Is it all about the money??

jazzyjan10jazzyjan10
in CDI Talk Archive
I am new to this forum and our CDI program is new as well. I am just curious as to what other thoughts are. Is your CDI program all about the money? I know that the money is important but I feel that we should also be looking for severity and thorough documentation as well, not just trying to come up with a CC or MCC to make money. It is bothering me more and more because I know of some CDI specialists that will query for a diagnosis and use any treatment, such as IVF for a UTI, or query for a UTI with only WBC in the urine but no other indications. Is it wrong for me to be thinking that these types of queries are inappropriate? Any and all thoughts are appreciated!

Comments

  • robert.hodges2robert.hodges2
    edited May 2016
    While money is a reality for any CDI program, the focus must be on getting a complete and accurate medical record that reflects the severity of illness of the patient. If you focus on the money, in my opinion you're looking at the wrong thing. You need to look at the patient and a complete and accurate record only enhances the quality and continuity of care. If you do that right, as others have said so well, the money will naturally follow.

    Robert

    Robert S. Hodges, BSN, MSN, RN, CCDS
    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
     

  • david.smithdavid.smith
    edited May 2016
    Welcome aboard. Personally our CDI program is about quality documentation in hopes of reaching optimal reimbursement, positive influence on CMI, better capture of severity of illness and risk of mortality, improved metrics on external reporting (Healthgrades), etc. Getting too focused on CC/MCC capture really limits the true value of the CDI program in my opinion. We should be getting clarification on the documentation wherever the opportunity exists regardless of financial impact. With that said, increased CMI/revenue is a realistic expectation of a CDI program but not the only one.
    I suppose the query is in the eye of the beholder, but seeking a diagnosis without solid clinical indicators is a slippery slope. RACs (and other auditors) will question a CC/MCC diagnosis if the indicators and treatments are not there. Just because a certain dx is documentation, doesn't necessarily make it so in the eyes of auditors. I only query when I can back up my question with indicators and treatments that are appropriate to the diagnosis/clarification sought.

    Just my .02


  • Unknown
    While a good, successful Documentation Integrity program will effect money. If a program focuses on the quality, accuracy and concise documentation of all diagnoses in the medical record, make sure all diagnoses meet the criteria for being reportable, ensures physicians understand why the specific documentation is so important in the medical record, money will come. Our focus here at Greenville Memorial Hospital is not just to capture the cc, MCC or highest DRG, our focus is a quality, concise,accurate picture of the patient's hospital stay and for the reason for hospitalization. We place physician queries on the medical record, even if it may lower the DRG. We want the clinical picture in the medical record to match the physician's documentation.

    We have been in existence here for seven years; our program has grown and expanded and through the years, we have "tweeked" and change with the times.

    In answer to your question, no it is not all about money--- it is about quality, accuracy and conciseness of documentation in the medical record.

    Juanita B. Seel, RN
    Supervisor Documentation Integrity
    Greenville Memorial Hospital
    Greenville, SC 29605
    email: JSeelRN@aol.com
    jseel@ghs.org
    Phone: 864-455-4981
Sign In or Register to comment.