The Physician Advisor’s Guide to Clinical Documentation Improvement

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The Physician Advisor’s Guide to Clinical Documentation Improvement

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The Physician Advisor’s Guide to Clinical Documentation Improvement

Physician advisors are not just needed for case management anymore. ICD-10-CM/PCS and the changing landscape of healthcare reimbursement make their input invaluable in the realm of CDI and coding, too. This book will help your physician advisors quickly understand the vital role they play and how they can not only help improve healthcare reimbursement, but also reduce claims denials and improve the quality of care overall.

This book will:

  • Provide job descriptions and sample roles and responsibilities for CDI physician advisors
  • Outline the importance of CDI efforts in specific relation to the needs and expectations of physicians
  • Highlight documentation improvement focus areas by Major Diagnostic Category
  • Review government initiatives and claims denial patterns, providing physician advisors concrete tools to sway physician documentation

 

Table of Contents

 

  1. CDI Foundation
    a)      Team composition
    b)      Staff responsibilities
    c)       Core competencies
    d)      Program structure
  2. Risk and severity adjustments
    a)      Data sources
    b)      Risk of mortality and secondary diagnoses
    c)       Physician Compare
    d)      Provider profiling
  3. Payment models
    a)      Bundled payments
    b)      MS-DRGs/APR-DRGs
    c)       HCCs
    d)      Value-based purchasing
    e)      HACs/POAs
    f)       E/M
  4. Coding foundations
    a)      Transition to ICD-10
    b)      Cooperating Parties
    c)       Examples of increased specificity
    d)      Coding guidelines as they apply to CDI
    e)      Coding Clinic influence
  5. Query compliance
    a)      Evolution of query practices
    b)      Effective query creation
    c)       Auditing/monitoring queries
  6. Clinical conditions
    a)      Stroke
    b)      Altered mental status
    c)       Encephalopathy
    d)      Functional quadriplegia
    e)      Respiratory failure
    f)       Pneumonia
    g)      Cardiovascular diseases
    h)      Kidney disease
    i)        Surgical complications
    j)        Musculoskeletal
    k)      Diabetes
    l)        Malnutrition
    m)    Pediatrics, obstetrics
    n)      Neoplasms
    o)      Sepsis
  7. Regulatory oversight/auditors
    a)      Recovery Auditors
    b)        Medicare Administrative Contractors
    c)       Compliance concerns
    d)      Electronic health record               
  8. CDI program monitoring
    a)      Auditing
    b)      Communicating statistics
    c)       Locating concerns

 

About the Authors

Trey La Charité, MD, is the physician advisor for the University of Tennessee Medical Center's clinical documentation integrity project and for coding. He completed his internship and residency training in internal medicine at UTMCK and is currently an assistant professor in the Department of Internal Medicine and a hospitalist at UTMCK. He previously served on the ACDIS advisory board.

James S. Kennedy, MD, CCS, CDIP, is the president of CDIMD-Physician Champions, a Nashville-based group of physicians, coders, and clinicians engaged nationwide as CDI physician advisors, ICD-10 medical informaticists, and DRG and HCC compliance advocates. His experience includes the private practice of medicine along with successful entrepreneurial healthcare-related business startups in the public and private sector. His expertise includes physician and hospital leadership, healthcare systems improvement, healthcare documentation and coding compliance, and government relations. He previously served on the ACDIS advisory board.

Published: May 2014