The Provider Query Toolkit: A Guide to Compliant Practices

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The Provider Query Toolkit: A Guide to Compliant Practices

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Available March 2020

The Provider Query Toolkit: A Guide to Compliant Practices

Available March 2020

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)

 

Available: March 2020

Pages: 125
Print ISBN: 978-1-64535-012-5 

About the Author

Karen Newhouser, RN, BSN, CCM, CCDS, CCDS-O, CCS, CDIP

Karen is the director of Clinical documentation improvement (CDI) education for MedPartners in Tampa, Florida. A nurse with 40 years’ experience, with a specialization in critical care, Newhouser has extensive experience in quality initiatives involving patient safety indicators, hospital acquired conditions, core measures, sepsis, and malnutrition, as well as ICD-10 education, auditing, data analysis, and reporting. Newhouser transitioned to a role in case management in 2001 and CDI in 2004.

In 2011, she earned a certificate in medical coding and billing as well as the Certified Clinical Documentation Specialist (CCDS) credential. That same year, Newhouser co-presented a poster for the fourth annual Association of Clinical Documentation Improvement Specialists (ACDIS) conference and joined MedPartners as the CDI supervisor at Barnes-Jewish Hospital in St. Louis. She has since been a valued speaker at numerous ACDIS and American Health Information Management Association events. Of late, Newhouser has focused on CDI opportunities in the outpatient environment and was a speaker at the inaugural ACDIS outpatient symposium in 2017. She also recently developed an extensive outpatient CDI academy for MedPartners.

Having been a mentor and preceptor throughout her career, she transitioned to the position of director of CDI education for MedPartners in 2014. In 2015, Newhouser earned the prestegious CDI Professional of the Year Award and was nominated to serve as an ACDIS Advisory Board member. Contact her at knewhouser@medpartners.com.

Table of Contents

Chapter 1: Healthcare reimbursement evolution

Chapter 2: Progression of query guidance

Chapter 3: Redefining query types

Chapter 4: The electronic health record

Chapter 5: Coding advancements

Chapter 6: Regulatory environment

Chapter 7: Query and documentation improvement outcomes

Appendix: Sample queries and additional tools