Medical Necessity

Comments

• robert.hodges2

  August 2012 edited May 2016

  I do it in an informal way. Having a case management/UR background I
  know what is needed to justify stay so when I see a long stay I start
  looking harder at the chart for the medical reasons to justify the stay.
  I also communicate daily with the UR nurses here and give them my
  working DRG and GMLOS for each patient. We have also discussed common
  issues and concerns and I have put those in my biweekly newsletter to
  help educate the providers.
  
  
  It's all a team approach here especially since we all know that
  documentation is at the core of taking credit for the care we provide.
  
  
  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
  
  
  "Patriotism is easy to understand in America; it means looking out for
  yourself by looking out for your country" Calvin Coolidge
• paxneros

  August 2012 edited May 2016

  Like Robert, we speak informally with our physicians regarding Medical
  Necessity. I include it with educational meetings and, at times, under the
  right circumstances incorporate it into my queries
  
  Medical Necessity is important for many areas. If Diagnoses and treatments
  are not supported by documentation it can impact what can be included for
  coding and reimbursement.
  
  N. Brunson, RHIA, CDIP, CCDS
• evanspx@sutterhealth.org

  August 2012 edited May 2016

  We provide scheduled seminars for our Medical Staff for the topic of Observation – how to order, when to utilize, and so forth. However, given one must interact on day one of the encounter (when observation is being considered or should be ordered), we do not ‘routinely’ address the topic of Observation as we perform CDI reviews. We schedule CDI reviews for 24-48 hours after admission in order to allow sufficient time for the review of studies and subsequent informed documentation of known or suspected diagnoses.
  
  
  
  Paul Evans, RHIA, CCS, CCS-P, CCDS
  
  Supervisor, Clinical Documentation Integrity, Quality Department
  California Pacific Medical Center
  2351 Clay #243
  San Francisco, CA 94115
  Cell: 415.637.9002
  Fax: 415.600.1325
  Ofc: 415.600.3739
  evanspx@sutterhealth.org
• vdavis2

  August 2012 edited May 2016

  We do assist when we can! We help review charts, educate physicians, and write appeal letters for medical necessity cases as well. We also went through Interqual training with our Case Managers and Intake Teams.
  
  Vicki S. Davis, RN CDS
  Clinical Documentation Improvement Manager
  Health Information Management Department
  Alamance Regional Medical Center
  Office (336) 586-3765
  Ascom Mobile (336) 586-4191
  Fax (336) 538-7428
  vdavis2@armc.com
  
  "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
• kshumpert

  August 2012

  I incorporate medical necessity for inpatient into my annual documentation reviews. Each physician with >50 admissions per year is required to meet with me as a component of re-credentialing. Additionally, I am required to meet each new physician (including ED) for CDI purposes and I include medical necessity. When I do the yearly sessions, I also touch base with case management and see if they have any physician issues and I incorporate those as well. I write all appeals for RAC and assist our Chart Auditor with any additional appeals.
  
  Kathy Shumpert, RN, BSN, CCDS
  
  Clinical Documentation Improvement Specialist
  Community Howard Regional Health
  Office 765-864-8754
  Cell phone 765-431-0123
  Fax 765-453-8447