Query templates with criteria and/or definitions
I am curious if other facilities use query templates that list criteria and/or definitions for the options? Specifically, I am asking about facilities that have not adopted facility-wide definitions. If you do or don't use criteria and/or definitions, please provide any feedback you have on why this is appropriate or inappropriate.
I really appreciate your feedback,
Amy Scott
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For feedback thoughts, how might this affect denial?
What about criteria that is not personalized to the patient?
Amy,
This is an excellent question and we are wrestling with the same issue however we do have facility approved criteria such as ASPEN for malnutrition and KDIGO definition for AKI. We are going back and forth with the coders as to see if including this is compliant. We want to simply include the content for reference as our Medical Records Committee has approved and adopted the criteria.
I am following for any feedback!
Nicole
Hello Amy,
I am interested in following this thread as this is something we have wanted to do as welll. We sought the advice of our Physician Advisor who said that adding definitions to queries was appropriate as long as the query is not leading inclusion of criteria to support diagnoses is allowed.
Thanks,
Skyler Sanders
We are working with a standard query approach for our most common queries: Respiratory Failure, Sepsis, and Encephalopathy to include those clinical indicators supporting the diagnosis. Roll out was approximately 3 months ago following Physician Leadership development and Compliance review. Current data shows a lower Agreed Rate (~10%) and higher No response (~5%)....consideration regarding this information identifies a likely less efficient ease of interpretation and clinician awareness opportunities regarding the standard approach rationale to assure documentation of dx is supported with the MEAT allowing for accurate reporting and billing.
Would you be willing to share the verbiage that you are using in these queries related to the clinical indicators? We have approved clinical indicators that were passed in 2019 for 6 of our most common diagnoses, but I want to be sure that the verbiage we are using in the queries to include them is compliant.
Thank you,
Nicole
ncopper@capitalhealth.org