CDI Review Rate and Query Rate

m.leblancm.leblanc
in CDI Talk Archive
Currently our 8+ year old program reviews all payors and sets a review rate of 80%. We prioritize Medicare and Medicaid and strive for 100% review before moving to other payors. Our current Query rate is set on a range from 15% to 25%. I am interesting to hearing what other programs are using as their benchmark around Review Rate and Query Rate?

Comments

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    We have only 2.9 FTEE for a 4 campus site - so, we sample, trying to cover a sampling of all payers. Our rough query rate is also 'about ' 15% or so. Our expectation is to review about 20 cases daily, providing for new cases as well as follow-up.

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org

  • robert.hodges2robert.hodges2
    edited May 2016
    Have you looked at the numbers in the 2013 Physician Query Benchmarking Survey on the ACDIS website? The last couple of pages may help address your question.



    http://www.hcpro.com/acdis/details.cfm?topic=WS_ACD_JNL&content_id=294678



    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



    VA Core Values: Integrity, Commitment, Advocacy, Respect, Excellence (“I CARE”)

    VA Core Characteristics: Trustworthy, Accessible, Quality, Innovative, Agile, Integrated



    "We are dealing with Veterans, not procedures; With their problems, not ours." --General Omar Bradley



  • afeighnerafeighner
    edited May 2016
    I am the only reviewer in an 150 bed hospital. I review all the Medicare charts M-F and see about 15-30+ charts/day (including new and review cases) . My query rate is between 15-20 %. We are looking to possibly expand to other payers as well, with the possible addition of another reviewer.

    Amber L. Feighner RN MSN
    Clinical Documentation Improvement Specialist
    Blanchard Valley Hospital
    1900 South Main Street
    Findlay, Ohio 45840
    419-425-5787

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    I might add I feel our query rate of about 15% is on target as we have a mature program. We seek to query only if/when our internal criteria for a condition are met and also we wish to be prudent each time we leave a query. We query for MS-DRG changes, APR-DRG changes, and also for educational opportunities that we know beforehand will not affect any reimbursement. I am making this statement about our query rate as some have indicated a desired goal should be set much higher - I tend not to agree with a blanket number given the number of variable, the prime consideration is the initial qualify of documentation reviewed as well as the longevity of the CDI process.

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org


  • afeighnerafeighner
    edited May 2016
    That is our exact policy as well. We query for MS DRG changes as well as APR DRG and SOI and ROM showing the physicians how their documentation affects the level of severity of their patients that is reported out. Education is an ongoing process for me as I am rolling out the ICD-10 queries to our Hospitalist and specialty groups and educating on the additional documentation that will be required. So far they are very receptive, fingers crossed that they remain that way.

    Amber L. Feighner RN MSN
    Clinical Documentation Improvement Specialist
    Blanchard Valley Hospital
    1900 South Main Street
    Findlay, Ohio 45840
    419-425-5787

  • Unknown
    edited May 2016
    Amber, I am right with you. We have about 160 beds and I am one. My review rate and query placement is equivalent to yours. I review based on percent payer. We are about 60% Medicare 40% other, so I review accordingly. Makes a compliant mixed, not focusing solely on one payer.




    Charlene Thiry RN, BSN, CPC, CCDS
    Clinical Documentation Specialist
    Quality Resources
    Menorah Medical Center


  • vanessa.falkoffvanessa.falkoff
    Hi,
    We review all Medicare and DRGs payors (of which we have quite a few) with a goal of 85-95 % review. We usually are at 95% or above. We have a goal of 15-20% for Medicare queries, and 10-15% for DRG payors. We also review 20-25% of other cases in the ICU/CCU and Trauma units. We have 2 full time RNs and one analyst/Jill of all trades for 475 bed county hospital.

    Vanessa Falkoff RN
    Clinical Documentation Coordinator
    University Medical Center
    Las Vegas, NV
    vanessa.falkoff@umcsn.com
    office 702-383-7322
    cell 702-204-0054
  • afloydafloyd
    We have a 400 bed system with 4 RNs. We see all payors with emphasis on Medicare and Medicaid. We have a review benchmark of 85% but are routinely 98-100% since we follow up with inpatient and discharged patients. We have a benchmark query rate of 20% but are usually at a 26-30% query rate. We have been in place since 2009 so are still trying to get a firm footing with our program.

    April Floyd, RN, CCDS
    Anderson RMC
    Meridian, MS
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