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Physician engagement webinar February 15!

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In responding to this year's ACDIS membership survey, hundreds of respondents indicated that obtaining physician support for their CDI efforts represented their biggest challenge. So, we're thrilled to have the 2016 CDI Professional of the Year award winner Karen DiMeglio, RN, MS, CPC, CCDS, director of CDI and appeals at Lifespan, and Jill O’Brien, MD, CHCQM, medical director of care management, physician advisor to CDI, at the Miriam Hospital, a Lifespan affiliate join us for a in-depth look at engaging providers in documentation improvement activities, during this webinar "Physician Advisors: The Ticket to Provider Engagement," on Wednesday, February 15, at 1 p.m., eastern.

You know the common physician compliants: It's all about the money! or If the coders would just assign the right code this wouldn't be a problem! DiMeglio and O'Brian have the best responses to these frustrations and will give you data tricks to enhance your argument and help you prove the value of your CDI efforts to your physician partners.

 

Publication: 
Volume 11, Issue 6
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News: Copy and paste issues affect patient safety

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Since the advent of electronic medical record (EMR) systems, CDI professionals have known that physician copy and paste errors pose a threat to accurate documentation. Consequently, these errors can also negatively affect patient safety as well, according to a report from the National Institute of Standards and Technology (NIST).

Not only can the copy/pasted data inaccurately represent the patient’s condition and episode of care, but it can deprive future healthcare providers of valuable patient information. “Using outdated information, truncating information, or including a large amount of potentially extraneous information can all lead to safety issues,” Lorraine Possanza, patient safety, risk and quality program director at the ECRI Institute said in a release from the ECRI Institute regarding the study.

The ECRI release suggests four methods to prevent the copy/paste errors from happening:

  1. Provide a way of making the copy/paste material easily identifiable in the EMR
  2. Ensure that the provenance of copy/paste material is easily available
  3. Ensure adequate staff training and education regarding copy/paste use
  4. Monitor, measure, and assess the copy/paste practices regularly

While neither the official report, nor the release from ECRI mention the role of CDI, CDI professionals can certainly make a difference in the accuracy of the chart and ensure that the copy/pasted material is correct. The accuracy of the chart is a direct concern of a CDI professional; being aware of copy/paste issues will ensure that the documentation and patient safety remain paramount.

Publication: 
Volume 11, Issue 7

News: CERT review shows insufficient documentation for facet joint injections

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A Comprehensive Error Rate Testing (CERT) study showed insufficient documentation caused the most improper payments for facet joint injections, according to the January 2016 Medicare Quarterly Compliance Newsletter, Just Coding reported.

CERT reviewed claims billed with HCPCS code 64635 (destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single facet joint) submitted from July through September 2015. A facet joint injection is a procedure using an imaging-assisted local injection and denervation technique. 

CERT reported a variety of insufficiencies in documentation for these claims, including:

  • Lack of a valid physician order with a physician signature or date
  • Lack of documentation adequately describing the service defined by HCPCS code or modifier
  • No documentation supporting medical need for the procedure
  • No physician signature on procedure notes, diagnostic reports, or progress notes
  • No preoperative surgeon’s office notes
  • No procedure notes
  • No submitted signature log or attestation
  • Valid ICD-9-CM codes reported, but they alone are not sufficient documentation

CERT provided an example of a physician asked by a CERT contractor for documentation when billing for HCPCS code 64636. The physician submitted the following:

  • A consent form
  • A procedure note from the date of service
  • A progress note from the date of service without indication that a conservative treatment was tried and failed

CERT reported that a medical reviewer requested additional documentation, and the provider sent duplicate documentation back. This documentation failed to meet the Local Coverage Determination (LCD) requirements for these services, which includes:

  • An initial evaluation from the physician summarizing diagnostic tests or procedures which justified the presence of facet joint pain
  • Any documentation ruling out another etiology for the symptoms
  • Documentation showing the patient failed conservative treatment before the facet joint injection was administered

As a result of the insufficient documentation, payment was recouped.

Editor Note: This article originally appeared in Just Coding. To read the full original article, click here.

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Volume 11, Issue 7

News: Missouri death certificates show significant cause of death inconsistencies

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Nearly half of the death certificates reviewed by the Centers for Disease Control and Prevention from 2009 to 2012 listed the cause of death inaccurately, according to a recent article in Health Leaders Media. The Morbidity and Mortality Report, published in January, reviewed 205 medical charts at random from eight separate hospitals in the Kansas City and St. Louis areas. The charts fell into one of three categories:

  • Heath disease
  • Cancer
  • Renal disease

Though CDI specialists do not have direct contact with the death certificates themselves, only 181 (88%) of the 205 selected charts were able to be reviewed because some charts were unavailable or incomplete for 24 patients, Health Leaders Media reported

Although the report does not speculate as to the reasons behind death certificate inaccuracies, CDI professionals certainly should ensure the records leaving their facilities are as clear as possible so that those handling the next stages of information transfer are equipped with as much detail as possible regarding patient conditions.

Publication: 
Volume 11, Issue 7

Local Chapter Update: Florida raffle winner to head to Vegas for conference

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The Florida ACDIS Chapter has been active since 2009. Over the years, they’ve grown their group to more than 150 CDI-related professionals, gathering quarterly. Networking events alternate between Fridays and Saturdays to allow those not able to take time off from daily review responsibilities the opportunity to attend. The Friday/Saturday events also allow participants time to travel and to make a weekend trip out of their visits if warranted. The group also rotates its meetings across the state, with host facilities having been located in Tampa, Miami, Jacksonville, and Orlando, just to name a few.

The chapter does collect dues generally to offset the cost of snacks and incidentals such as decorations for its fun, themed, events. (Note there is no direct financial relationship between ACDIS national and its local chapters.) Annually, the group uses a portion of the funds collected to purchase a seat to the ACDIS annual conference and raffle it off to attendees. This year, the lucky winner is Edna I. Betances-Harold, CDIP, CCDS, CCS, of UF Health Shands Hospital and Academic Health Center.

Thanks to the Florida ACDIS Chapter leaders for doing such a great and we’re looking forward to meeting you in Vegas, Edna!

The following is a list of upcoming events are various local chapters:

February

  • The next ACDIS Westchester (New York) Chapter meeting will be held Thursday, February 16, 3-5 p.m., at Phelps Memorial Hospital in Sleepy Hollow. An agenda and additional information will be forthcoming. For additional information, contact Kerry Seekircher at kseekircher@nwhc.net.
  • Kentucky/Southern Indiana ACDIS Chapter meets Thursday, February 16, 1-4 p.m., at Clark Memorial Hospital in Jeffersonville. For information, contact Leah N. Savage, at Leah.Savage@nortonhealthcare.org
  • The Minnesota and Wisconsin ACDIS chapters join for a webinar hosted by ACDIS Editorial Director Melissa Varnavas regarding CDI salaries and career ladders on Wednesday, February 22, 1-2 p.m., central, via teleconference. Click here to register for the webinar. For information, contact Faye Bakke at faye.bakke@essentiahealth.org.
  • The Alabama ACDIS Chapter meets Friday, February 24, 9 a.m. to 3 p.m., at DCH Regional Medical Center in Tuscaloosa. For information, email acdisalabama@gmail.com or contact Jeffrey Wayne Morris at jwmorris@health.southalabama.edu.
  • The North Carolina and South Carolina ACDIS chapters join forces for a group event on Friday, February 24, 8:30 a.m. to 4:30 p.m., at Palmetto Health Baptist in Columbia. Presentations feature former ACDIS Advisory Board members Fran Jurcak on preparing for the CCDS exam, Cheryl Ericson on the future of CDI profession, and Don Butler on the role of physician advisors in CDI efforts. The program also features a presentation on CDI specialists place at interdisciplinary rounds with Holley Pegram, Sandie Pressely, and Kay Blue. For information, contact the NC ACDIS Chapter at ncacdis@gmail.com.

March

  • The pediatric networking group APDIS meets Thursday, March 2, via webinar. For information, contact Leah N. Savage, at Leah.Savage@nortonhealthcare.org
  • The Indiana ACDIS Chapter Spring Conference takes place Saturday, March 4, at St. Vincent Hospital in Indianapolis. For information, contact Lee Walton at LAWalton@stvincent.org.
  • The Kansas City Missouri ACDIS Chapter meets Tuesday, March 7, at 2-4 p.m., at Liberty Hospital. For information, contact Christine Schattenfield, cneuman@saint-lukes.org.
  • Tennessee ACDIS Chapter co-leader Sherri Clark, BSN, RN-BC, CCDS, CCS, heads to Knoxville Convention Center on March 8, where she participates on a panel discussion titled 'The powerful impact of CDI & Coding on Quality Reporting: Core Measures, PSIs, Outpatient CDI.” For more information, visit http://thima.org/annualmeeting/.
  • Leaders of the Washington ACDIS Chapter will head to Spokane to join the Washington AHIMA leaders for its annual conference event March 16-18 at Red Lion at the Park. For more information, visit http://www.wshima.org/annualmeeting/.
  • The Ohio ACDIS Chapter meets March 23 at the University Hospitals’ customer service center in Highland Heights. For information, contact Lisa McLuckie at lmcluckie@wchosp.org.
  • The Massachusetts ACDIS Chapter meets Thursday, March 30, 11 a.m. to 2 p.m., at The Miriam Hospital in Providence, Rhode Island. For information, contact Joyce M. Williams, at JWilliams@Lifespan.org.

Save the date

  • The St. Louis Missouri ACDIS Chapter meets April 19, 6:30-8 p.m., at St. Luke’s. Outside food/drink is against hospital policy, so no pot luck this time. For information, contact Michael McKelvey, michael.mckelvey@bjc.org.
  • The California ACDIS Chapter holds its third-annual conference Friday, September 15, 8 a.m. to 4 p.m., at Torrance Memorial Medical Center. For information, contact Rani V. Stoddard at stoddardrv@henrymayo.com.  
  • Missouri’s three ACDIS local chapters join for a full-day conference event on October 14, at the University of Kansas Hospital. For information, contact michael.mckelvey@bjc.org.
Publication: 
Volume 11, Issue 7

Membership Update: ACDIS Quarterly Conference Call next Thursday

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ACDIS members are invited to register for ACDIS Quarterly Membership Conference Call which takes place Thursday, February 16, 1 p.m., eastern, by visiting the call archive page on the ACDIS website. Members should also watch for call instructions via email. After registering, you will receive a confirmation email containing information about joining the webinar.

This call features a special roundtable discussion with the ACDIS advisory board leaders and special guest ACDIS Director Brian Murphy. Pre-submitted questions for the board are welcome and encouraged. Email ACDIS Associate Editorial Director Melissa Varnavas at mvarnavas@acdis.orgWhile we cannot guarantee your question or discussion point will be addressed on the call, we will try to work in as many as possible.

This is an ACDIS membership benefit and only available to ACDIS members. Please do not share the dial in instructions.

Please dial in 10 minutes early due to high caller volume and we look forward to talking with you!

Note: This call qualifies for one (1) continuing education credit for Certified Clinical Documentation Specialist (CCDS) holders. To obtain this credit you must complete the keysurvey link which will available shortly following the live call.

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Volume 11, Issue 7

News: Sepsis accounts for many of the 30-day unplanned readmissions

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Sepsis accounts for a higher rate of unplanned readmissions than acute myocardial infarction (AMI), heart failure, pneumonia, and chronic obstructive pulmonary disease (COPD), according to a recent JAMA study which analyzed the proportion and cost of 30-day readmissions, Revenue Cycle Advisor reported.

CMS uses 30-day readmission rates as a measure of quality of care and pays particular attention to AMI, heart failure, pneumonia, and COPD readmissions because they are frequent and costly.

Researchers analyzed data from the 2013 Nationwide Readmissions Database and identified index readmissions for adults 18 and older who had an unplanned readmission within 30 days of discharge. The JAMA study excluded index admissions for patients who expired, left against medical advice, were transferred, or had a stay that occurred in December (data for 30-day readmissions not available for this month). Researchers also considered the proportion of AMI, heart failure, pneumonia, and COPD cases that may overlap with a sepsis diagnosis.

Sepsis accounted for 12.2% of index readmissions within 30 days, with heart failure trailing at 6.7%, pneumonia at 5.2%, COPD at 4.6%, and AMI at 1.2%. In addition, the average cost of a sepsis readmission was found to be $10,070, compared to $9,533 for pneumonia, $9,424 for AMI, $9,051 for heart failure, and $8,417 for COPD.

Editor’s Note: This article originally appeared in Revenue Cycle Advisor on February 14, 2017. To read the original article, click here.

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Volume 11, Issue 8

News: CMS releases projections of national health expenditure date

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The national health expenditure growth is expected to average 5.6% annually over 2016-2025, according to a report published by Health Affairs and authored by CMS’ Office of the Actuary, CMS reported. It is projected to outpace the projected growth in Gross Domestic Product (GDP) percentage points, resulting in the health share of GDP to rise from 17.8% in 2015 to 19.9% by 2025, largely due to the projected growth in medical prices. Total health spending is projected to have reached nearly $3.4 trillion for 2016, a 4.8% increase from 2015. The report also found that by 2025, federal, state and local governments are projected to finance 47% of national health spending, a slight increase from 46% in 2015.

Additional findings relating to the total national health spending growth, Medicare, private health insurance, Medicaid, medical price inflation, prescription drug spending, and the insured share of the population, were also reported.

To read the full report, click here. To read CMS’ news release, click here.

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Publication: 
Volume 11, Issue 8

Membership Update: February Conference Call recording posted

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We hope you enjoyed the February 16 Quarterly Conference call. During this call the ACDIS Advisory Board addressed:

  • Sepsis-3
  • Vidant response to OIG audit findings regarding malnutrition
  • Escalation policies and verbal query compliance
  • How to handle "NSTEMI Type 2"
  • Patent Foramen Ovale (PFOs) and congenital guideline advice

This is an ACDIS membership benefit and only available to ACDIS members. Note: This call qualifies for one (1) continuing education credit for Certified Clinical Documentation Specialist (CCDS) holders. To obtain this credit you must visit the quarterly conference call page and complete the CEU survey. A certificate will be emailed to you.

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Volume 11, Issue 8

News: Whistleblower suit accuses UnitedHealthcare of improper billing

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A False Claims Act lawsuit accuses UnitedHealthcare Group of a scheme which may have allowed its subsidiaries and other insurers to improperly overcharge Medicare by “hundreds of millions — and likely billions — of dollars,” The New York Times reported.

Benjamin Poehling finance director for UnitedHealthcare Medicare and Retirement (a Medicaid Advantage affiliate) originally made the accusations in 2011 claiming that senior leadership created “a corporate culture that demands and rewards financial success from its employees,” by asking them to ensure patients looked sicker than they really were. The sicker the patient, the higher the reimbursement. 

The complaint released this week by the Department of Justice (DOJ) enumerates the ways in which UnitedHealthcare engaged in “systematic fraud.” Two specific accusations include:

  • “Upcoding” risk adjustment claims by submitting claims for diagnoses that the patient does not have or for which the patient was not treated in the relevant year, or by claiming that a patient was treated for a more serious condition than the member actually has
  • Refusing to correct previously submitted risk adjustment claims when defendants discover, or in the exercise of reasonable care should discover, that those previously submitted claims were false

Medicare Advantage rules require in-person verification of clinical indicators on a regular basis by a qualified professional to qualify for risk adjustment factors.

An email message from Poehling’s division chief financial officer, Jerry Knutson, attached to the complaint urges staff members “to really go after the potential risk scoring that you have consistently indicated is out there.”

“Let’s turn on the gas!” Knutson’s email states. “What can we do to make sure we are being reimbursed fairly for the members and risk we take on more than what we are currently doing.”

The DOJ is currently investigating accusations against UnitedHealthcare and WellMed Medical Management (acquired by UnitedHealthcare in 2011). While the two suits are separate, the Justice Department reserves the right to combine them should they see fit.

Editor’s Note: To read a more in-depth look at the ongoing investigation, read the article by the New York Times, here. To read Poehling’s complete complaint, click here.  

Publication: 
Volume 11, Issue 9

News: Vidant provides firm rebuttal to OIG findings related to malnutrition

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Accused of misreporting malnutrition in a January 2017 OIG audit, Vidant Medical Center, a 909 bed acute care teaching hospital, fought back with a collaborative rebuttal of the findings published alongside the original audit results.

The OIG found Vidant owed $1,403,132 in improper payments for codes 261 and 262 relating to malnutrition marasmus. Vidant refuted each OIG claim in turn, step-by-step, highlighting CMS’ auditors lack of uniform clinical criteria and demonstrating its own industry-supported criteria for malnutrition diagnoses.

“Reviewers failed to use any identifiable guidelines for the assessment and diagnosis of malnutrition, such as the Academy of Nutrition and Dietetics (AND)/American Society for Parenteral and Enteral Nutrition (ASPEN) Guidelines,” Vidant’s rebuttal states.

“Marrying the clinical and coding requirements was a really strong part of their rebuttal,” Cheryl Ericson, MS, RN, CCDS, CDIP, manager of clinical documentation services for DHG Healthcare in Charlotte, North Carolina, said during last week’s ACDIS Quarterly Conference call. “It’s great that Vidant says they use ASPEN criteria.”

Facilities should establish set criteria for difficult diagnoses. For malnutrition, ASPEN represents a national standard although facilities can work with their physicians, coders, and CDI professionals to define clinical standards for their use incorporating appropriate references and supportive documentation. “You do need a consensus for the criteria you’re using though,” Ericson said.

Additionally, Vidant’s rebuttal took a collaborative approach, bringing “a team of more than 20 people, including physicians, HIM representatives, coders, dietitians, and compliance experts,” who carefully reviewed all 100 claims included in the OIG sample. The rebuttal complains that its team of 20 “spent close to four full days with them reviewing on a chart-by-chart basis” when the OIG auditors came onsite the week of June 6, 2016.

“The collaboration amongst the team with the rebuttal is really good for the industry,” Anny Yuen, RHIA, CCS, CCDE, CIP, VP of revenue cycle at R3 Health Solutions in Miami, Florida, said during the Quarterly Call. There was a time when CDI specialists tended to work in silos, but the best approach to an audit rebuttal is through collaboration.

Nevertheless, after reviewing the hospital’s comments, the OIG maintained that its findings and recommendations were valid for all 89 claims found to be in error.

Editor’s Note: To read the full OIG audit report and Vidant’s rebuttal, click here. To listen to the ACDIS Quarterly Conference Call and hear the further discussion amongst the board on this topic, click here.

Publication: 
Volume 11, Issue 9
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OIG audit findings

News: CMS awards approximately $100 million to help smaller practices with the quality program

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CMS awarded roughly $100 million in aid to 11 small physician practice organizations to help meet Quality Payment Program (QPP) initiatives, according to a February 17 news release.

The educational efforts will focus on practices in rural, health professional shortage, and medically underserved areas providing assistance with choosing and reporting various quality measures as well as broader education all QPP aspects.

In addition, CMS also offers free webinars and in-person presentations as well as a helpline for all things QPP related.

Publication: 
Volume 11, Issue 9

News: 2016 revenue goals proved elusive for many physician practices

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More than a quarter of physician practices fell short of revenue goals in 2016, according to a poll released January 17 by the Medical Group Management Association, Physician Practice Insider reported.

The poll, which gathered more than 1,000 responses, asked respondents whether or not 2016 net revenue goals were met. A plurality (30%) said revenue fell short; however, 29% said their practices exceeded revenue goals. Rounding out the top three, 27% said 2016 revenue was on target.

Editor’s Note: This news brief originally appeared in the February 21, 2017, issue of the Physician Practice Insider. The original article can be accessed here.

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Volume 11, Issue 9

News: ICD-10-CM codes for reporting diseases of the musculoskeletal system in 2017

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The codes in ICD-10-CM Chapter 13, Diseases of the Musculoskeletal System and Connective Tissue, cover diagnoses for conditions throughout the body. Due to the wide scope of conditions in the chapter, it had extensive updates for 2017, Just Coding reported.

The changes encompass a number of codes relating to the musculoskeletal system, including:

  • M04.-, cryopyrin-associated periodic syndromes and other autoinflammatoy syndromes
  • M21.61-, M21.62-, bunions and bunionettes
  • M26.60-, M26.61-, M26.62-, M26.63-, temporomandibular joint disorders
  • M50.-, cervical disc disorders
  • M62.84, sarcopenia
  • M84.-, atypical femoral fracture
  • M97.-, periprosthetic fractures

Just Coding suggests reviewing these various code changes to see what new details need to be documented to help the coders document the most appropriate codes.

Editor’s Note: To read the complete list and explanations of the code updates to ICD-10-CM Chapter 13, read Just Coding’s article here.

Publication: 
Volume 11, Issue 9

Membership Update: Quarterly Conference Call posted

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We hope you enjoyed the February 16 Quarterly Conference Call. During this call the ACDIS Advisory Board addressed:

  • Sepsis-3
  • Vidant response to OIG audit findings regarding malnutrition
  • Escalation policies and verbal query compliance
  • How to handle "NSTEMI Type 2"
  • Patent Foramen Ovale (PFOs) and congenital guideline advice

ACDIS Quarterly Conference Calls take place the third Thursday of each quarter as a benefit of membership. Remaining 2017 calls include:

  • May 18
  • August 17
  • November 16

All calls take place at 1 p.m., eastern. ACDIS members are notified of registration details via email one week prior to the call. Registration details are also available on the Quarterly Conference Call page on the ACDIS website roughly one month prior to the call.

Quarterly Conference Calls qualify for one (1) continuing education credit for Certified Clinical Documentation Specialist (CCDS) holders. To obtain this credit you must complete the keysurvey link located on the Conference Call page.

If you are not receiving ACDIS membership information please contact our customer service department customerservice@hcpro.com to make sure we have the most recent, correct email address for you.

Also, if you have completed the keysurvey link for your CE but did not receive a certificate by email, please double check that you entered the correct email address into the survey. ACDIS received a number of automatic undeliverable replies due to typos and firewalls. Using your own, personal email address (e.g., Gmail, yahoo, or other) rather than your facility/work address often works best to avoid spam filters.

ACDIS Advisory Board members always enjoy assisting members. If you have a question you’d like to get their insight on, please email ACDIS Editor Linnea Archibald at larchibald@acdis.org.

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Volume 11, Issue 9

Membership Update: CDI Journal coming soon, your voices wanted

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Unfortunately, the January/February edition of ACDIS’ CDI Journal has been delayed but not to worry, we expect to publish it shortly and know members will appreciate insights regarding CDI priorities for 2017, analysis of changes in physician query policies and procedures, tips for remote CDI efforts, and recommendations for handling shifts in your facility’s case mix index.

Also stay tuned for the forthcoming March/April edition of the Journal which explores CDI efforts related to quality measures such as present on admission, patient safety indicators, and the effect of record reviews for quality on publically reported data.

Finally, we wanted to let you know about our editorial calendar for the remainder of 2017. These are the topics we’ll be delving into:

  • Regardless of setting: An exploration into non-acute care setting CDI
  • Summer reading: Strategies for providing CDI training to a variety of stakeholders
  • Payment shifts: Tools to adapt to a changing reimbursement landscape
  • Strategies for denials management

If you’d like to be interviewed or contribute to the CDI Journal in anyway please contact ACDIS Editor Linnea Archibald at larchibald@acdis.org

Publication: 
Volume 11, Issue 9

Local Chapter Updates: Find a chapter near you by attending an upcoming event

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It’s been an exciting week for local chapter activities so far. More than 100 CDI-related professionals from the states of Wisconsin and Minnesota joined ACDIS Associate Editorial Director Melissa Varnavas via webinar to discuss career ladder opportunities and productivity expectations on Wednesday.

On Friday, the Alabama ACDIS Chapter meets in Tuscaloosa welcoming nearly 60 professionals at its networking event. Furthermore, the South Carolina and North Carolina ACDIS Chapters meet Friday, as well. They’re expecting more than 120 attendees and have presentations with well-known speakers including Don Butler, Cheryl Ericson, and Fran Jurcak.

Good luck and have fun everyone!

The following is a list of all the upcoming events for ACDIS local chapters. If you have an upcoming event you would like to include, please email Melissa Varnavas (mvarnavas@hcpro.com) and Linnea Archibald (larchibald@hcpro.com).

February

  • The Alabama ACDIS Chapter meets Friday, February 24, 9 a.m. to 3 p.m., at DCH Regional Medical Center in Tuscaloosa. For information, email acdisalabama@gmail.com or contact Jeffrey Wayne Morris at jwmorris@health.southalabama.edu.
  • The North Carolina and South Carolina ACDIS chapters join forces for a group event on Friday, February 24, 8:30 a.m. to 4:30 p.m., at Palmetto Health Baptist in Columbia. Presentations feature former ACDIS Advisory Board members Fran Jurcak on preparing for the CCDS exam, Cheryl Ericson on the future of CDI profession, and Don Butler on the role of physician advisors in CDI efforts. The program also features a presentation on CDI specialists place at interdisciplinary rounds with Holley Pegram, Sandie Pressely, and Kay Blue. For information, contact the NC ACDIS Chapter at ncacdis@gmail.com.

March

  • The pediatric networking group APDIS meets Thursday, March 2, via webinar. For information, contact Leah N. Savage, at Leah.Savage@nortonhealthcare.org
  • The Indiana ACDIS Chapter Spring Conference takes place Saturday, March 4, at St. Vincent Hospital in Indianapolis. For information, contact Lee Walton at LAWalton@stvincent.org.
  • The Kansas City Missouri ACDIS Chapter meets Tuesday, March 7, at 2-4 p.m., at Liberty Hospital. For information, contact Christine Schattenfield, cneuman@saint-lukes.org.
  • Tennessee ACDIS Chapter co-leader Sherri Clark, BSN, RN-BC, CCDS, CCS, heads to Knoxville Convention Center on March 8, where she participates on a panel discussion titled 'The powerful impact of CDI & Coding on Quality Reporting: Core Measures, PSIs, Outpatient CDI.” For more information, visit http://thima.org/annualmeeting/.
  • The Connecticut ACDIS Chapter meets Thursday, March 9, 1:30-3 p.m., at The Hospital of Central Connecticut in New Britain. For information, contact Nancy Napolitano napolitanonancy@hotmail.com.
  • Leaders of the Washington ACDIS Chapter will head to Spokane to join the Washington AHIMA leaders for its annual conference event March 16-18 at Red Lion at the Park. For more information, visit http://www.wshima.org/annualmeeting/.
  • The Arizona ACDIS Chapter meets Wednesday, March 22, 5:30-8:00 p.m., at Mimi’s Café at Desert Ridge in Phoenix, to discuss end stage liver disease with hepatic encephalopathy. For information, contact Alma Yap at rnalmay@gmail.com.
  • The Ohio ACDIS Chapter meets March 23 at the University Hospitals’ customer service center in Highland Heights. For information, contact Lisa McLuckie at lmcluckie@wchosp.org.
  • The Massachusetts ACDIS Chapter meets Thursday, March 30, 11 a.m. to 2 p.m., at The Miriam Hospital in Providence, Rhode Island. The is at capacity but the team is currently taking a waiting list. If you previously RSVP’d but cannot attend please notify leadership to make room for others. For information, contact Joyce M. Williams, at JWilliams@Lifespan.org.

Save the date

  • The St. Louis Missouri ACDIS Chapter meets April 19, 6:30-8 p.m., at St. Luke’s. Outside food/drink is against hospital policy, so no pot luck this time. For information, contact Michael McKelvey, michael.mckelvey@bjc.org.
  • The California ACDIS Chapter holds its third-annual conference Friday, September 15, 8 a.m. to 4 p.m., at Torrance Memorial Medical Center. For information, contact Rani V. Stoddard at stoddardrv@henrymayo.com.  
  • Missouri’s three ACDIS local chapters join for a full-day conference event on October 14, at the University of Kansas Hospital. For information, contact michael.mckelvey@bjc.org.
Publication: 
Volume 11, Issue 9

CCDS Update: Is your CCDS up to date?

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Roughly 100 previous Certified Clinical Documentation Improvement (CCDS) holders failed to recertify in a timely manner, and were recently reclassified as inactive.

CCDS holders need to maintain their certification, earning 30 certified education units (CEU) toward the CCDS every two years on the anniversary of the date on which they passed the exam. For information regarding recertification, click here.

ACDIS membership provides up to 10 of those annually through the following methods:

  • Six CEUs for reading the CDI Journal and completing the associated quiz
  • Four CEUs for listening to the Quarterly Conference Call and completing the associated survey

CCDS holders are responsible for ensuring their certification is active.

Don’t confuse renewing your ACDIS membership with recertifying your credential.

If you have any questions regarding CCDS and recertification, please email Penny Richards at prichards@acdis.org.

 

Publication: 
Volume 11, Issue 9

Membership Update: Please take a moment for JustCoding’s product survey

News: Study shows nearly 10% improper payment rate for radiation oncology services

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Radiation oncology services billed to CMS had a 9.6% improper payment rate in 2015, leading to Medicare improperly pay $137 million for these services, according to a study reported in the January 2016 Medicare Quarterly Compliance Newsletter, JustCoding reported.

Radiation therapy may be administered in outpatient clinics and services may be billed based on the Healthcare Common Procedure Coding System (HCPCS) codes. Those working with radiation therapists should review codes highlighted by the study, including:

  • 77300, basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off-axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician
  • 77301, intensity modulated radiotherapy (IMRT) plan, including dose-volume histograms for target and critical structure partial tolerance specifications

Code 77301 requires a treatment plan developed by the physician, medical physicist, and dosimetrist and is required for the delivery of IMRT, according to CMS. One of the leading causes of improper payment for these services was lack of documentation, including the radiation therapy plan. Other items missing from the medical record included:

  • The physician’s signature
  • The signature log or attestation for an illegible signature
  • The correct date of service
  • The documentation submitted did not adequately describe the service defined by the HCPCS code

Editor’s note: This article originally appeared in JustCoding, here. For more information, see the Medicare Claims Processing Manual or read the Medicare Quarterly Compliance Newsletter for an example and more CMS resources. 

Publication: 
Volume 11, Issue 10
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