Medical Necessity

acarducc@montefiore.org

Do your CDI nurses speak with physicians about improving medical record documentation to support the medical necessity of an inpatient stay or to support upgrading an observation case to inpatient status??


Ann-Marie Carducci, RN, MPA, CPHM, CPHQ, CPC, CCS, CCDS
Director, Utilization Management
Montefiore Medical Center
914-377-4678 - Yonkers Office
718-904-2695 Einstein Office
917-574-6781 - Cell
email: acarducc@montefiore.org

robert.hodges2

I do it in an informal way. Having a case management/UR background I
know what is needed to justify stay so when I see a long stay I start
looking harder at the chart for the medical reasons to justify the stay.
I also communicate daily with the UR nurses here and give them my
working DRG and GMLOS for each patient. We have also discussed common
issues and concerns and I have put those in my biweekly newsletter to
help educate the providers.


It's all a team approach here especially since we all know that
documentation is at the core of taking credit for the care we provide.


Robert


Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov


"Patriotism is easy to understand in America; it means looking out for
yourself by looking out for your country" Calvin Coolidge

paxneros

Like Robert, we speak informally with our physicians regarding Medical
Necessity. I include it with educational meetings and, at times, under the
right circumstances incorporate it into my queries

Medical Necessity is important for many areas. If Diagnoses and treatments
are not supported by documentation it can impact what can be included for
coding and reimbursement.

N. Brunson, RHIA, CDIP, CCDS

evanspx@sutterhealth.org

We provide scheduled seminars for our Medical Staff for the topic of Observation – how to order, when to utilize, and so forth. However, given one must interact on day one of the encounter (when observation is being considered or should be ordered), we do not ‘routinely’ address the topic of Observation as we perform CDI reviews. We schedule CDI reviews for 24-48 hours after admission in order to allow sufficient time for the review of studies and subsequent informed documentation of known or suspected diagnoses.



Paul Evans, RHIA, CCS, CCS-P, CCDS

Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org

vdavis2

We do assist when we can! We help review charts, educate physicians, and write appeal letters for medical necessity cases as well. We also went through Interqual training with our Case Managers and Intake Teams.

Vicki S. Davis, RN CDS
Clinical Documentation Improvement Manager
Health Information Management Department
Alamance Regional Medical Center
Office (336) 586-3765
Ascom Mobile (336) 586-4191
Fax (336) 538-7428
vdavis2@armc.com

"The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens

kshumpert

I incorporate medical necessity for inpatient into my annual documentation reviews. Each physician with >50 admissions per year is required to meet with me as a component of re-credentialing. Additionally, I am required to meet each new physician (including ED) for CDI purposes and I include medical necessity. When I do the yearly sessions, I also touch base with case management and see if they have any physician issues and I incorporate those as well. I write all appeals for RAC and assist our Chart Auditor with any additional appeals.

Kathy Shumpert, RN, BSN, CCDS

Clinical Documentation Improvement Specialist
Community Howard Regional Health
Office 765-864-8754
Cell phone 765-431-0123
Fax 765-453-8447