Outpatient CDI information
Would anyone have information about their outpatient CDI program they would be willing to share?
For instance, what areas in the facility are you reviewing as part of you outpatient CDI (ED, Same day surgery, hospital owned physician practices)??
Does outpatient CDI include those patient in the hospital who are currently observation status (occupying a bed)?
If your facility does not have outpatient CDI, do your inpatient CDI's review those patient who are in observation status?
We currently only review inpatients (all payers, self pay).
Thanks in advance
LeeAnn
Tagged:
Comments
Hi LeeAnn,
I started down the OP path about two years ago. All of these areas, as you know, are considered OP but I had to determine where to start. I did that by looking at a lot of data (denial, payor contracts, etc.). Our facility owned physician group had contracts with Medicare Advantage payers, and there was a bonus opportunity there if we improved our RAF score. This is where we found our biggest opportunity right off the bat. We are now part of an ACO and participate in a MSSP. So there is significant opportunity. Our OP CDI program is expanding to the larger medical group this summer. We started out small in one region with just family medicine and internal medicine physicians and then expanded it to Cardiology and plan on expanding further to endo and neuro. We have shifted from reviewing MA patients to Straight Medicare, and our other ACO products.
Karen.schaefer@stjoe.org
Hello,
Are any of you working in Ambulatory/OP CDI with physician practices focusing on HCC capture in at-risk contracts who would be willing to share some information about your program?
Specifically looking for a model to help launch this initiative and would like to share how others have made a difference.
How many lives/patients in your risk contracts, MSSP?
What was your baseline RAF? Improvements seen?
Program model/Staffing/Approach for implementation
Productivity
Tools/Vendors used
Appreciate any information you are willing to share and if you would be so kind, I would be happy to set up a brief call with you to discuss.
Thank you in advance,
Kris Kegarise
Our program model is to have a nurse do a prospective chart review and a coder who is CRC certified and HCC coding trained do a prospective and retrospective review. We cover only Medicare lives right now due to the size of our health system. Originally, we started with only Primary Care in one region and were able to cover Medicare Advantage and Medicare. We then moved on to reviewing Cardiologist visits. The goal was to move into specialists reviews, but we merged with a large health system and have expanded to primary care only at this point through the entire system.
Hi there,
Do you have any data on productivity for nurses/coders? How are you tracking progress or that the program is doing well? RAF scores? Capture Rate?
@ssipunu
We track our data manually on spreadsheets. Each HCC diagnosis that CDI has shown a direct impact on is tracked and then when it goes out on a claim, we take credit for the RAF of that diagnosis. Then each month that data is gathered and presented to our C-suite to show shared savings progress.
I will need to present a monthly excel report to C-suite of progress with our ACO MSSP HCC diagnosis/RAF captured per provider - does anyone have a specific template they can share so that I have an idea of how it can be presented to C-suite as I am new to this area? Thank you
Would you be able to share a sample template of your worksheet if it is a successful process for you? Thank you
Our Healthcare System is currently only using CDI for Inpatient record review.
Recently, a provider asked me how Inpatient CDI reviews impacted the ACO and its revenue, and if there was any correlation between the work done in the inpatient setting and the outpatient ACO world.
My recommendation to the provider was to continue documenting to the highest specificity appropriate and to ensure good documentation.
Any tips or explanations are very welcome! Thanks in advance!
I am trying to find out HCC weights for 2021. I looked all over CMS.gov and cant seem to find it anywhere. I noticed that, for 2020, some facilities and insurance payers developed HCC cheat sheets with a list of HCC's and the weight associated with each HCC. Where can we find these HCC weights for 2021?
thank you!
Hi ssipunu, we are in similar situation here and already have an outpatient ambulatory program. Right now we are planning to expand to outpatient in acute care hospital setting.. so looking at (ED, Trauma ED, OBS, Cath Lab, IR, Denials, HCCs).. we are in beginning stages so hoping to network with you =) We've received several recommendations from a vendor that i can share.... perhaps recommendations could be useful to your program? =)