Expanding to ED/outpatient

katysuegood@gmail.com

Hi all!

There has been some recent discussion in my facility about expanding to the ED/ outpatient arena. I’m trying to get some baseline info and am hoping someone will be able to answer my questions.

1. Which outpatients do you review (OBS status, ED, outpatient surg, ancillary?).
2. What are you reviewing for primarily? Since these are not paid on a DRG system, I am assuming the focus is different.
3. How do you expect ICD-10 to impact reimbursement of outpatient records and how does this impact your review process?
4. What resources did you sue when implementing this process? Is there any training available?

Any information would be greatly appreciated. I know very little about this and would love any input.

Thanks!!


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

paxneros

I would be interested in this informations as well. Must be a hot topic!

Thank you,

Norma T. Brunson, RHIA,CDIP,CCS,CC

sbaine

Hello,

will try to answer your questions below:

1. Which outpatients do you review (OBS status, ED, outpatient surg, ancillary?).
a) we currently do not review outpt services unless a question arises regarding reimbursement held due to insufficient documentation. Often it boils down to diagnosis lacking clarity for charges billed.

2. What are you reviewing for primarily? Since these are not paid on a DRG system, I am assuming the focus is different.

a) see above. We did educate MDs, staff nurses on documentation requirements from CMS for outpatient and observation services that validate the reasoning behind the observed time and care provided.

3. How do you expect ICD-10 to impact reimbursement of outpatient records and how does this impact your review process?

a) we expect a harsher look by CMS for redundancies in billing charges, charges not meeting guidelines for part B charges. It may entail an addtl FTE to cover outpt services for a definitive review if we see patterns of reimbursement denials.

4. What resources did you use when implementing this process? Is there any training available?

a) not there yet but plan on building current inpatient knowledge level with more knowledge on outpt services for CMS.

Good Luck and hope this helps. Just an FYI. we are implementing a Case Manager in the ED and that person will be taught principles of documentation validation/clarification from the CDI perspective to assist with the decision making of in-patient versus observation versus outpatient in a bed status by physicians.

katysuegood@gmail.com

So are most efforts focused on correct assignment and documentation to support IP vs OBS status? Are you involved in ensuring comprehensive documentation that would impact potential denials of patients that were not moved to IP?
We have a fairly robust UR team that handles the IP/OBS issue and we are also using EHR (executive health resources) to aid in that decision and the required documentation to support it.

Thanks for your responses!

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

Unknown

Sounds like people are thinking outpatient CDI centers around observation versus inpatient which is a step in the right direction. The piece that is missing is a true CDI initiative that addresses significant documentation deficiencies in operative reports and other commonly sighted documentation shortfalls contributing to self-inflicted denials, the likes of wound care, HBO therapy, pain management injections (ESI), expensive drug therapies (Remicade, Reclast, IVIG,etc.), and common procedures such as lesion removals, colonoscopies, nuclear medicine scans, blepharoplasty, to name many. There is much opportunity for CDI improvement here. The challenge is getting started.

There is going to be a session on outpatient CDI initiatives in May at the national conference. You may wish to attend.

katysuegood@gmail.com

Thanks! Yes, this is the part I am very unclear on. I (very unfortunately) will likely be in the middle of a cross country move during the conference, but we are hoping to send someone from our team.

Thanks for the info!!

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

Unknown

I am also very interested in the outpatient arena. At this point we have barely gotten our feet wet in the ED and I fought for that presence. Our leadership has yet to understand the far-reaching ability of a strong CDI team or the true value of specificity in documentation. They are still rooted in cc/mcc capture.
Presently, we are only in ED so I cannot speak to the outpatient aspects. But, I have every intention of attending that session at the conference. I already had my eye on it:) Thanks for that feedback!
-Jane

Unknown

Jane, I think the speaker who is presenting will be good.