CDI &/Or Query Auditing

dbutler

In the recent ACDIS On-line Poll ("What is your process/policy for ensuring that physician queries are compliant (i.e., non-leading)?" about 6% indicated they use an outside consultant.

I would be VERY interested in getting more information about this--
*What consultant provides this service?
*What percentage of cases and how are those choosen?
*What information is communicated back as far as findings or recommendations?
*What standard(s) does the consultant apply as far as the total CDI review performance as well as compliance (especially query standards)?
*What is the total service?

ANY information shared would be welcomed.

Please contact me directly if you would like to have your response confidential.

Thanks,
Don

Donald A. Butler, RN, BSN
Manager, Clinical Documentation
PCMH, Greenville NC
dbutler@pcmh.com

sbeatty

We initiated CDIP with 3M. They annually came back for education
regarding the ICD-9 October updates, and audited charts we reviewed to
evaluate coder and reviewer performance. Our queries were part of that
audit and they were evaluated for compliance with AHIMA standards, I
believe. I can't say that I actually heard what the standards for query
compliance were that they used-if I heard, I've forgotten. The number of
cases requested were usually about 50, making up less than 10& of
reviewed cases but >30 charts to be a statistically valid sample. We
sent a list of all Medicare admissions, and that was analyzed against
the cases we actually reviewed. The targeted cases were those with CC or
in later years, MCC/CC opportunity, as well as DRG pairs such as those
identified in the PEPPER report. The results of this survey were
communicated to a combined reviewer/coder meeting with our managers
present. We all then heard what was going well and where our
opportunities for improvement lay. We were measured against the MEDPAR
80th percentile, which we decided would give us the best benchmark and
adjust for any coding errors being made in other organizations, thereby
impacting the MEDPAR database.

I hope that description is helpful. We no longer have a contract with 3M
for these consultative services. We hire our own independent auditor to
review a sample of our cases for coding and CDI compliance. We have
discussed purchasing the MEDPAR data ourselves and generating our own
reports. We established early on that we had a positive impact on
severity, risk and coding specificity. We now focus on a quality
experience for the patient with our contribution being a specific and
accurate medical record. The reimbursement will be appropriate is we do
our jobs correctly. What that amount is becomes immaterial.

Sandy Beatty, RN, BSN, C-CDI
Columbus Regional Hospital
2400 E. 17th Str.
Columbus, IN 47201
(O) 812-376-5652 (M) 812-552-6997


"Great leaders are almost always great simplifiers, who can cut through
argument, debate, and doubt to offer a solution everybody can
understand."

General Colin Powell

dog

Sandy wrote:

"We now focus on a quality experience for the patient with our contribution being a specific and accurate medical record. The reimbursement will be appropriate if we do our jobs correctly. What that amount is becomes immaterial."

That needs to be framed and mounted on every CDS wall, with a gift-wrapped copy to the CFOs.

Renee

NormaB

Just wish we could convince the "powers that be" of that philosophy. $$$ talks - loudly.

dbutler

Thanks Sandy.
How did they come up with 50? For me, with 1300 cases/month as our focus population, don't think it would be statistically significant.
You mentioned an independent auditor -- is that someone that is employed internally for that (and other) roles? or someone that you bring in from outside?

Sounds like a service that 3M offers that is similar to many consultants -- program maintenance and ongoing support.

You mentioned Medpar data, and I know we had discussed a concept I had of being able to develop an Access data base from an annual CMS table (7 I think). Have been overwhelmed with events and demands and haven't gotten that built yet. With the release of the final IPPS last week, I have more of an impetus to get it done so perhaps in the next month or so. Will share the tool once I do complete it.

Don

Donald A. Butler, RN, BSN
Manager, Clinical Documentation
PCMH, Greenville NC
dbutler@pcmh.com


Never give in. Never, never, never, never--in nothing, great or small, large or petty--never give in, except to convictions of honor and good sense. Never yield to force. Never yield to the apparently overwhelming might of the enemy
Sir Winston Churchhill

dbutler

I agree with Sandy......

And with that philosophy money does talk -- LOUDLY --

With that approach, we do ensure that we are getting the maximum APPROPRIATE reimbursement

In addition we get:
** Good profiling ROM / SOI (and in the medium to long term that also means $$)
** More often a second cc/mcc (decreasing risk of $$ bleed with RAC, etc.)
** Better physician buy in (when they realize the focus isn't money but accuracy, completeness & credit for sick patients -- physician cooperation = $$)

The challenge is measuring, demonstrating, communicating & convincing the powers that be of this truth!!

Don

sbeatty

Thanks, Don. I would love to see what you do with the 7A and 7B tables.
I had them reformatted last fall by one of our data analysts so I could
try to do something similar to what you are proposing. It was my opinion
that the consultant audit had limited usefulness and was of low validity
since the sample was