ACDIS Live! Malnutrition OIG Investigations and Auditor Denials: How a Multidisciplinary Team-Based Approach Is Your Best Defense - On-Demand

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ACDIS Live! Malnutrition OIG Investigations and Auditor Denials: How a Multidisciplinary Team-Based Approach Is Your Best Defense - On-Demand

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ACDIS Live! Malnutrition OIG Investigations and Auditor Denials: How a Multidisciplinary Team-Based Approach Is Your Best Defense - On-Demand

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Available ON-DEMAND

Presented on:
Thursday, August 23, 2018

Presented by:
Melinda Battaile, MD
Donald A. Butler, RN, BSN
Kristen Gonzalez, MHA, RHIA
Shelby Humphreys, RHIA
Debbie Martin, MSN, RN
Vaughn M. Matacale, MD
Catherine Njeri Njuguna, MS, RDN, LDN, CDE
Leah D’Aurora Richardson
Ashley Strickland, RDN, LDN, CNSC

Level of Program:
Advanced

Sponsored by:
ACDIS

Vidant Health has been at the forefront of applying ASPEN/AND guidelines for the diagnosis and treatment of malnutrition in their patient population. This clinical initiative, introduced in 2013 and aimed at improving patient care and outcomes, resulted in an increased capture rate of severe malnutrition codes.

Following on the heels of the kwashiorkor audits, the Office of Inspector General (OIG) decided to test the waters on severe malnutrition and the ICD-9 codes 261 and 262, targeting Vidant.

Vidant, confident in their clinical initiative and coding compliance, fought back.

Through a concerted effort, CDI specialists, coders, physician advisors, dietitians, and others reviewed records targeted by the OIG and developed comprehensive defenses regarding the accuracy of the diagnoses that were clinically valid, properly documented, and correctly coded.

During this extensive ACDIS Live! program, participants will hear from members of the core team at Vidant about how they handled the situation when the OIG came knocking. Learn what the OIG targeted and why, understand how a team-based approach can form the basis of a coordinated audit defense, and take steps to create a comprehensive process for compliant query practices related to malnutrition.

At the conclusion of this program, participants will be able to: 

  • Understand the clinical implications of diagnosing and treating malnutrition
  • Recognize the impact of properly capturing malnutrition codes
  • Apply Official Guidelines for Coding and Reporting and AHA Coding Clinic guidance to support compliant malnutrition coding
  • Understand clinical guidelines such as ASPEN/AND criteria and definitions to support malnutrition documentation and coding
  • Understand the audit and appeals processes related to the OIG
  • Apply lessons from Vidant OIG appeals to their own facility’s appeals and to appeals processes in general
  • Recognize available resources and tools to develop an audit defense


Who Should Listen?

  • Chief financial officers
  • Compliance officers
  • Hospital legal counsel
  • CDI directors, managers, and specialists
  • Coding directors, managers, and specialists
  • HIM directors and managers
  • Physician advisors
  • Dietitians


Agenda

  • Clinical impact of identification and treatment of malnutrition
    • Joint Commission and CMS directives regarding addressing malnutrition
    • RDN training
    • CDI and coding partnership
    • Education
    • Capture data/graph
  • OIG: Letter of intent to audit (letter of engagement)
    • Why us?/Could this be you?
    • 261 AND 262
    • Audit process
    • OIG on-site
  • Rebuttals/appeals
    • Conflicting denials and inconsistency
    • Lack of uniform criteria and transparency of criteria
    • Denial rationales
    • Clinical examples
    • AHA support letter
    • ASPEN assessment and response
  • First appeal/lessons learned
    • Approach/rationale
    • Packet organization
    • Legal perspective
    • Independent reviews
    • Legal precedent
    • Local/federal lobbying authorities
  • Dealing with CMS leadership
    • Current status
    • CMS audits for malnutrition/national (OIG/MAC)
    • Future plans
    • ASPEN/ACDIS task forces
  • Live Q&A


Continuing Education

AHIMA
(Live + On Demand) - This program has been approved for 3 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.

Ability to claim credits for this webcast expire on: 8/22/19

CCDS
(Live + On Demand) - This program has been approved for 3 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification, offered as a service of the Association of Clinical Documentation Improvement Specialists (ACDIS).

Ability to claim credits for this webcast expire on: 8/22/19

ANCC
(Live + On Demand) - HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This educational activity for 3 nursing contact hours is provided by HCPro.

Ability to claim credits for this webcast expire on: 8/22/19


Webinar system requirements and program materials: 
To fully benefit from the webinar experience, please note you will need a computer equipped with the following:

Browser: Microsoft Internet Explorer 6 or later, Firefox, Chrome, or Safari, with JavaScript enabled 
Internet: 56K or faster Internet connection (high-speed connection recommended) 
Streaming: for audio/video streaming, Adobe Flash plug-in or Safari browser on iOS devices 

Prior to the webinar, you will receive an email with detailed system requirements, your login information, presentation slides, and other materials that you can print and distribute to all attendees at your location. 

CAN'T LISTEN LIVE? 
No problem. The On-Demand version is also available. Use it as a training tool at your convenience—whenever your new or existing staff need a refresher or need to understand a new concept. Play it once or dozens of times. A $399 value! 

PLEASE NOTE 
Participation in the webinar is just $399 per site. All materials must be retrieved from the Internet. 

Call your customer service representative toll-free 800-650-6787 or email customerservice@hcpro.com if you have questions.


Meet the Speakers

Melinda Battaile, MD

Melinda Battaile, MD, is a physician advisor for Vidant Health, a multi-hospital health system based in Greenville, North Carolina. She became a full-time physician advisor in 2014. Dr. Battaile has a master’s degree in management of clinical informatics from Duke Medical School and is a board-certified, practicing fellow of hospital medicine.

Donald A. Butler, RN, BSN

Donald A. Butler, RN, BSN, is the director of the Clinical Documentation Physician Advisor Program at Vidant Health. Butler previously served for eight years implementing and managing the 11-member CDI team at Vidant Medical Center in Greenville, an 860-bed tertiary care center serving the eastern third of North Carolina. Butler served 11 years as a U.S. Navy nurse with a broad variety of clinical and leadership experiences. He was honored as the 2011 CDI Professional of the Year by ACDIS and has served as an ACDIS Advisory Board member.

Kristen Gonzalez, MHA, RHIA

Kristen Gonzalez, MHA, RHIA, is the senior HIM administrator at Vidant Health. She has more than 20 years in the healthcare industry serving as area service manager for a national release of information company and director of HIM for a community hospital. In her current role, she oversees HIM for a large health system, which includes a 900-bed academic medical center, seven community hospitals, and more than 80 physician practices. Gonzalez holds a bachelor’s degree in HIM from East Carolina University and a master’s degree in healthcare administration from UNC Chapel Hill. She is an active member of AHIMA.

 

Shelby Humphreys, RHIA, is corporate director for coding and CDI at Vidant Health. She has worked in HIM since graduating from East Carolina University in 2004 with a bachelor’s degree in HIM. Humphreys has worked in the physician practice and hospital settings for the better part of her career. She currently has responsibility over inpatient/outpatient coding, auditing, education, charge capture, and CDI within the health system.

Debbie Martin, MSN, RN

Debbie Martin, MSN, RN, has been a nurse for more than 30 years in various settings of critical care, occupational health, clinical information analytics, and CDI, with experience in various levels of healthcare management. Martin is currently the CDI manager at Vidant Health, where she oversees 16 CDI specialists; she is also a member of the facility’s Patient Safety Indicator review committee.

Vaughn M. Matacale, MD

Vaughn M. Matacale, MD, is the director of the physician advisor program for Vidant Health. He began physician advisor training in 2008 and became a full-time advisor in 2013. Currently, he directs a team of full-time physician and ALP advisors to provide DRG validation, coder, and CDI specialist support, and systemwide medical staff education on clinical documentation and its impact on finance and quality. He also served for the last 12 years as a utilization review consultant. Dr. Matacale has more than 12 years’ experience in hospital medicine and continues to practice.

Catherine Njeri Njuguna, MS, RDN, LDN, CDE

Catherine Njeri Njuguna, MS, RDN, LDN, CDE, is the clinical nutrition services department manager for Vidant Medical Center, Vidant Health’s Nutrition Council Chair, and affiliate faculty for Eastern Carolina University’s Department of Family Medicine. She has more than 15 years of experience as a dietitian, with roles including clinical dietitian and diabetes lifestyle coach for the CDC’s National Diabetes Prevention Program. She’s ARAMARK’s South Region peer review coordinator, and served as a past-president and president-elect of Wichita Falls Dietetic Association. Njeri’s experience in strategic initiatives includes leading Vidant’s efforts to educate the clinical nutrition team, providers, and clinical documentation specialists using the ASPEN/AND malnutrition guidelines.

Leah D’Aurora Richardson

Leah D’Aurora Richardson is an attorney at K&L Gates, LLP, in the firm’s regulatory healthcare group located in Research Triangle Park, North Carolina. She focuses on regulatory healthcare law, including Medicare and Medicaid reimbursement, Recovery Audit Contractor administrative appeals, Medicare Administrative Contractor (MAC) pre-payment reviews, MAC and OIG post-payment audits, and government investigations and inquiries.

Ashley Strickland, RDN, LDN, CNSC

Ashley Strickland, RDN, LDN, CNSC, is the adult clinical dietitian supervisor at Vidant Medical Center. She has practiced in the acute inpatient setting for more than 10 years and was deemed Vidant’s subject matter expert in the Nutrition Focused Physical Exam (NFPE) and malnutrition. She has worked to develop, instruct, and manage the competencies of all Vidant dietitians and other key medical professionals. Strickland is an independent contractor for the Academy of Nutrition and Dietetics, for which she travels nationwide to educate dietitians on conducting an NFPE. She also serves as the wellness champion for Vidant’s clinical nutrition services department.