Everyone working in CDI knows that the job would be much easier without physician pushback—but that’s an unrealistic pipe dream, it seems. Year after year, ACDIS’ surveys turn up the same results: The number one challenge for CDI programs is always physician engagement.
Outpatient has been the buzzword in CDI circles for some time now, leading to increased resources for the expansion (such as the first annual ACDIS Symposium: Outpatient CDI, the Outpatient CDI Pocket Guide: Focusing on HCCs, and First Steps in Outpatient CDI: Tips and Tools for...Read More »
by Trey La Charité, MD, FACP, SFHM, CCS, CCDS
In 2015, I wrote 44 appeal letters challenging DRG validation/coding denials. In 2016, I wrote 88 appeal letters. Last year, I penned 159. We already received more than 40 DRG validation denials in January of this year. Does this trend...Read More »
Outpatient. Hierarchical Condition Categories (HCC). Quality. Value-based purchasing. Pediatric. Interdisciplinary, integrated CDI response and analysis. Such topics have been the buzzwords of the industry for many years, and for good reason.
Regulatory shifts associated with the 2010...Read More »
ACDIS currently has more than 40 state and local chapters as well as networking interest in the Eastern Mediterranean, Australia, the Bahamas, and elsewhere. In addition to these geographically based educational offerings, ACDIS also supports topic-focused efforts such as the CDI educators’...Read More »
All short-term acute care facilities earn reimbursement from Medicare according to the inpatient prospective payment system (IPPS), right? And all outpatient facilities obtain reimbursement according to the rules in the outpatient prospective payment system (OPPS), correct?
Because of payers’ propensity for denials, facilities need to have a process in place for managing denials’ root causes on the front end and appealing them on the back end. This, however, can involve a lot of hard work and headaches.
By Cheryl Manchenton, RN, BSN
From a bird’s–eye view, your CDI program may be a well-oiled machine. CDI specialists pose queries, physicians respond, and coders assign the most accurate and specific codes. But, what happens as your organization continues its journey from volume-...Read More »
