Attention Stacy Forgensi Re: one-day chest pain IP admissions

sbeattysbeatty
edited May 2016 in CDI Talk Archive
Are you under RAC review for medical necessity now, or are you just
getting prepared with the help of a consulting firm?



Sandy Beatty, RN, BSN, C-CDI

Clinical Documentation Specialist

Columbus Regional Hospital

Columbus, IN

(812) 376-5652

sbeatty@crh.org

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






Comments

  • Unknown
    edited May 2016
    We are in area B, the RAC have not sent us any requests yet.... But we have hired a consulting firm who reviews every case that does not meet medical necessity for inpatient status (the RN screens each Medicare admission using Millman). The big focus seems to be getting the inpt vs out pt status and corresponding order correct. The consulting firm sends a confirmation on every case they review stating the correct status. They do not focus at all on the physician documentation, although they do MD to MD calls to request more information if inpatient criteria is not in the documentation.
    My concern is the increased number of one day stays that are now inpatient status and don't always have the "diagnosis" or other documentation to support inpt status. Coders cannot code from the consultants determination letters even tho they do have some clinical info on them.

    So to answer your question, yes we are just getting prepared but wondering if we are focusing too much on just the admit order being correct.

    Christina Raad RN
    Clinical Documentation Specialist
    Central DuPage Hospital
    630 933 4193
    pager 630 255 1164


  • sbeattysbeatty
    edited May 2016
    Thanks, Christina. Are you in the same organization as Staci Forgensi?
    She had posted a similar consult usage and we were curious if these
    decisions are being made in response to actual RAC reviews or as
    "prophylaxis."



    Sandy Beatty, RN, BSN, C-CDI

    Clinical Documentation Specialist

    Columbus Regional Hospital

    Columbus, IN

    (812) 376-5652

    sbeatty@crh.org

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


  • Unknown
    edited May 2016
    We are in region B as well. I understand we received our first request for
    10 charts last week. It appears that the charts are short stays with PDX of
    sepsis and for extensive surgery unrelated to the PDX.


    Kim Beard
    Clinical Documentation Specialist




  • Unknown
    edited May 2016
    No I am not in same organization.... I also am curious how other organization are handling RACS.

    Christina Raad RN
    Clinical Documentation Specialist
    Central DuPage Hospital
    630 933 4193
    pager 630 255 1164


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