I did a pilot project in our inpatient rehab, and was able to impact the CMI/financial numbers significantly. Please let me know if you are willing to discuss with me regarding the pilot I have done. I am more than happy to provide great insights into it.
As you know, CDI can capture Tier-comorbidities in inpatient rehab setting which will optimize revenue cycle.
Please email me at sreenath.meegada@megohealth.com
I do CDI in the IRF setting, which is part of a university multi-facility system. There are many different nuances. Happy to discuss at suzanne.swisher@gmail.com.
Hello! I am looking to find more information on CDI in the post-acute setting. Are there any bootcamps, webinars, or helpful information around on this to teach/education a new CDI Specialist that would be starting this position?
I do CDI in the inpatient rehab unit that is part of a larger hospital system. I was watching a UDSmr webinar and the coder stated that she didn't think I should use any information from previous records in a query during the rehab stay. I have used information from the acute stay in a query if the client was just discharged from our acute care hospital. For example, if the A1c was 11 a few days prior to the acute rehab admission, I would use that information in a query for diabetes. Am I wrong in doing this?
Hey Lori - i'm pretty sure that was me asking that question during the webinar. Per the ACDIS guidelines I think it is appropriate and have also spoke with another CDIS with IRF experience who agreed. I think it is appropriate. I think UDS does have some good information more related to coding than CDI specifically.
Do you have any thoughts on querying for accuracy of the chart vs querying only to change the tier? Do you query to clarify the IGC?
I always query to clarify the IGC if I don't think it's correct. The Clinical Evaluators where I work don't get it right at least 30% of the time. In one of the two facilities that I review, the providers don't read the Pre-Admission Screen very closely so they just sign it without verifying the IGC. I query for IGC, for tiers, and for the correct diagnoses while in rehab. The providers also include some acute care diagnoses and I query to rule them out if they aren't valid for the rehab admission.
I am potentially about to embark on the rehab CDI journey- I currently do acute inpatient CDI and the rehab would be in addition to that in our small rural hospital. If it's ok, I may need to reach out as well
For those that have embarked on a CDI program in the IRF - how do your query rates differ from the acute setting, and have you had to adjust your benchmarks?
Thanks for the question, Suzanne. I do both IRF and acute care clients. The query rate has not been adjusted for me. It seems to work out fine. However, if someone was doing only IRF clients, I would think that the query rate could be adjusted because you're not looking for the same types of diagnoses.
I'm in Maryland, which is different than MS DRG world with APR DRG, SOI, ROM. Given that, hopefully our queries do make an impact. I have had a difficult time finding other resources for IRF CDI. AHIMA published a Rehab Toolkit several years ago. Most of what I found is focused on the IRF PAI and we just do CDI and coding for the UB04. Therefore, we do not work closely at all with an IRF PAI coordinator, the etiological Dx, or IGC assignment. I actually have many questions, and have been stalled by the seeming lack of consistency and availability of resources available. For example, what should be assigned for PCS codes.... every single therapy received, or bundled codes?
Suzanne, your situation is very unique. I have used the UDSmr webinars to learn about coding for UB04 and for the IRF-PAI. However, if you don't submit an IRF-PAI, how do you get paid? Is it a set contract amount for each client? How do you get paid from Medicaid and/or Medicare and/or Medicare Advantage?
How we get paid drives our coding. That's why I query for any tiered conditions and for conditions that could be used to adjust for any inpatient readmissions within 30 days of discharge. I don't assign codes for therapy or barium swallow studies. I do assign codes for debridement or other surgery that occurred while the patient was in rehab. If you get paid only based on SOI/ROM then you could query for any condition that increases the SOI/ROM.
UDSmr has software that supports the IRF-PAI, but they may still know of resources that could help you. Also, are there other coders or CDIs at inpatient rehab facilities in Maryland whom you could ask?
Has anyone had any experience with the IRF PAI in Epic? It's supposed to pull in diagnoses, but it does not seem to work right with our new implementation of Epic. I don't see how it could be useful to the PPS coordinator who fills out the IRF PAI.
Comments
Hello there,
I did a pilot project in our inpatient rehab, and was able to impact the CMI/financial numbers significantly. Please let me know if you are willing to discuss with me regarding the pilot I have done. I am more than happy to provide great insights into it.
As you know, CDI can capture Tier-comorbidities in inpatient rehab setting which will optimize revenue cycle.
Please email me at sreenath.meegada@megohealth.com
Sreenath Meegada MD MPH CCDS
Internal Medicine Hospitalist
I do CDI in the IRF setting, which is part of a university multi-facility system. There are many different nuances. Happy to discuss at suzanne.swisher@gmail.com.
Suzanne, I would love to discuss your findings as we will be starting a pilot soon. Please let me know if you would be open to this.
Hello! I am looking to find more information on CDI in the post-acute setting. Are there any bootcamps, webinars, or helpful information around on this to teach/education a new CDI Specialist that would be starting this position?
Thanks! Skyler
I do CDI in the inpatient rehab unit that is part of a larger hospital system. I was watching a UDSmr webinar and the coder stated that she didn't think I should use any information from previous records in a query during the rehab stay. I have used information from the acute stay in a query if the client was just discharged from our acute care hospital. For example, if the A1c was 11 a few days prior to the acute rehab admission, I would use that information in a query for diabetes. Am I wrong in doing this?
UDSmr has a lot of boot camps for coders who do inpatient rehab. I've taken their courses and they are very thorough.
Lori Ballantyne at lori.ballantyne@sharp.com
Hey Lori - i'm pretty sure that was me asking that question during the webinar. Per the ACDIS guidelines I think it is appropriate and have also spoke with another CDIS with IRF experience who agreed. I think it is appropriate. I think UDS does have some good information more related to coding than CDI specifically.
Do you have any thoughts on querying for accuracy of the chart vs querying only to change the tier? Do you query to clarify the IGC?
Thanks, Skyler
I always query to clarify the IGC if I don't think it's correct. The Clinical Evaluators where I work don't get it right at least 30% of the time. In one of the two facilities that I review, the providers don't read the Pre-Admission Screen very closely so they just sign it without verifying the IGC. I query for IGC, for tiers, and for the correct diagnoses while in rehab. The providers also include some acute care diagnoses and I query to rule them out if they aren't valid for the rehab admission.
Thanks for responding, Lori
Skyler and Lori,
I am potentially about to embark on the rehab CDI journey- I currently do acute inpatient CDI and the rehab would be in addition to that in our small rural hospital. If it's ok, I may need to reach out as well
Thanks
Peggy
Peggy, I'd be happy to talk with you about rehab. My email is
lori.ballantyne@sharp.com
For those that have embarked on a CDI program in the IRF - how do your query rates differ from the acute setting, and have you had to adjust your benchmarks?
Thanks for the question, Suzanne. I do both IRF and acute care clients. The query rate has not been adjusted for me. It seems to work out fine. However, if someone was doing only IRF clients, I would think that the query rate could be adjusted because you're not looking for the same types of diagnoses.
If anyone does IRF CDI, it would be helpful to know:
Do you only query to get tiered comorbidities?
What resources have helped you besides the webinars from UDSmr?
How closely do you work with the PPS coordinator and the clinical evaluators to get the correct etiology and IGC?
Any other questions?
Hi Lori,
I'm in Maryland, which is different than MS DRG world with APR DRG, SOI, ROM. Given that, hopefully our queries do make an impact. I have had a difficult time finding other resources for IRF CDI. AHIMA published a Rehab Toolkit several years ago. Most of what I found is focused on the IRF PAI and we just do CDI and coding for the UB04. Therefore, we do not work closely at all with an IRF PAI coordinator, the etiological Dx, or IGC assignment. I actually have many questions, and have been stalled by the seeming lack of consistency and availability of resources available. For example, what should be assigned for PCS codes.... every single therapy received, or bundled codes?
Thank you,
Suzanne
suzanne.swisher@gmail.com
Suzanne, your situation is very unique. I have used the UDSmr webinars to learn about coding for UB04 and for the IRF-PAI. However, if you don't submit an IRF-PAI, how do you get paid? Is it a set contract amount for each client? How do you get paid from Medicaid and/or Medicare and/or Medicare Advantage?
How we get paid drives our coding. That's why I query for any tiered conditions and for conditions that could be used to adjust for any inpatient readmissions within 30 days of discharge. I don't assign codes for therapy or barium swallow studies. I do assign codes for debridement or other surgery that occurred while the patient was in rehab. If you get paid only based on SOI/ROM then you could query for any condition that increases the SOI/ROM.
UDSmr has software that supports the IRF-PAI, but they may still know of resources that could help you. Also, are there other coders or CDIs at inpatient rehab facilities in Maryland whom you could ask?
You do have a unique situation.
Thank you, Lori Ballantyne
Has anyone had any experience with the IRF PAI in Epic? It's supposed to pull in diagnoses, but it does not seem to work right with our new implementation of Epic. I don't see how it could be useful to the PPS coordinator who fills out the IRF PAI.