Pre bill review

laura.mancinilaura.mancini
in CDI Talk Archive
I was unable to attend this year's ACDIS Conference but one of our facilities did send a rep and she gave a summary of some key points she shared in a recent meeting. She mentioned there were some mature programs that performed retrospective/pre-bill reviews post discharge. Unfortunately she didn't remember specific facilities since there were so many representatives from so many facilities.

For those programs that have a similar position would you be willing to share your job description.

Thanks!

Comments

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    I'm not sure if this is exactly what you are referring to but...

    I personally review every record in which the patient died in the hospital. I review them after they have been draft coded but before the coding has been released to the billing department. The charts are on hold until I release them to be billed. The focus is slightly different. I am primarily focused on SOI/ROM as well as ensuring the correct Pdx. While I am not responsible for the coding, I also look closely at certain issues like complication codes. It is just a part of my job and we initiated it a little over a year ago. It is time consuming and I would estimate that I send about 30% of my time on it. How this is performed and tracked has changed over time. Initially all reviews were done directly with the coding manager (literally looking at each record together) and we had a spreadsheet. Now, we have developed a worklist in MIDAS where I track/input all the data and I do all the reviews independently and just bring in the coding manager for coding issues that are over my head. We are not a "mature" program but this was a priority for our facility.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • dvitalone1dvitalone1
    edited May 2016
    We look at records that are discharged but not coded when they are referred to us (CDI RNs) by the coders. There are only certain cases where coders refer to CDI for a "second opinion" based on DRG:

    Death cases without MCC/CC
    TIA as PDx
    Stroke cases without MCC/CC
    Acute resp Failure as PDx
    Any symptom as PDx

    Hope this helps.
    [cid:image001.jpg@01CD4F9C.76D1B600]
    Dawn M. Vitalone, RN
    Clinical Documentation Improvement Specialist
    Community Hospital
    Munster, IN 46321
    dvitalone@comhs.org
    219-513-2611

  • elizabeth.hyndelizabeth.hynd
    edited May 2016
    We look at the same with the addition of surgical cases without cc/mcc and pneumonia's to see if we can get specificity on the type.

    Elizabeth Hynd RN, BSN, CPUR
    Clinical Documentation Specialist
    863-687-1100 ext. 7313

Sign In or Register to comment.