Presented by Rae Freeman, HCCS and Dr. James Dunnick, The Dunnick Group Hospital Transformation Consortium Clinical Documentation Improvement Series “Four Key Roles for CDI: CDI Specialist” July 18, 2017 A PORTION OF THESE MATERIALS WERE PRODUCED PURSUANT TO THE Iowa Small Hospital Improvement Program (SHIP) Grant FY 17 IA Contract #5888SH01 and the Georgia Small Hospital Improvement Program FY17.
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Presented by Rae Freeman, HCCS and
Dr. James Dunnick, The Dunnick Group
Hospital Transformation ConsortiumClinical Documentation Improvement Series
“Four Key Roles for CDI: CDI Specialist”
July 18, 2017
A PORTION OF THESE MATERIALS WERE PRODUCED PURSUANT TO THE Iowa Small Hospital Improvement
Program (SHIP) Grant FY 17 IA Contract #5888SH01 and the Georgia Small Hospital Improvement Program FY17.
WEBINAR ETIQUETTE
Hospital Transformation Consortium
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WEBINAR RESOURCES
Hospital Transformation Consortium
As an IACET Authorized Provider, HomeTown Health, LLC offers
CEUs for its programs that qualify under the ANSI/IACET
Standard. HomeTown Health, LLC is authorized by IACET to
offer 0.1 CEUs/1 credit hour for this program.
In order to obtain these units, you must: • Attend webinar/view recording in its entirety within 30 days• Pass online quiz with 80% or better.• Complete webinar evaluation.
Following this webinar, all attendees who have viewed the recording in its entirety will receive an email with a link to the quiz and evaluation.
Anyone that misses the webinar can view the recording online, posted on the program Dashboard, for CEUs.
CONTINUING EDUCATION
Hospital Transformation Consortium
CONTINUING EDUCATION
Hospital Transformation Consortium
HTHU provides over 300 courses online, over 100 Webinars a year, and various live training conference and workshops. Accredited Education from the International Association for Continuing Education & Training (IACET). (Who accepts the IACET CEU? Full list at www.iacet.org)
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Therapy)• Federal Emergency Management Agency• Georgia, Massachusetts and Ohio Board of Nursing• Georgia Professional Standards Commission• Human Resources Certification Institute (for their
Professional in Human Resource Designation)• National Association of Rehabilitation Professionals in the
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Engineers• The American Association of Integrative Medicine• The American College of Forensic Examiners
Institute• The American Council on Pharmaceutical Education• The American Psychotherapy Association• The International College of The Behavioral Sciences• The National Board for the Accreditation of
Occupational Therapy (NBCOT)
ACTION ITEM: GROUP PARTICIPATION
Hospital Transformation Consortium
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Welcome & Introductions Desi Barrett,
HomeTown Health, LLC
Four Key Roles for CDI: The CDI Specialist Rae Freeman, Senior
Manager Consulting -
HCCS
“Doctor’s Notes: Thoughts from a Physician” Dr. James Dunnick,
The Dunnick Group
Upcoming Events & Resources Annie Lee Sallee,
HomeTown Health, LLC
AGENDAClinical Documentation Improvement Series
Program Goals
Clinical Documentation Improvement Series
A CDI program’s purpose is to improve healthcare records to ensure improved patient outcomes, data quality and accurate reimbursement. This series of continued ICD-10 support with a specific focus on CDI will bring together Physicians, coders, and others that have the ability to increase revenue by coding to the highest level of specificity.
The goal of this program is to improve hospital financial processes by helping to develop a CDI program within small/rural hospitals through specific training to the four main roles within a CDI Program: CDI Specialists, Physicians, Nurses and Scribes.
What you Told Us…
Clinical Documentation Improvement Series
“We have a Clinical Documentation Improvement (CDI) program in place:”
Consortium
Pre-Assessment
Survey Results
What you Told Us…
Clinical Documentation Improvement Series
In pursuit of a Clinical Documentation Improvement (CDI) program, our hospital has: (select all that apply)
Consortium
Pre-Assessment
Survey Results
What you Told Us…
Clinical Documentation Improvement Series
Which of the following best describes the training/certification of your coding/CDI team?
Consortium
Pre-Assessment
Survey Results
What you Told Us…
Clinical Documentation Improvement Series
What are your hospital's greatest areas of need related to Coding or Clinical Documentation Improvement? What specifically are you hoping to get out of this program?
Consortium
Pre-Assessment
Survey Results
Trainer BiographyClinical Documentation Improvement Series
Rae Freeman, RHIA, CDIP, CCS-PSenior Manager, Consulting
HCCS - Healthcare Coding & Consulting Services
Rae is an acknowledged HIM expert who performs speaking and education
functions in addition to administering HCCS’s consulting services program.
Rae received a Bachelor of Science degree in Health Information
Management from Southwestern Oklahoma State University and is an RHIA,
a Certified Documentation Improvement Practitioner (CDIP) and a Certified
Coding Specialist-Physician based (CCS-P).
Rae has worked in healthcare for 21 years in positions ranging from coder to
Physician Office Manager and HIM Director. She is president-elect for the
Florida Health Information Management Association and is a past president
of the Texas HIM Association as well as the local Southwest Florida HIM
Association.
Disclosure of Proprietary InterestClinical Documentation Improvement Series
HCCS does not have any proprietary interest in any
product, instrument, device, service, or material
discussed during this learning event.
The education offered by HCCS in this program is
compensated by the HRSA Small Hospital Improvement
Program (SHIP) grant, Iowa FY17-18, Contract
#5888SH01 and the Georgia SHIP Grant Program FY17.
Because the cost of non compliance is much greater than the cost of compliance.
The Physician will always ask, “What’s in it for me?”
The answer is, “Increasing your income and increasing your value to payers.”
WHY BE COMPLIANT
CMS processes approximately 5 million claims Per day
OR
1.8 billion per year
210,000 per hour
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CMS PAYMENTS
2015 Federal Budget
1. MC/MC 24%
1. SS 24%
3. Defense 16%
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CMS $
Medicare: Medicare spending growth was projected as 5.0 percent in 2016 and is expected to average 7.1 percent over the full projection period 2016-2025.
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Medicare is in Trouble
The Government is not kidding about cost containment.
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AN AUDIT TEST QUESTIONQuestion: What percent of charges submitted to Medicare are fraudulent?
A. 5%B. 10%C. 30%D. 50%
Answer: C. Medicare believes that 30% of submitted claims are fraudulent.
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ECONOMIC PENALTIES
•Civil false claims act:
1. $5,500 – 11,000 per claim
2. Three times the value of each claim
•Criminal false claim act:
1. Felony
2. Up to 5 years imprisonment
3. $25,000 fine
•MC/MC civil monetary penalties law:
1. $10,000 per claim
2. Three times the value of each claim
Other – CIA, Exclusion List
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Entity $ Amount Fined
One Hospital 13,000,000.00
Physical Therapist 2,400,000.00
Physiatrist 1,500,000.00
ENT 750,000.00
Family Practice Physician 162,676.00
Dentist 84,00.00
Cardiologist Charged
Coders CIA, Fined
ECONOMIC PENALTIES
“A 16-count indictment was unsealed in federal court charging a cardiologist, Dr. XX, 55, with performing unnecessary catheterizations, tests, stent insertions and causing unnecessary coronary artery bypass surgeries as part of a scheme to overbill Medicare.”
August 21, 2014, U.S. Attorney Northern District of Ohio Steven M. Dettelbach
THE PHYSICIAN RISK
XX Hospital faces 15 lawsuits over improper heart procedures
Hospital is facing 15 lawsuits and is the subject of a federal investigation over improper interventional cardiology procedures, according to a recent Securities and Exchange Commission filing.
Written by Ayla Ellison (Twitter | Google+) | February 13, 2015
Recommended Resource:Pre-Program Resource Course on HTHU.net: “Developing & Maintaining a CDI Program for Small Hospitals” (Course Link)
This course explains what clinical documentation improvement is, defines the purpose of a CDI program, and explains how CDI efforts can positively affect an organization’s key performance indicators, balancing quality measures and reimbursement. Specific case examples are provided to illustrate how CDI can affect the reimbursement of a given admission. Additionally, real life scenarios are provided from several hospitals to support the impact of a strong CDI program within a hospital. Lesson II provides details on how to develop and operate a CDI program within an organization. Whether you already have existing CDI efforts in place or you are starting from scratch, you will gain understanding on how to run a CDI program based on organizational goals. Clinical documentation improvement efforts both large and small can help to improve documentation and thus quality measures and reimbursement.
Learning Outcomes Upon completion of this course, you will be able to:• Recall how a clinical documentation improvement (CDI) program will impact key performance indicators for your hospital.• Recognize the importance of a CDI program.• Describe necessary components of formalizing a CDI program.
Learning Outcomes Standard:Based upon guidance published by American Health Information Management Association (AHIMA) as well as the Association for Clinical Documentation Improvement Specialist (ACDIS).
presented by HCCS , The Dunnick Group, LLC, & HTHJoin the Coding Team of Trainers for this series on Clinical Documentation Improvement for small hospitals,
including a discussion on the four key roles needed for a successful CDI Program. Training will be provided
for CDI Specialists, Coders, Physicians, Nurses, and Scribes in implementing a program in your hospital.
Webinars held at 10 am CST/ 11 am EST on dates below.
July 18, 2017: Four Key Roles for CDI: Role #1 - CDI Specialist Webinar Training 0.1 CEUs
August 15,2017: Four Key Roles for CDI: Role #2 – Physicians
(“Why be compliant-what’s in it for me?”)Webinar Training 0.1 CEUs
October 17, 2017: Four Key Roles for CDI: Role #3 - Nurses & Scribes Webinar Training 0.1 CEUs
March 2018: Rural Coding/CDI Specialist Certification Support Course 1 Support Course 0.1 CEUs
Rural Coding/CDI Specialist Certification Support Course 2 Support Course 0.1 CEUs
Rural Coding/CDI Specialist Certification Support Course 3 Support Course 0.1 CEUs
CONSORTIUM TRAINING
Quarterly Coding & ICD-10 Update Series presented by HCCS In order to help hospitals stay on top of the latest changes and ongoing challenges in coding
requirements, experts in the field come together to share their knowledge in the world of coding
and ICD-10. Recommended audience will include: Coders, HIM Managers/Directors, Business
Office Staff interested in the topic.
June 27, 2017: Hitting the Mark on Compliant OB coding in ICD-10 Webinar