Need to document the acuity of the patient to get them to certify as IP
Is there a difference between medical necessity and CDI?
How to accurately assess SOI & ROM
What are the quality scores SOI and ROM?
How do those scores work?
What role do they play in readmission rates and mortality rates
What is O/E, Observed over Expected
So how do you compare a 35yo with an 80yo with a similar diagnosis, explain an example
How are Medicare and commercial insurances using these factors?
The 12 elements that should be in your History & Physical
What are the 12 elements that should be in the ideal H&P?
Can you divide these 12 elements into sections?
Explain the 12 Elements
Are there any standards out there?
Do you have any statistics or personal experience from chart reviews as to how often these elements are absent?
The bullets you MUST have in an H&P
What is the best way in your opinion to summarize Acuity?
Is the A/P the area where you would find them?
What could be the difference between a problem list and a SOAP note?
How long should this be?
Timing of the dictation of the H&P (re: Acuity)
What are some of the standards as to when an H&P needs to be dictated and on the chart?
Does timing play a role on what is in the H&P – i.e., the documentation of the acuity?
Avoiding conflicts, contradictions
Standards for a Discharge Summary (DCS)
What are those standards?
Where do they come from?
What is your experience for how often they are missing?
Are there different time requirements as for when a DCS need to be completed?
Synopsis & Objectives
Presentation by: John Zelem, MD, FACS Physician Owner at Streamline Solutions Consulting, Inc.
Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, CCDS, C-CDI, C-DAM CEO & Founder, Core-CDI Co-Founder, Top Gun Audit School
Ernie de los Santos, MBA, SSA, SAC President, Co-Founder, Top Gun Audit School
We hear all the time that we have a tough time engaging our physicians for matters important to the function of the hospital. There needs to be a way to make them part of the solution not part of the problem.
Using the word E.N.G.A.G.E. as an acronym, there are six different areas to consider to increase engagement. Physicians over the years have specialized in what seems to be their favorite radio station: WIIFM, "What’s In It For Me."
We need to find ways to get them to understand it’s not all about them. In order to be successful, there needs to be a team concept, as there is no “I” in team. The lack of engagement has frustrated hospital leaders for a long time.
Patient care cannot take place without physicians, yet they are part of the problem, as the hospital gets the penalty, not the physician. Most physicians want to do the right thing, let’s help them to engage!
This presentation will suggest some measures to accomplish this.
What works, what doesn’t work?
Presenting to Physicians
Synopsis & Objectives
It is perhaps the most vexing issue for providers, hospitals and patients: the effect of merely classifying a hospital stay as either Inpatient or Outpatient.
Certainly, to patients, this is the veritable “distinction without a difference” – except the patient feels the difference in their pocketbook.
For providers, it is not much easier to determine a proper patient status - whatever that means. For the delivery of care, an inpatient environment is certainly capable of more intensive care, while an outpatient environment is less so, by definition, and indeed in reality is not as capable, albeit not very far away from being so, in many locations.
After spending more than a decade teaching and/or discussing the difference, Dr. John Zelem, Glenn Krauss, and Ernie de los Santos have all seen many providers and hospital revenue cycle professionals left with wondering how to enact a system of both thinking about the differences, and enabling processes to choose a proper patient status. How does one create something like that, that is systematic, reliable, efficient and adaptable? The endeavor seems more like an infinite game of Whack-a-Mole than a studied, sensible method of applying business rules, much less achieving healthcare's enshrined Triple Aim.
In this one-hour talk, the presenters review Inpatient and Observation definitions, documentation requirements and billing concepts. Of course, the permutations of the infamous 2 Midnight Rule are discussed, as well as the pitfalls of attempts to use its so-called Exceptions. The critical roles of Utilization Review and Utilization Management are reviewed with references to all the regulatory rules and guidance. And finally, the overall role of clinical documentation is defined, with keys, tips, examples and takeaways as to what constitutes "high-quality" documentation - that is, documentation that not only best communicates the story of the patient but also is able to survive payer audits for appropriate, deserved reimbursement.