Blended Model?

leah.taylorleah.taylor
in CDI Talk Archive
Do any of you work with Case Management and complete medical necessity(UR) reviews when you do CDI reviews? If so how does that change staffing needs/focus?

Thanks!

Leah Taylor,RN, CCDS
557 Brookdale Drive
Statesville, NC 28625
E- leah.taylor@iredellmemorial.org
p- 704-878-7436

Comments

  • heidi.koenigheidi.koenig
    edited May 2016
    I just had an element of CM added on to my duties. I leave a working DRG with GMLOS on the chart for case management to use. The only part that makes staffing a problem is that I am one person doing a formally 2 person job. When there are 8 CM and one of me, it's slightly frustrating.

    Thanks,
    Heidi Koenig, RN
    Clinical Document Specialist
    Ocala Regional Medical Center
    Heidi.koenig@hcahealthcare.com
    352-401-1686
  • cstukenbergcstukenberg
    edited May 2016
    We do not have that as a formal part of our role, however, our eyes and ears are open if we see or hear anything that would impact Case Management, Med necessity or UR. We send our LOS,/DRG list to the case managers so they have our working DRG for concurrent LOS.
    Thanks,
    Colleen Stukenberg

  • robert.hodges2robert.hodges2
    edited May 2016
    The closest I get to this is that I securely email my working DRG list
    to the UR nurses so they can monitor the LOS based on the working DRG.
    I do make it very clear to them that this is not a final DRG and should
    be used for informational purposes only.



    Robert



    Robert S. Hodges, BSN, MSN, RN

    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



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

  • NormaBNormaB
    edited May 2016
    We are strictly Clinical documentation. We have more Concurrent coding duties as we are the ones who assigned the DRG and resulting LOS for CM.

    We send a copy of our notes which contain current DRG/LOS and info. we are focusing on to our CMs each day.

    I also sit in on one of the Team Meetings for the medical assignment. That way I know who is going to Nursung homes, Rehabs or Hospital to Hospital transfers and can make sure those charts are coded and have the DRG assigned for transfer DRGs.

    Other than keep our data current (querying for an MCC/CC and adding that info.) we concentrate fully on documentation -at this time. :) Everything is subject to change.

    Norma T. Brunson, RHIA,CCDS

  • cstukenbergcstukenberg
    edited May 2016
    We also sit in on the interdisciplinary team meeting for discharge planning, etc as we are able. It helps put the whole picture together.

  • dallend@einstein.edudallend@einstein.edu
    edited May 2016

    We are strictly CDI. We do not assign DRGs - The only paperwork we leave in the chart is our query forms. Our case managers use interqual. They assign a DRG at the time they do their reviews. They can ask us a question while we are on the unit. We are not responsible for quality, medical necessity, etc.
    We are very busy with our CDI duties.

  • cbarnescbarnes
    edited May 2016
    No...that would be completely unmanageable for us. We have 3.75 CDSs for CDMP. There are 7 Care Coordinators and 1 Part-Time CC and 1 PRN CC and 1 Float CC that deal w/ UR, etc. Plus, 4 nurses ( CDAs) that deal w/ private payors, SP, Pass Adv and Medicaid. And 3 Social Workers that do D/C Planning, etc. Even w/ what seems like alot of staff we are on the RUN everyday w/ no end in sight.

  • Unknown
    edited May 2016
    We attempted to combine the job functions of CDI and UR for medical necessity initially, it did not work out well consequently we longer do this. We continue to be responsible for core measures on the units we cover.


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