The Provider Query Toolkit: A Guide to Compliant Practices

Queries are the hallmark of CDI specialists’ work, no matter the setting or programmatic structure. Along with query compliance updates and coding guidelines, the introduction of electronic health records (EHR), clinical validation denials, quality programs, and more have made following industry and compliance standards more difficult.

The Provider Query Toolkit: A Guide to Compliant Practices provides a comprehensive analysis of query guidelines and easy-to-follow strategies to improve query processes. This valuable resource, perfect for both the new CDI specialist and those looking for a refresher on CDI query fundamentals, examines recent changes in coding and payer nuances, denial trends, query compliance, and quality programs impacting the CDI specialist.  

The Provider Query Toolkit: A Guide to Compliant Practices includes sample queries, policies, and procedures — all with a fresh twist from a new author for the current CDI climate.

This book will provide:

• Foundational knowledge for new CDI specialists of query processes and an awareness of compliance concerns
• Guidance for managers/directors to establish compliant query practices and provide policies to stay updated on current regulatory changes
• Support for those expanding their reviews (and therefore queries) to a new area, such as outpatient or clinical validation
• Assurance that processes and compliance standards are being met regardless of setting (short-term acute care, long-term acute care, children’s hospital, rehab facility, or physician practice)

Click here to access chapter previews.

Published: April 2020

Pages: 146
Print ISBN: 978-1-64535-012-5 

Table of Contents

Chapter 1: Back to the Patient

Chapter 2: The Watchful Eye

Chapter 3: Documentation and Query Guidance Progression

Chapter 4: Query Standards

Chapter 5: Coding Guidelines

Chapter 6: The Electronic Health Record

Chapter 7: Outcomes

Appendix: Sample queries and additional tools**

About the Author

Karen Newhouser, RN, BSN, CCDS, CCDS-O, CCS, CDIP, CCM
Clinical Documentation Integrity Content Manager
AMN Healthcare Revenue Cycle Solutions

Karen Newhouser is the clinical documentation integrity (CDI) content manager for AMN Healthcare Revenue Cycle Solutions in Tampa, Florida. In addition to several decades of experience as a nurse— mostly in the critical care sector—Newhouser has nearly two decades of experience in the CDI and case management realm. She is an expert in compliant query best practice, quality initiatives, clinical validation, provider engagement initiatives, auditing, and data analysis.

In addition to Newhouser’s devotion to her family, writing and education are her passions, as evidenced by her commitment to sharing knowledge with others through speech and print as she strives to set others up for success. Newhouser has been a valued speaker at numerous ACDIS and American Health Information Management Association events geared toward both inpatient and outpatient settings.

Newhouser is the author of previous ACDIS titles, including The CDI Specialist’s Guide to Evaluation and Management and has co-authored the CCDS-O Study Guide and the 2020 ACDIS Outpatient Pocket Guide. 

Newhouser is a member of ACDIS, AHIMA, AAPC, CCMC, and Sigma Theta Tau International Honor Society of Nursing. She sat on the ACDIS Advisory Board from 2015-2018 and was honored to be named the 2015 ACDIS CDI Professional of the Year. Contact her at karen.newhouser@amnhealthcare.com.

Chapter Previews

Check out these chapter previews for a full idea of what you can expect!