CDI Strategies - Volume 10, Issue 4

News: CMS underpays Medicare Advantage plans for treating chronic conditions

January 28, 2016
News, Quality & Regulatory

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 »
CDI Journal - Volume 10, Issue 4

Ask ACDIS: Seeking clarification on diabetes advice

July 1, 2016
Ask ACDIS, Clinical & Coding

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 »
CDI Journal - Volume 10, Issue 4

Coding Clinic for CDI: Deciphering diabetes documentation advice

July 1, 2016
ACDIS Guidance, Clinical & Coding

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 »
CDI Strategies - Volume 10, Issue 4

Q&A: How can we ensure the right documentation for a level of care recommendation?

January 28, 2016
Ask ACDIS

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 »
CDI Journal - Volume 10, Issue 4

Risk adjustment and CDI: A natural evolution

July 1, 2016
ACDIS Guidance, CDI Expansion

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 »
CDI Journal - Volume 10, Issue 4

Physician Advisor's Corner: The ‘new’ DRG denial strategy

July 1, 2016
Clinical & Coding, Quality & Regulatory

by Trey La Charité, MD

I have previously addressed the issue of auditor denials. However, given the industry changes I have witnessed in the last 12–18 months, it is time to revisit  this problem. And, per communications with colleagues in the CDI world, I suspect the same...Read More »
CDI Journal - Volume 10, Issue 4

From the Forum: Manage denials for BMI morbid obesity

July 1, 2016
ACDIS Guidance, Clinical & Coding

by Katherine Rushlau

When Dee Banet, RN, MSN, CCDS, CDIP, and her CDI team sent out a claim for a surgical patient with body mass index (BMI) greater than 40 with morbid obesity as a secondary diagnosis, they did not expect the claim to be denied; after all they...Read More »
CDI Journal - Volume 10, Issue 4

Meet a Member: Triathlon athlete loves continued learning

July 1, 2016
ACDIS Guidance

Melinda Scharf, RN, BSN, CCDS, CCS, regional clinical documentation integrity educator at St. Joseph Hospital in Irvine, California, has worked in CDI since 2008 after serving as a pediatric nurse for 10 years and an ER nurse for 11.Read More »

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