The Complete Guide to CDI Management

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The Complete Guide to CDI Management

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The Complete Guide to CDI Management

Cheryl Ericson, MS, RN, CCDS, CDIP
Stephanie Hawley, RN, BSN, ACM
Anny Pang Yuen, RHIA, CCS, CCDS, CDIP

Managing a CDI department can be a daunting task for new and seasoned managers alike. The Complete Guide to CDI Managementprovides CDI program managers and directors with insight into the most common issues associated with implementing, staffing, running, and growing a CDI department. The book also covers core skills such as auditing and metrics, and it provides strategies for overcoming challenges related to electronic records, changing regulatory landscapes, and resource limitations.

The Complete Guide to CDI Managementincorporates the deep expertise of multiple authors with varied backgrounds who have come together to share their firsthand knowledge. From reporting structures and productivity measurement to defining a mission and physician engagement, this definitive resource addresses the wide array of issues facing CDI managers and directors in today’s hospital environment.

Table of Contents

About the Authors

Introduction

Chapter 1: An Introduction to CDI for the New Manager

  • History of Coded Data
  • The Medical Coder
  • The Prospective Payment System
  • Adding “Severity” Into the DRG Methodology
  • CDI Basics
  • Summary


Chapter 2: Growing a CDI Department

  • The Traditional Role of CDI
  • CDI Review Population
  • Principal Diagnosis Assignment
  • Types of DRG Reviews
  • Quality Focus
  • Summary


Chapter 3: Developing Relationships

  • Sharing the Mission
  • Physician Engagement
  • Obstacles to Developing a Physician Relationship
  • Leveraging Queries as an Educational Tool
  • The Art of Clinical Validation
  • The Query Format
  • Query Templates
  • Fostering a Relationship With Coding
  • Networking
  • Summary


Chapter 4: Department Structures and Staffing Expectations

  • Department Structures
  • Staffing/Hiring
  • Physician Advisor
  • Creating a Career Ladder
  • Continuing Education
  • CDI Department Meetings
  • Evaluations
  • Credentialing
  • Initialing vs. Revitalizing
  • Summary


Chapter 5: Demonstrating the Return on Investment

  • Measuring Success
  • Productivity and Sample Metrics
  • Summary


Chapter 6: Challenges and How to Overcome Them

  • Organization Issues
  • Resource Issues
  • Summary


Appendixes

  • Appendix A: Resources


About the Authors

Cheryl Ericson, MS, RN, CCDS, CDIP, AHIMA-Approved ICD-10-CM/PCS Trainer, is the clinical documentation program manager at ezDI. Ericson is responsible for all clinical documentation initiatives at ezDI, including the development of an innovative approach to CDI that integrates all the competing clinical data initiatives associated with reimbursement, quality of care metrics, and medical staff collaboration with a focus on people, processes, and systems. Ericson collaborates with the product design team as a CDI subject matter expert to define and design the technology elements that support an enterprise cloud-based computer-assisted suite of products, including ezCAC, ezCDI, and ezAssess. Ericson, who currently serves on the Association of Clinical Documentation Improvement Specialists (ACDIS) advisory board and credentialing committee, is recognized as a CDI subject matter expert for her body of work, which includes many speaking engagements and publications for a variety of industry associations. Prior to joining ezDI, Ericson was the CDI education director for HCPro and associate director of education for ACDIS. She also managed CDI, core measures abstraction, and utilization review departments at a large academic medical center. Ericson has an extensive background in adult education, data analysis, healthcare revenue cycle, and CMS guidelines.

Stephanie Hawley, RN, BSN, ACM, is an RN who holds a Bachelor of Science from the University of Nebraska Medical Center and is an accredited case manager. She has worked in various capacities within case management over the past 10 years in intensive care, orthopedics, neurology/neurosurgery, and obstetrics. Hawley has functioned as a case management supervisor and as an audit and denials manager, and is currently fulfilling the role of the director of case management, auditing, & education at Regional West Medical Center. Hawley was instrumental in developing and implementing the CDI program at Regional West Medical Center, a rural 182-bed regional referral center and one of only three level two trauma centers in Nebraska. Hawley understands the limitations and frustrations encountered in rural facilities and brings the ability to overcome many of these obstacles. She has an energetic and enthusiastic personality and enjoys the challenges associated with CDI. She has prepared and executed many hours of education to assist providers in more accurately reflecting their publicly reported data and ensure that the facilities they work for get their entitled revenue.

Anny Pang Yuen, RHIA, CCS, CCDS, CDIP, AHIMA-approved ICD-10-CM/PCS trainer,is the director of ambulatory CDI services for Enjoin. Yuen is a health information management (HIM) and CDI professional who has extensive experience in healthcare and revenue cycle consulting. She has implemented and re-invigorated many CDI programs nationwide and has provided on-site CDI support to major health systems. Prior to joining Enjoin, Yuen was the corporate director of CDI at Penn Medicine. In this role, she was responsible for the oversight of four hospitals and was successful in developing a unified and multidisciplinary corporate CDI process focused on improving provider documentation through specialty-specific education. Yuen is an active member of the American Health Information Management Association (AHIMA), ACDIS, and the Philadelphia/Southern New Jersey local ACDIS chapter. Yuen currently serves on the ACDIS advisory board, to which she was elected in 2015. She holds a Bachelor of Science in HIM from Temple University, where she minored in business.

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Published: January 2016

Page count: 132
Dimensions: 8.5x11
ISBN: 978-1-55645-488-2