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thank you Mar good morning everyone or
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good
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afternoon um to me is good morning so
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I'm I am so happy you guys are all
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attending this webinar um our topic of
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discussion today is CDI getting back to
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the basics and best
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practice and you know um uh Mar just uh
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gave a presentation of myself so I'm
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just going to add that I am
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a an active member of the uh vitalware
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Team here in in health Catalyst and I'm
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a revenue transformation senior
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consultant um just a a short disclaimer
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statement this presentation was current
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at the time it was published or provided
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via the web and is designed to provide
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accurate and alterative information in
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regard to the subject matter cover the
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information provided is only intended to
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be a general overview with the
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understanding that neither the presenter
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nor the event sponsor is engaged in
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rendering a specific coding advice it is
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not intended to take the place of either
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the written policies or
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regulations we encourage participants to
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review the specific regulations and
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other interpretive interpretative
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materials as
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necessary all CPT codes are Market by
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the American Medical Association and all
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revenue codes are copyrighted by the
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American Hospital
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Association
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so before I go into the objectives of
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our webinar I would like to start by by
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making some
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clarification uh the CDI as such came
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out to light back in
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2007 right after Medicare implement
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mented the msdg system back in those
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early days
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um the uh the the the the the profession
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was known as clinical documentation
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Improvement uh throughout the years and
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due to the fact that
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uh the revenue cycle and and and and the
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prospective Payment Systems had gotten a
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little bit more
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complicated the the the name the CDI has
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changed nowadays officially is known as
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clinical documentation
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Integrity personally I I I I do agree
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with the
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change
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traditionally when when we were
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establishing the the the profession some
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providers were not happy by by us coming
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and telling them we are going to improve
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your documentation uh some of them took
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it like we were in implying like their
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documentation was not good and so the
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bottom line now with Integrity is a lot
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more broad coverage and and you know to
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me it's a lot more descriptive on on on
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on what we do throughout the
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presentation of our webinar I'm going to
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be using the term CDI sometimes I might
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be saying clinical documentation
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Improvement or clinical documentation in
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Integrity uh they apply to the same same
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same field so the objectives of our
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webinar are to improve the health
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revenue cycle through best clinical
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documentation coding and
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reiners being able to identify the
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players in
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CDI uh nurses Physicians and him
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Personnel I'm going to explain more in
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detail about these participants later on
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be able to identify the goals of CDI
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identify what the the role of a provider
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in CDI is being able to differentiate
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between an
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msbr and an APR
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drg be able to State how a drg is
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calculated and recognize the elements of
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reimbursement even though we are going
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to go in detail uh through those
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elements on of reimbursement I just
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wanted to present like a little summary
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of them they are the hospital Blended
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rate the geometric length of state or
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GM the relative weight and the case mix
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index so we are going to do a little
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overview of what is
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CDI well CDI is the process of enhancing
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medical data collection to maximize
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claims reimbursement revenue and improve
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Care Quality payers relay on clinical
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documentation and accurate coding to
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justify value based
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reimbursement this this value based
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reimbursement as I was stating at the
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beginning of our webinar uh is so
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important
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I mean
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traditionally the the uh the the the
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payment the prospective Payment Systems
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have been looking at the sick or the
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sicker or the sickest patient with the
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the value based reimbursement the value
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based models what we are looking is at a
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whole integration of the of the patient
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let's
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say uh value based programs not only
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consider what the acute problem of my
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patient is as of today they look at
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previous history of the patient they
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look at Chronic conditions and based on
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that uh depending on the condition on
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the chronic condition they they are able
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to do risk risk factor adjustments
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so this this is like the future of the
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revenue cycle the value based
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models and um I'm going to give you a a
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quick description of
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CDI okay CDI breaches the gap between
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the clinical language and the cing
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language and you might say what is that
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Gap you know a Gap is like a blockage
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let's assume you have a a patient that
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uh has a known diagnosis of of of cancer
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and this patient is in remission is's
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taking
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chemotherapy
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and he's got a long long clinical
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history and of course a a big uh medical
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chart he is
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admitted for a gastrointestinal bleeding
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okay and at the time of coming into the
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hospital the doctor is just documented
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as a principal diagnosis just
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anemia uh
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we come to the to the um to the time of
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discharging and and then our coder the
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CER is kind of confused because he's
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looking through the chart and he's
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looking at the history of
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cancer patient is having
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chemotherapy and patient got a history
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of an anemia and chronic diseases a
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history of anemia in neoplastic diseases
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so at this stage
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um he is with no avail because anemia is
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so unspecific so the CDI person is going
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to communicate with the attending
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physician and the attending physician
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comes up with the clarification of the
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diagnosis in this case the diagnosis is
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going to be um acute blood loss anemia
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which is a lot more specific something
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we look in CDI is for a
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specificity okay the CDI is a team
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approach using concurrent or
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retrospective reviews of the clinical
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documentation and data in the medical
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record okay A Team approach meaning that
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we have to interact with nurses with
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case managers with uh him personnal and
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of course with the attending physician
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and we do two kinds of reviews one of
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them one of them are the concurrent
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review
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this means that the patient is still in
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the hospital and while the patient is in
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the hospital the CDI team is browsing
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through the chart and getting to to to
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to to to identify any pieces of
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documentation that are not properly uh
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uh integrated and quering the doctor in
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necessary to to get a a a a you know a a
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chart that is is current is is
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completely accurately coded the
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retrospective reviews these are the
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reviews that are performed later on
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right after the uh the patient is being
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discharged uh maybe like uh six weeks
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after the patient has been discharged
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chances are the bill has has been the
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hospital has been paid and it you know
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these retrospective reviews are
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sometimes performed by hospitals who
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hire uh CDI auditor Personnel to review
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the previous documentation and to uh you
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know isolate problems that might be
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corrected in the future uh in the
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clinical
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documentation and the the purpose of
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those
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reviews is to identify any and clarify
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any B incomplete missing or
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contradicting
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uh clinical documentation in order to
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support patient care accurate coding and
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reporting of the true severity of the
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patient illness I'm going to give you an
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example of each one of these uh
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situations like uh when we have some
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vague clinical
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documentation vague clinical
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documentation would be for instance um a
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patient that came up because of an
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abdominal problem and got an acute
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abdominal condition uh let's say a
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colesis thitis and require
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surgery well next day the patient the
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doctors start doing the rounds and one
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physician might say and might dictate um
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patient is doing fine uh uh the wound
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looks good well that's that's big
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documentation something expected would
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be like uh okay this patient is on on on
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his first 24 hours of of
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postoperative uh a period postcystectomy
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and is presenting with a 12 CM of a of a
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surgical wound which looks clean uh the
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the borders are approaching uh uh
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properly
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and there are no signs of infection so
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that's that's some more complete
00:12:00
description of the wound of this patient
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then we have the incomplete piece of
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documentation let's say the same patient
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when he came to the hospital he was
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having a severe abdominal pain um
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something incomplete will be the doctor
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saying well the patient is a 28 years
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old male and it came with a with a
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severe abdominal pain that's it well
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that's
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incomplete uh something complete will be
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okay the patient is a 28 years old Fe
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male who came in with 12 hours of
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evolution of a severe acute pain on the
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on the
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lower right hand side quadrant of the
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abdominal area and the pain irradiates
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to the back and is exacerbated with
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certain foods and it it gets relief with
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over the counter medication Etc so
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that's a more
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complete form of describing the the
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abdominal pain missing a
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documentation every time we admitted a
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patient uh
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patient goes through the development of
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a history and physical history and
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physical has several section missing
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documentation might be the case of H the
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doctor omitting the family history uh or
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it's not uh giving us the allergies the
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patient might have to medication or to
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any any drugs so that's that's that's
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missing
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information and lastly is the the case
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of a contradicting clinical
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information um let's let's let let's
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have a a scenario in which a patient is
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admitted because of asthma
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obervation and then you see or the CDI
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looks at the notes and and and it says
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that the patient is responding
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responding to inhal
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corticosteroids and something important
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they are giving him bit Agonist and and
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and and the patient is responding to to
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to to this therapy then there is a
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progress note where it says that the
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patient got status asmatic
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status asticus is a patient on which his
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or her asthma is is so bad that do not
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respond to Beta Agonist treatment so in
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here there is like a contradicting piece
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of information most likely uh the uh the
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clinical documentation Improvement
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specialist is going to generate a query
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for
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clarification
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um who are the CDI specialist CDI
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Specialists are nurses Physicians health
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information management
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professionals and other professionals
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with clinical and coding
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backgrounds certification is available
00:15:15
through Aima and AIS Aima is the
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American health information management
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association and AIS is the association
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of clinical documentation Improvement
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specialist I see I've seen great nurses
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performing CDI and I've seen some nurse
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practitioners and and and and even super
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super specialists in nursing like a
00:15:42
doctors in nursing performing cdis they
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do great jobs uh I've seen Physicians
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I've seen Physicians changing her
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practice uh to becoming a CDI this was
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not my case by the way but I've seen
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some people do doing that and you see
00:16:01
health information management
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professionals basically the register
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health information Associates or the
00:16:09
register health
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information um
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technicians and they do great uh
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clinical documentation in groupement
00:16:21
Personnel uh the requirements to become
00:16:24
a CDI okay you have to have two years of
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clinical doc documentation improvment
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experience and you have to to have some
00:16:33
college
00:16:35
education and then you have to sit for
00:16:38
an examination with AA and or
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icis cdi's specialist analyze and
00:16:48
interpret clinical documentation and
00:16:50
data for Clinical Laboratory and
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Radiology indicators Radiology is so
00:16:57
like a broad term I mean maybe MRIs
00:17:00
maybe CD scans and and treatments
00:17:04
required for accurate representation of
00:17:07
the security of illness expected risk of
00:17:10
mortality and complexity of care of the
00:17:16
patient what are the goals of
00:17:19
CDI
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well is I identify and clarify missing
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conflicting or non-specific physician
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physician
00:17:27
documentation related to diagnosis and
00:17:31
procedures support accurate diagnosis
00:17:34
and procedural coding Dr assignment
00:17:38
severity of illness and expected risk of
00:17:41
mortality leading to appropriate
00:17:44
reinar and improved communication
00:17:47
communication is a very important word
00:17:49
between Physicians and other members of
00:17:52
the healthare team hospital and
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physician profiles and quality of
00:17:57
medical care so was saying communication
00:18:00
and I'm going to go back to the previous
00:18:03
slide and we we looking here at this
00:18:07
clinical and and laboratory radiologic
00:18:13
indicators I'm saying all of this
00:18:16
because um the CDI has a a very very
00:18:21
important tool of
00:18:23
communication with the Physicians or the
00:18:26
the the the attending providers
00:18:30
and that that communication is
00:18:33
established to the query and the way a
00:18:36
Hima defines a query they say a query is
00:18:39
a communication tool or process used to
00:18:43
clarify documentation in the health
00:18:45
record for documentation integrity and
00:18:49
accurate code assignment for an
00:18:51
individual encounter in any Healthcare
00:18:55
setting um
00:18:58
we we we have come to a really important
00:19:01
point a medical record could be a legal
00:19:06
record and it's the same with a query um
00:19:12
Aima and
00:19:14
ICD they have developed this set of
00:19:18
guidelines for achieving a compliant
00:19:21
query practice and and they say a
00:19:24
leading query a leading query is one
00:19:27
that is not supported by the clinical
00:19:29
elements or the clinical indicators in
00:19:33
the health record and or directs a
00:19:36
provider to a to a specific diagnosis or
00:19:41
procedure the justification for instance
00:19:44
the inclusion of relevant clinical
00:19:46
indicators for the query is more
00:19:49
important than the query format so I was
00:19:52
saying a little while ago I mean that
00:19:54
you are leading a physician uh is not
00:19:57
good let's say
00:19:59
um you have a patient who presents uh
00:20:03
with asthma or or C OPD ex
00:20:06
asservation that's the principal
00:20:09
diagnosis and then you are uh browsing
00:20:12
through the chart and you identify some
00:20:15
clinical indicators of acute respiratory
00:20:18
failure uh the person has shortness of
00:20:21
breath uh he or she is unable to to
00:20:25
elaborate a complete phrase without the
00:20:28
need of grasping for air uh the
00:20:30
concentration of oxygen on the gas
00:20:33
laboratory values is low and you know
00:20:37
the patient is receiving assistance to
00:20:39
to to to breathe through through a cath
00:20:43
or sometimes the patient is incubated so
00:20:46
there are signs and and and and clinical
00:20:49
indicators of acute respiratory
00:20:51
failure the correct Avenue would be like
00:20:54
like like drafting a a query with all
00:20:57
the elements to to to be sent to the
00:21:01
doctor and and see if we can get
00:21:03
diagnosis of of acute respiratory
00:21:05
failure a leading situation would be in
00:21:08
the case of which you write a a
00:21:12
physician a query and you
00:21:16
say Dr Smith in on reference to Patient
00:21:22
ABC the patient is having difficulty
00:21:25
breeding and got some Laboratory
00:21:29
values you know which
00:21:32
are in in line with acute respiratory
00:21:35
failure can you please document acute
00:21:38
respiratory failure on your chart that's
00:21:42
that situation is leading the doctor to
00:21:44
obtain a diagnosis and that's completely
00:21:48
a big
00:21:49
n um then what is the provider role in
00:21:55
CDI okay providers are expected to
00:21:58
provide
00:22:00
complete um clear accurate and
00:22:03
consistent documentation of a patient's
00:22:05
health history present illness and curse
00:22:09
of treatment this includes precise
00:22:12
documentation of OBS of observations and
00:22:15
evidence of medical decision making for
00:22:18
the determination of diagnosis and
00:22:20
treatment plan and along with the
00:22:23
outcome of all test and laboratory
00:22:25
studies studies procedures and
00:22:29
treatments providers should thoroughly
00:22:31
document every diagnosis as
00:22:33
comprehensive as possible in a specific
00:22:36
diagnostic
00:22:40
verish uh in here I'm going to give you
00:22:43
a couple of clinical examples of the
00:22:45
effects of accurate documentation and
00:22:48
coding uh due to proper clinical
00:22:51
documentation I'm going to start by
00:22:53
saying something really quick about it
00:22:56
how the diagnosis are integrated when
00:23:00
when the patient is admitted to the
00:23:02
hospital number number one diagnosis is
00:23:05
the principal
00:23:07
diagnosis the principal diagnosis is the
00:23:11
condition that is established after a
00:23:13
study of being uh the main reason the
00:23:17
patient was brought into the hospital or
00:23:20
was admitted into the
00:23:22
hospital and then we have the
00:23:24
comorbidities the comorbidities are all
00:23:27
the other diseases that you know are
00:23:31
part of the patient problematic but they
00:23:35
are not the main reason why the patient
00:23:37
came to the
00:23:38
hospital um some of those
00:23:41
comorbidities may be CC's which means
00:23:46
comorbid condition or mcc's which is a
00:23:49
major comorbid conditions or maybe some
00:23:53
others which are smaller maybe like like
00:23:57
hypertension or you can have like a like
00:24:01
osteoarthritis or some of some chronic
00:24:04
conditions which which are conditions
00:24:06
but not necessarily being midsize or Cc
00:24:10
or major size or
00:24:13
MCC so I'm telling you this for you to
00:24:16
probably understand better the situation
00:24:18
with this next example this this case
00:24:21
was a 60 years old male with principal
00:24:24
diagnosis of acute renal failure this
00:24:28
falls into the drg
00:24:30
684 which is renal failure without Cc or
00:24:35
MCC relative weight of this drg is
00:24:40
615 and the geometric length of the
00:24:43
state is 2.2 days and with an
00:24:46
approximate reimbursement of
00:24:51
$4500 the provider of this uh case later
00:24:55
on documents the patient has a comp the
00:24:59
compensation of his congestive heart
00:25:02
failure congestive heart failure is one
00:25:05
comorbidity and it's one of those
00:25:07
conditions on which they are not major
00:25:10
condition they are not midsize or CC
00:25:14
conditions CDI browes through the chart
00:25:18
and finds an Eco cardiogram showing low
00:25:21
ejection fraction and a BMP value of
00:25:24
more than
00:25:26
850 this this BM m p is supposed to be
00:25:29
not higher than 100 let's say and the
00:25:33
the ejection fraction should be at the
00:25:35
middle of the level between the being
00:25:38
low or
00:25:39
high um this BMP being high is telling
00:25:44
us that it might be an acute exageration
00:25:47
of a hard
00:25:50
situation um despite the excellent
00:25:52
treatment by the doctor and the patients
00:25:56
good response by the second day in the
00:25:59
hospital no documentation of the kind or
00:26:02
accurity of the heart failure has been
00:26:05
documented um this this situation is
00:26:08
quite often you see it quite often uh
00:26:12
the patient comes into the hospital the
00:26:13
doctor has a lot of things on his plate
00:26:17
and he's giving him he's treating the
00:26:20
patient for
00:26:21
CHF and the only situation and you know
00:26:25
that the patient the doctor is been
00:26:26
successful the only situation he is not
00:26:29
giving us the first and last name of the
00:26:32
of my
00:26:33
CHF
00:26:35
and you know at this stage as I said
00:26:38
before there is no documentation on the
00:26:40
kind and Acuity of the heart
00:26:43
failure okay the CDI specialist deploys
00:26:47
a query and the attending physician
00:26:49
documents acute and chronic heart
00:26:53
failure he has provided us with a middle
00:26:56
and last name to our heart failure and
00:26:58
our drg now becomes drg 682 which is
00:27:02
renal failure with MCC this this acute
00:27:07
on chronic a systolic heart failure is
00:27:10
an
00:27:11
MCC and the relative weight now is 1.
00:27:14
478 and the elos is
00:27:17
4.3 it went up from uh
00:27:22
615 and the gml being 2.2 and going up
00:27:27
to 1 478 and the OS
00:27:32
4.3 the higher relative weight the
00:27:35
higher glos are representing a higher
00:27:38
severity of illness of our patient this
00:27:41
patient requires increased resources and
00:27:44
the overall reimbursement for this drg
00:27:46
is approximately $5,000 more than the
00:27:50
drg
00:27:53
684 I have another example for you this
00:27:57
was the case of a 69 years old female
00:28:01
who was admitted with a principal
00:28:02
diagnosis of acute
00:28:04
pneumonia with hypertension
00:28:07
COPD acute kidney injury and alter
00:28:11
mental status all of these are the
00:28:14
comorbidities and you can see the
00:28:17
AKA which is acute renal failure also is
00:28:21
bolded meaning that uh this is a a cc
00:28:25
this is a midsize condition
00:28:28
uh when he comes in we we establish the
00:28:32
the work in the as being 194 pneumonia
00:28:36
and puracy with CC the weight is
00:28:40
863 and the OS is 2.6 with a
00:28:44
reimbursement of approximately
00:28:48
5547 upon revision of the chart by the
00:28:51
CDI they found documentation of history
00:28:55
of
00:28:55
dementia probable delirium
00:28:58
and a neurology note stated uh probably
00:29:02
in self
00:29:04
aop the attendant attending provider
00:29:08
documents alter mental status is
00:29:11
improving in a progress
00:29:14
note um like to say something for you
00:29:18
guys to understand why what the term
00:29:20
isopathy is when when you get a patient
00:29:24
that um comes in with uh another
00:29:28
alteration of his metabolic system uh
00:29:32
sometimes in this case I mean the
00:29:34
patient got pneumonia and most likely
00:29:37
got dehydrated so he develop acute
00:29:40
kidney failure and while that happens uh
00:29:45
the patient might develop a little
00:29:47
driness a little alteration of his
00:29:50
mental
00:29:51
status and maybe like like low cognitive
00:29:56
function at at that time F so that and
00:30:00
then when they give this patient IV
00:30:03
Solutions and they start the treatment
00:30:05
for the most part the the mental stat
00:30:08
will come backs to normal that's the
00:30:10
typical case of an inal opathy and in
00:30:13
this case we are seeing here that the
00:30:15
attending provider said in a progress
00:30:19
note that his alter mental status is
00:30:22
improving at this stage there is some un
00:30:25
clear documentation of the alter mental
00:30:27
St
00:30:28
is it delirium is it enal opathy un
00:30:32
specified is it metabolic enal opathy so
00:30:36
a medical query is
00:30:39
necessary the CDI writes a non-leading
00:30:42
query for the clarification of the alter
00:30:44
mental status attendan physician reviews
00:30:47
the Lo documentation and selects the
00:30:51
option of metabolic andropathy which is
00:30:55
a major comorbid condition
00:30:58
again we have obtained a more precise
00:31:01
description of the patient alter meal
00:31:04
Styles metabolic inop as I was saying is
00:31:07
an MCC and our Dr now is 193 pneumonia
00:31:12
and puracy with MCC with a higher weight
00:31:15
is now 1.3 107 and the Y of
00:31:19
4.2 before we
00:31:22
got
00:31:24
863 and ym less of 2.6 with the
00:31:29
184 uh
00:31:32
VG in this case uh the weight and the
00:31:36
glos went up and again the higher
00:31:38
relative weight and the higher glos are
00:31:41
representing a higher severity of
00:31:43
illness of our patient this patient
00:31:45
requires increte resources and the
00:31:47
overall reimbursement for this drg is
00:31:50
approximately
00:31:53
8425 uh before we got 5546
00:31:58
doar of
00:32:01
reimbursement so those are the effects
00:32:04
of uh of implementing a good clinical
00:32:07
documentation improvement in our
00:32:10
practices um we're going to go to the
00:32:12
reimbursement side of it and I'm going
00:32:15
to give you a little anatomy of a drg
00:32:19
and the
00:32:20
ipps a drg stands for disease related
00:32:24
group and ipps is impatient prospective
00:32:28
payment
00:32:30
system IPS is a method of reimbursement
00:32:34
on which medicare payment is made based
00:32:37
on predetermined fixed amount each Dr
00:32:42
encompasses similar diagnosis and
00:32:45
interventions thought to incur similar
00:32:48
resources or cost a single drg is
00:32:52
assigned to categorize an impatient
00:32:54
Encounter of
00:32:56
care there are are two main drg systems
00:33:00
one of them is the
00:33:01
msdg medical severity drg that's the one
00:33:05
I was telling you at the beginning that
00:33:07
was implemented in 2007 by Medicare and
00:33:11
it's used by CMS to standarized
00:33:14
reimbursement of care provided to
00:33:16
Medicare beneficiaries as well as some
00:33:19
private
00:33:20
payers
00:33:22
apdg is a little bit more uh recent and
00:33:26
is known as all refine
00:33:29
drgs and and it is used by some State
00:33:33
meditate programs and private payers and
00:33:37
they use basically the same uh uh uh
00:33:41
system to implement their drgs but they
00:33:44
have an extra way of measuring the the
00:33:48
the like the severity of illness we have
00:33:50
four degrees like grade one is stage one
00:33:55
is minor uh two is mod rate and three is
00:34:00
Major and four is Extreme you know the
00:34:04
severity of illness uh whereas the
00:34:07
medical
00:34:08
Medicare
00:34:10
msdg it measures its aity through the uh
00:34:16
presence or not of CC's and
00:34:20
mcc's so bottom line the a drg is a
00:34:24
little bit more complete and CMS
00:34:28
is is is looking into coming to a system
00:34:31
in which uh they develop a model more
00:34:36
like the a APR
00:34:40
drg so what are the elements of reiners
00:34:44
as I showed them to you when at the
00:34:46
beginning of the presentation they are
00:34:48
the hospital Blended rate the gmlos or
00:34:52
geometric length of State the relative
00:34:56
weight the MS the RG assignment and the
00:34:59
case mix
00:35:02
index Hospital Blended
00:35:05
rate uh this is a hospital as specific
00:35:08
reimbursement rate associated with with
00:35:12
its unique patient populations to each
00:35:15
and separate hospital and this is like
00:35:19
the base rate of that
00:35:21
hospital and it is composed the hospital
00:35:24
Blended rates of a base rate Plus at
00:35:27
owns for local wage variations local
00:35:31
taxes if the the uh the hospital has
00:35:35
teaching capabilities meaning is
00:35:38
training residents or is training
00:35:41
nursing personnel and then is also
00:35:45
composed of hospitals with a
00:35:47
disproportionate share of indent
00:35:50
patients that's the hospital Blended
00:35:52
rate the
00:35:54
OS this is the national mean length of
00:35:57
State for a particular
00:35:59
mstg by excluding outlier cases the
00:36:04
reduces the effect of very high or low
00:36:07
values which would would bias the mean
00:36:11
if a straight or average arithmetic mean
00:36:14
is used the mlos is used to determine
00:36:18
perdm payment rate for patients transfer
00:36:22
to postacute care settings for a spe for
00:36:24
a specified msdrs
00:36:27
for for example if a patient is
00:36:29
transferred to another acute care
00:36:31
hospital before the OS is reached the
00:36:34
hospital is paid twice the perdm rate
00:36:37
for the first day of the stay and the
00:36:40
perdm uh for each subsequent day up to
00:36:44
the full msdg
00:36:47
amount relative
00:36:49
weight relative weight der from a
00:36:52
complicated combination combination of
00:36:54
length of State severity of illness
00:36:58
uh res resource utiliz utilization and
00:37:02
cost each drg has its a specific
00:37:06
value value of drg's weight varies
00:37:09
depending on different interaction with
00:37:12
comorbidities I have some examples for
00:37:15
you like the dg5 is a liver transplant
00:37:19
with
00:37:19
MCC uh this is a high weight drg the
00:37:24
weight is 10.43 90 and the Y is
00:37:28
approximately 15.3 days and the
00:37:31
reimbursement of a liver transplanted
00:37:34
patient is approximately
00:37:38
$6,250 have a drg
00:37:41
78 this is hypertensive andal opathy
00:37:45
with CC and the weight in this Dr is
00:37:50
1.57 17 the Yos is 3.2 with an
00:37:55
approximate reimbursement of 50
00:37:58
590 then we have the drg
00:38:00
313 which represent uh represents chest
00:38:05
pain the weight is 724 the glos is
00:38:10
1.7 with the approximate reimbursement
00:38:13
in
00:38:17
4246 how is the msdg assignment okay
00:38:22
they they are close to 1,000
00:38:25
Dr Dr assignment is driven by principal
00:38:30
diagnosis secondary diagnosis procedures
00:38:34
gender and this charge
00:38:38
Stacks case M mix index it is the
00:38:42
average of all drg weights for a
00:38:45
specific passion volume and time period
00:38:48
the CMA is proportional to reimbursement
00:38:51
and the overall severity of illness of a
00:38:54
patient
00:38:55
population alocum I might indicate might
00:38:59
indicate the are assignments that do not
00:39:02
adequately reflect theability of illness
00:39:05
the resources used to treat patients or
00:39:09
the quality of care
00:39:11
provided and I have some examples this
00:39:13
is the drg calculation this is the msdg
00:39:18
293 for heart failure and we have a
00:39:21
relative weight of 6
00:39:24
736 a hospital Blended rate
00:39:27
of 6,000 and an msdg payment of
00:39:32
4,042 a geometric length of stay of this
00:39:36
drg is approximately
00:39:38
2.5 days um this is a CMI representation
00:39:44
over time in this case you have a a time
00:39:49
period this is like the uh from 10
00:39:53
October of 2016 to September of 2017
00:39:57
17 um it's like like like U uh the
00:40:02
fiscal year 2016 and
00:40:05
2017 in this case uh they were
00:40:08
considering four different
00:40:10
drgs uh the 291 378
00:40:14
470 and they show the description this
00:40:17
is CHF with MCC uh 378 isg hmer with CC
00:40:24
470 ma major joint replacement with
00:40:27
which in this case is the higher weight
00:40:29
and the sepsis with MCC is the second in
00:40:32
in in being second
00:40:36
um higher weight with this
00:40:40
drgs and you have the number of this
00:40:42
Charge
00:40:45
cases and sorry about that in this case
00:40:49
this is the total is 92 patients
00:40:53
discharged you get the sum of all the
00:40:56
the the Rel weights and
00:40:59
then you calculate the CMI by dividing
00:41:03
the total total amount of the the
00:41:05
weights of the of the drgs by the
00:41:08
discharg cases and we got a a CMI of
00:41:13
1.62
00:41:15
6203 the reimbursement in this case is
00:41:19
calculated by multiplying the discharg
00:41:22
volume by the CMI by the Blended rate
00:41:26
and we get
00:41:27
the final uh amount that this hospital
00:41:30
is going to get which is
00:41:33
8,769 with 64 cents so as you can see I
00:41:39
mean integrating well our diagnosis and
00:41:42
our drgs is really really important to
00:41:46
obtain a a a a good and probably a high
00:41:51
high
00:41:54
reimbursement um I'm gonna I'm gonna
00:41:56
just go to the final summary of this
00:41:59
presentation after this review we can
00:42:02
summarize the benefits of clinical
00:42:04
documentation Integrity clear
00:42:07
documentation can have very positive
00:42:10
results for Hospital Revenue cycles and
00:42:13
offers an opportunity to improve coding
00:42:16
and maximize reimbursement a strong
00:42:20
revenue cycle rest on accurate timely
00:42:24
data as per a survey amount among CDI
00:42:29
Specialists the top barrier to
00:42:31
effectively implementing C CDI strategy
00:42:34
is a lack of understanding among staff
00:42:37
about a strong document documentation
00:42:40
practices back in
00:42:43
2016 there was a survey performed by the
00:42:45
Black Book Market Research in which they
00:42:49
found 90% of hospitals that had
00:42:51
implemented CDI had earned at least 1
00:42:56
million more in healthcare revenue and
00:42:59
claims
00:43:01
reimbursement after implementing CDI
00:43:04
Arizona Bas Summit Healthcare Regional
00:43:06
Medical Center increased the
00:43:08
organization CMI by 20% with MCC
00:43:12
capturing Rising 37% and CC capturing
00:43:17
22.8% the case makes case mix index an
00:43:21
additional diagnosis capture translated
00:43:24
to over 558,000 more Revenue in just a
00:43:28
few
00:43:29
months health systems are transforming
00:43:32
to a more complex datadriven value based
00:43:36
reimbursement model as I was telling you
00:43:37
a little while ago a system of this
00:43:40
nature demands clear evident based
00:43:43
documentation which needs whole
00:43:46
Integrity of the health provider
00:43:48
diagnosis and therapeutic approaches to
00:43:52
ensure not only a healthy patient
00:43:54
population but a whole healthy and
00:43:56
strong
00:43:57
an improved revenue
00:44:00
cycle uh thank you so much and I'm going
00:44:04
to go to the question and answer
00:44:11
section that was great thanks alandro
00:44:13
would you like me to read the questions
00:44:15
for you yes defitely so first one did
00:44:19
diagnosis Related Group Change to
00:44:22
disease related
00:44:24
group can you repeat the question yeah
00:44:27
did diagnosis Related Group Change to
00:44:31
disease related
00:44:33
group
00:44:37
um it's basically the
00:44:40
same the Dr is diagnosis related gr
00:44:44
that's that's the the the drg is is is
00:44:47
the
00:44:48
abbreviated
00:44:50
um part but this the diagnosis Related
00:44:53
Group is they are the same thing okay
00:44:57
great and then next question how do
00:45:00
hospitals identify their per DM rate for
00:45:04
transfer drg payments okay that's that's
00:45:07
a good question um there are part of the
00:45:12
the integration of a
00:45:14
drg uh is identifying what is the
00:45:18
discharge status of
00:45:21
the of the case and if we look at the
00:45:26
list of the
00:45:27
drgs there are some of them that are
00:45:31
Post Acute Care
00:45:33
drgs and so when that happens you have
00:45:38
to do a complete
00:45:40
recalculation of the reimbursement I
00:45:43
mean some of the uh some of the um
00:45:46
postacute care uh drgs I'm going to give
00:45:50
you some examples and it's like a
00:45:53
intracranial hemor or C inart with MCC
00:45:58
that that is a a a postacute transfer DG
00:46:02
so there is a list and when when you
00:46:05
find some of those uh you have to
00:46:09
recalculate the reimbursement for the
00:46:10
hospital in other words the hospital who
00:46:13
is receiving the payment to continue the
00:46:15
treatment is going to receive the higher
00:46:19
reimbursement
00:46:21
great um we actually don't have any more
00:46:25
questions right now okay so oh one more
00:46:29
just came in how do you handle hard POA
00:46:33
and HAC
00:46:35
queries uh another really important uh
00:46:40
question uh when we do our our
00:46:44
analysis we have to to look at the
00:46:47
present on admission
00:46:49
indicator um there are some conditions
00:46:53
that uh uh if they are not non admission
00:46:58
and if they are Hospital acquired
00:47:01
conditions Medicare is not going to pay
00:47:03
for them and you know you have to really
00:47:07
really and carefully look at the person
00:47:10
on admission indicator of each claim
00:47:13
that's an excellent question thank
00:47:16
you great what's the number one oh sorry
00:47:20
go ahead yeah and that that's especially
00:47:23
important when you have when you're
00:47:25
dealing with like CC or mcc's which
00:47:29
typically are paid at a higher rate but
00:47:32
if that if that condition is H is
00:47:36
present is not present on admission it
00:47:39
means that probably the hospital didn't
00:47:41
take good care of of some general uh uh
00:47:45
measurements to take care of the patient
00:47:47
so it might be penalized with less
00:47:50
reimbursement great what's the number
00:47:53
one strategy to increasing CC and MCC
00:47:56
capture
00:47:58
rates um increasing CC and MCC capture
00:48:02
rates um we go back to um to doing a
00:48:08
good clinical documentation practices
00:48:11
and you know the CDI specialist uh have
00:48:15
to read sometimes in between the lines
00:48:18
and let's say you have a patient with a
00:48:22
cerebal vascular accident and you know
00:48:26
part of the the the the um Therapeutics
00:48:29
on part of the diagnostic
00:48:33
uh procedures of this Cas is just let's
00:48:37
say getting an
00:48:38
MRI we have to we as cdis have to look
00:48:41
carefully at the the report of the of
00:48:44
the um Mite sometimes the Mite might say
00:48:49
there is an area of vasogenic Edema and
00:48:53
the doctor is giving us the diagnosis of
00:48:55
CVA but is not telling us uh the patient
00:49:00
got uh cerebral edema so a query is an
00:49:04
how to an automatic and and an immediate
00:49:07
solution of trying to document that
00:49:10
diagnosis the coders or the cdis
00:49:13
especially the coders they cannot
00:49:15
capture a diagnosis from a a radiology
00:49:19
stud so we have to quer the Phan for he
00:49:21
to validate that hidden
00:49:24
diagnosis so that's a way of just being
00:49:27
careful with our reviewing of
00:49:30
documentation is a way of increasing the
00:49:32
number of CC's and
00:49:35
mcc's great another question how do you
00:49:39
get the doctors to better document this
00:49:41
is a big
00:49:42
problem it is and my my solution
00:49:46
throughout my my my my years of
00:49:50
experience um what I try to do is
00:49:53
approaching the the the the
00:49:55
practitioners in a very subtle way uh
00:49:59
number one
00:50:01
uh making them realize that we are
00:50:04
acting as as an ally of him you know we
00:50:08
are trying for him to look better by
00:50:11
integrating uh their diagnosis in in in
00:50:15
in a in a best fashionable way um
00:50:19
Physicians have a lot in in in in into
00:50:23
their plates and you know rece this
00:50:27
silly query sometimes is like anation
00:50:29
for them but if you show them that by
00:50:32
doing that his or her profile is going
00:50:35
to look better that might be a reason to
00:50:39
stimulate him into documented
00:50:42
documenting better their their
00:50:47
cases okay we have no other questions at
00:50:51
this time so I can go ahead and start my
00:50:55
just my closing remarks and if any other
00:50:56
questions come up we still have a couple
00:50:58
couple more minutes so just a reminder
00:51:01
that after the presentation today by the
00:51:03
end of the day the ceu certificates and
00:51:08
the link to the presentation recording
00:51:10
and slides will be sent out to you over
00:51:13
email so look look out for those just by
00:51:15
end of day
00:51:17
today and if you have any other
00:51:20
questions you can always email us um
00:51:23
we'd be happy to answer those for you
00:51:25
and I think that all and we still have
00:51:27
no questions so um I think we can go
00:51:31
ahead and close it
00:51:32
up so thanks so much Alejandra for
00:51:34
presenting for us today was great uh
00:51:36
thank you so much really appreciate yeah
00:51:40
thank you thanks
00:51:42
everybody bye bye Marine bye thank you
