information request

sbeattysbeatty
edited May 2016 in CDI Talk Archive
Good morning, colleagues! I hope all of you had a fantastic Christmas
and are ready to jump into the New Year.



I need to hear from organizations that review all payers, not just
Medicare or Medicaid. What volume of reviews/person do you do daily? Do
you review 3rd party cases at a different frequency than you do the
Medicare/-Caid population? How do you measure return on investment and
impact of your reviews on 3rd party cases? We aren't paid for 3rd party
cases by DRG here in Indiana, so we're trying to determine how one would
measure productivity and plan for staffing.



Also I read with great interest Lynne's blog about doing all payers.
Lynne, can you elaborate more on the OIG finding selective payer review
a "no-no?" I'm advocating for us to do all payers as a compliance issue
and need some supporting documentation for my director. I'm aware that
the Medicare Conditions of Participation indicate that Medicare patients
receive the same level of care as all other patients-does this extend to
chart review and billing? If so, can you provide me with a citation to
support reviewing all payers?



Thanks much for any and all feedback.



Sandy Beatty, RN, BSN, CCDS

Clinical Quality Management

Columbus Regional Hospital

2400 E. 17th Street

Columbus, IN 47201

sbeatty@crh.org

Comments

  • catladyrncatladyrn
    Interesting question, Sandy, and so on-point!

    In my previous position, I reviewed all DRG payors. I was told to prioritize Medicare, but I did everybody.

    I was hired into my current position with the expectation that the hospital would branch out from only reviewing Medicare to reviewing all DRG payors. I do review every chart that is assigned to me, regardless of payor. I am on track to have almost 400 total cases completed for the month of December; usually I run around 300 per month.

    But my colleagues continue to prioritize Medicare, and if they feel their caseload is too high, they skip the non-Medicares altogether. I have tried to share with them the OIG findings against selective payor review, to no avail. I know a lot of their decision-making has to do with the consultant company only tracking Medicare data. Personally, as a compliance measure, I'd like to see us review all payors, including non-DRG payors, but the software we use isn't conducive to absorbing reviews that can't impact revenue. I'm also not the Queen. :)

    Renee


    Linda Renee Brown, RN, CCRN, CCDS
    Certified Clinical Documentation Specialist
    Banner Good Samaritan Medical Center
  • robert.hodges2robert.hodges2
    edited May 2016
    I Review all patients regardless of payer, but then I'm a small facility. My continued focus is on continuity of care and ensuring the medical record is as accurate and complete as possible. I will admit that my situation is rather unique, but that's what I do here especially since we can't bill Medicare or Medicaid by law.

    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

  • dvitalone1dvitalone1
    edited May 2016
    Right now we are reviewing all DRG payers (Medicare and commercial). Our program is new

  • ggoodman@virginiahospitalcenter.comggoodman@virginiahospitalcenter.com
    edited May 2016
    At our facility we are currently reviewing the charts of all inpatients regardless of payer source. We are not, however, currently reviewing peds, labor and delivery, or psych and addictions.

    Greta Goodman

    Clinical Documentation Improvement Specialist
    Clinical Documentation Improvement Program
    Virginia Hospital Center
  • NormaBNormaB
    edited May 2016
    I would be interested in knowing how many CDS (FTE's) are needed for those who are working in the "all-payor" groups and how many units/patient care areas each one covers? What softare do you use and how much data do you enter for your reviews?

    In my Utilization Management days I covered 3 areas, reviewed all payers every three days (except for commercial payers), I also did the admitting coding to set my DRG and LOS (comment for the "Coding Class?" Thread), and I know I review around 50+ patients a day.

    I mention this because it seems to take longer to do CDI and I do not do many things dfferent from my UM position except queries. I do know our software is slower than what I used "back then".

    So I would like to know how others break this down for all payor review.

    NBrunson, RHIA, CCDS

  • jskagenjskagen
    At my former position I was part of 7 CDS team and we reviewed every inpatient admission regardless of payor except for pediatric and labor and delivery and neonatal. The hospital size was a level III trauma hospital with 300 beds and the average number of new admits was 50-60 per day. When we changed to reviewing every inpatient admit we had our consulting company set up our software so that we could choose whether the payer was Medicare or non-Medicare so that these could be tracked separately.


    Julie Skagen RN BSN
    CLinical Documentation Specialist
    Medical Records
    Bozeman Deaconess Hospital
    1-406-522-1802
    jskagen@bdh-boz.com
  • michelleclynemichelleclyne
    edited May 2016
    Hello All,

    We review inpatient charts regardless of payer source, except for
    Peds/OB/NUR/Rehab. We are a 200 bed facility with 2 FTE CDI's and we
    are not assigned any specific areas. We cover the house and when one is
    gone we do it all. The software is a combination of 3M coder / Navigant
    / Meditech - none of which talk to each other. We look for accuracy and
    completeness of the chart, query for specificity and not necessarily to
    get a CC/MCC. We put the working DRG into the Meditech system to help
    the nurses/Care Management be aware of the anticipated LOS for the
    patient.


    Michelle Clyne, RN, BS
    Clinical Documentation Improvement Specialist
    Good Samaritan Hospital

  • lspryszaklspryszak
    The OIG's Compliance Plan Guidance can be found here:

    http://oig.hhs.gov/authorities/docs/cpghosp.pdf
  • Unknown
    edited May 2016
    What software and consulting company are you using?


    Virginia Bailey RN, CCDS
    Certified Clinical Documentation Specialist
    Morton Plant Northbay Hospital
    727-859-4880 or ext 74880 from within system


  • jskagenjskagen
    They use JA Thomas Guide.


    Julie Skagen RN BSN
    CLinical Documentation Specialist
    Medical Records
    Bozeman Deaconess Hospital
    1-406-522-1802
    jskagen@bdh-boz.com
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