What do you do when a query is answered as 'none/no/other'.
Good afternoon
I need some input please. When a physician answers 'no/none/other' on a written query when the clinical indicators really does point to a specific diagnosis, what is your process? Do you leave it as in asked and answered and move on? Do you educate the physician afterwards and suggest they rethink the diagnosis? Escalate it to a physician advisor/consultant if you have one? Educate the physician at a later time, or do another verbal query after educating the physician?
Your input is greatly appreciated. Thanks everyone!
Comments
Hi,
Sometimes it's tough to get what you are looking for in a written query. Some things need a verbal conversation and let the provider tell you his thoughts behind the condition and talk it through. It may be something you didnt think of, or maybe he has questions regarding the query.
If you are having trouble with a particular service line, that's an education opportunity, or a discussion meeting to find out what's behind the responses.
Providers respond to numbers and stats......do an anaylsis and show them the impact of their answers and how they compare with their peers.
Good luck!
Angela, RN, CCDS
Thanks for your reply! We do verbal and written queries. I was just wondering if, when a physician answers 'no' to a query if you go back and have a verbal conversation and then change the outcome if the physician agrees. Initially when we had our training it was okay for the physician to disagree and we would leave it at that. I'm wondering if that has changed.
Renee, RN, CCDS
It's a healthy program when the MD's disagree or provide alternate diagnoses. I wouldn't attempt to get a Provider to change their answer on a query but might have a verbal conversation or do some education if I saw a trend or see that a particular Provider isn't understanding what we are asking.
Jeff
Yes Jeff, I agree 100% When we had our training a few years back 'no' or 'unable to determine' was okay to use. Of course when that became the 'go-to' answer, or if all clinical indicators point to a specific diagnosis and the physician disagree we would escalate it to our physician advisor or consultant. We have had a few new managers recently (none with previous CDI experience) and they want us to 'push back" on those negative replies without involving the physician advisor. My concern is that we may be crossing the line between being compliant and leading. Thanks for the replies. Great to get opinions from others!.
Renee, RN, CCDS
It really can be frustrating when you don't get a "thoughtful " response to a query.
I've run into this problem with a few physicians who answer every query "unable to determine". Not to be snarky but how hard is to say yes the patient has a stage 4 pressure ulcer when you include the WOCN note and a picture in the query? Or that the patient has malnutrition when you include the RD evaluation and treatment plan?
What I have been doing is a multi pronged approach:
Annual education on why we query...improving quality scores, preventing PSI's, assisting in getting specificity into the record, preventing denials, improving CMI etc
Tracking responses: the doctors who "always" answer "unable to determine" or never answer are visited by our physician advisor and receive additional education with specific examples and their own stats to show why a "thoughtful" response matters. (Obviously an occasional unable to determine is expected)
Our PSI and denials management programs are very interested when queries are not answered and we get a PSI or a denial and then conversations happen between program directors about how this could have been prevented.
If all else fails, our physician advisor talks with the physicians director and the director has a chat with the physician. We're fortunate that we only have a handful of physicians who don't respond in a thought manner.
CDI places all of our queries and we routinely audit and educate on writing a "good" query. The question has to be clear as well as having appropriate response options with supporting documentation/clinical indicators.
We're very fortunate that for the most part, out physicians document well and respond with useful answers. We've had fabulous support from senior management which I think has had a huge impact.
Cynthia Mead RN CCDS