ncacdis@gmail.com. 
• The Georgia ACDIS Chapter meets at Emory Healthcare in Atlanta, November 11, 8:30 a.m. For information, contact Julie Bell at julieltbell@gmail.com.
• The Westchester County New York networking group meets Tuesday, November 15, from 4 p.m. to 6 p.m., at Northern Westchester Hospital in Mount Kisco. Bring a snack or pot-luck item for the group. For information, email Kerry Seekircher, westchesteracdis@yahoo.com. 
• The CNY Central New York CDI networking group meets Friday, November 18, 2-4 p.m., at Marley Education Center, Pomeroy School of Nursing, in Syracuse, New York. Reservations required by November 14. For information, contact Dawn Burr at dawnburr@crouse.org. 

With special guest Erica E. Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc. Consulting Services in Clinical Documentation, CDI, and ICD-10, and Sharme Brodie, RN, CCDS, CDI education specialist with ACDIS/HCPro. 

Results of AHA RACTRAC Survey, 2nd Quarter 2016 referenced on today's show can be found here: http://www.aha.org/content/16/16q2ractracresults.pdf

by Melissa Varnavas

At our office in Middleton, we sit beside a row of windows overlooking a parking lot and—at the moment—rolling hills of autumnal foliage shrouded in mist. About an hour ago, a big ‘ole crow landed on the window ledge and poked at each window pane before spreading its blue-black wings and sailing off to a nearby tree.

So, I thought I’d spend this note “crowing” about the publications available to ACDIS members and let you know about a few items coming in the next month or so.

In case you missed it, the September/October edition of the CDI Journal, covers a number of controversial concerns including:

• The professional background of CDI specialists
• The state licensure needs for nurses in CDI
• Changes to Official Guidelines for Coding and Reporting
• Tips for appealing denials
• Sepsis-3 in the pediatric realm

Speaking of Sepsis-3, ACDIS Advisory Board member Paul Evans, RHIA, CCDS, CCS, CCS-P, delves into some thoughts about addressing reviews and queries in the white paper “How ‘R’ are you coding severe sepsis? Why the R-code matters.” In it, Evans reviews the various clinical guidelines for sepsis diagnosis as well as coding and documentation requirements. He offers case study examples of situations CDI professionals may very well face within their typical record reviews and provides some query examples.

ACDIS white papers are in-depth articles which discuss CDI best practice, advances new ideas, increases knowledge, or offers administrative simplification. It is less formal than a position paper, so as Evans writes in this release, his aim is to simply “review some of the aspects of differing definitions of severe sepsis and demonstrate why the coding of severe sepsis is important while providing some practical tips.”

Another white paper released just this week focuses on the need for a consensus of clinical definitions related to pediatric respiratory failure. A work group consisting of coders, pediatric nurses, physicians, and CDI professionals from the ACDIS membership met over the course of a year to review data from the field and coalesce various documentation conundrums those working in this area face.

“The lack of specific clinical criteria for the diagnosis of acute respiratory failure in the pediatric population, without intubation or arterial blood gas measurements, have led to the development of numerous institution-specific criteria for this disease,” the work group states.

While the white paper outlines prevailing CDI-related concerns, provides clinical scenarios, and offers some suggested actions. It also seeks additional insight and clarity from the institutions, such as The Society of Critical Care Medicine and The Society of Pediatric Critical Care Medicine, regarding clinical definitions of pediatric respiratory related diagnoses.

Finally, I very much enjoyed working with our friends over in HealthLeaders Media on a special section titled “From Finance to Quality: CDI Departments Expanding Their Reach,” in its most recent magazine.

Many CDI program leaders agonize over how to make the case for expanding their program efforts into quality-related record reviews, says Dee Banet, RN, MSN, CCDS, CDIP, director of CDI at Norton Healthcare in Louisville, Kentucky, and a past ACDIS Advisory Board member in the report. And yet, as government increasingly ties payment to quality with initiatives like pay-for-performance, the dividing line between patient care and fiscal concerns is slowly dissolving.

These highlights represent just a few of the items recently released by ACDIS. Members of the ACDIS Advisory Board have nearly completed work on a special white paper regarding career ladder creation in the field as well as a new report based on survey data regarding CDI productivity expectations. And, the 2016 CDI Salary Survey garnered more than 1,000 responses this year. So, no doubt, CDI professionals will be excited to dig into that data once the analysis is released later this month!

Now that’s something to crow about!

Editor’s note: Varnavas is the Associate Editorial Director for ACDIS with responsibilities related to its various publications and website offerings as well as the more than 40 local chapters across the country. Contact her at mvarnavas@acdis.org.