Clinical documentation improvement (CDI) specialists and case managers share a common goal but often are not on the same page when it comes to improving documentation within the hospital, says Glenn Krauss, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, director of enterprise solutions for Zirmed, in...Read More »
Providence St. Peter Hospital in Olympia, Washington, has had a successful inpatient CDI program for seven years. In spring 2014, the facility, which encompasses 32 clinics and two acute care hospitals, began discussing CDI in the ambulatory setting, says...Read More »
For CDI specialists, the daunting landscape of changing healthcare initiatives may seem like a broad expanse of impenetrable woods. It's an ecosystem which includes quality-based initiatives related to readmission reductions, 30-day mortality, Patient Safety Indicators, complications, present on...Read More »
CMS underpaid Medicare Advantage plans for the cost of treating patients with multiple chronic conditions, which the organization admitted to in November. However, a new report from healthcare consulting company, Avalere Health, shines a light on some of the specifics. Read More »
Q: I am looking for additional clarification regarding the recent AHA Coding Clinic for ICD-10-CM/PCS concerning diabetes and the use of the word “with.” While the examples often used in Coding Clinic are specific, the actual...Read More »
Call me unorthodox, but let’s start at the back of the latest edition of the American Hospital Association (AHA)’s Coding Clinic for ICD-10-CM/PCS for this review. Here, on pp. 36–37, we have the clarifications, including some potentially confusing—and possibly conflicting—information...Read More »
Q: As part of an integrated access management program, what medical documents are needed to perform a medical necessity review so that the access care coordinator (ACC) can offer a level of care recommendation to the physician?Read More »
Healthcare reimbursement is changing; both CMS and private payers are working toward payment methodologies that reflect quality of care versus quantity of care. In most cases, quality is measured based on patient outcomes. The concept of risk adjustment is now being applied to healthcare...Read More »