Upgrading your Clinical Documentation Improvement Program
Who can benefit from this program?
Hospitals with existing CDI programs and opportunity for CMI growth.
Hospitals with HAC and Readmission Penalties.
1. Free Data Analysis of your opportunities
2. A Random Sample Audit of 100-200 Cases to determine focused areas of
opportunity
3. Comprehensive Clinical & Systems Training
– Including Clinical Documentation Improvement Upgrade Program Systems & Clinical Manuals
and Clinical Documentation Improvement Upgrade Program Developed Tools
4. Focused Recommendations to capture identified opportunities
5. Systems and Tools Upgrade
6. Specific querying/re-coding/re-billing instructions for cases identified in the
audit.
– Re-billing opportunity may cover most or all of the total cost of Clinical Documentation Improvement Upgrade Program
Eliminating HAC Penalties Program
Who can benefit from this program?
Hospitals that currently have a HAC Penalty (56% repeat the following year)
Hospitals with multiple HAC Penalties
Hospitals with a HAC Score close to the 75th Percentile threshold
HAC/HAI Cases can be a quality or a complex documentation/definition/coding issue. At some sites, more than 50% of identified cases were not true HAC cases.
Stage 1: A Low-cost audit of HAC Penalty cases
If findings verify that CFMA assistance would significantly decrease HAC Score, decision to proceed with implementation.
Stage 2: Implementation:
– Discussion/education of all potential change cases
– Provision of tools for future use
– Team auditing (hospital / CFMA) of 2019 HAC/HAI collection period cases to prevent a repeat penalty
– Development of concurrent HAC/HAI program: no case is final billed or submitted without an internal review first
– Continued support on challenging cases
The program should be completed in 2-4 months
Clinical Documentation Improvement Program
Who can benefit from this program?
Hospitals that do not have a Clinical Documentation Improvement Program
1. Free Analysis of a hospital’s most recent data:
– What ballpark level of opportunity exists?
2. Initial Random Sample Audit:
– Determines the benchmark level of opportunity & establishes the goal for implementation
– Helps everyone to understand on a case by case basis why the documentation/coding
opportunity exists
– Provides an early opportunity to meet and evaluate CFMA’s team members
3. Full Implementation of a Clinical Documentation Improvement System:
– Training the team to fully comprehend the clinical/coding opportunities
– Building effective teamwork between Clinical Documentation Specialists and the Coding Staff
– Manuals and tools
– Making it easy for the Medical Staff to help
– Expanding the effort to POA, Never Events, Core Measures, Transfer DRGs, Core
Indicators, Quality Scores, Obs/Admission decisions
– Reducing the volume of denials
– Teamwork for more successful appeals
– Compliance Audits
– Preparing your doctors for ICD10-CM
Upgrading Your Case Management Program
Who can benefit from this program?
Hospitals with a high OBS rate
Hospitals with ongoing Readmission Penalties
1. Integrating CDI into your Utilization Review program
2. Re-tooling your Entire Utilization Review Program
– Creating an Up-To-Date Formal UR Program
– Your current program is homegrown and no longer meets rapidly expanding demands of
Medicare & other payers
– The Case Manager becomes the expert guide to the medical staff
– Understanding and using the InterQual Criteria
– Observation Status Guidelines
– Insurance Verification
– The Daily Process
– Manual and Tools
– Using Code 44
– Improved Obs/Admissions decision making
3. Analyze Readmission statistics
– Assist in reducing Index Admissions
– Developing Transitional Care Services
– Forming liaisons with Community Providers to reduce readmissions
4. Prepare your Case Management Department for the future of ACOs and P4P