CDI - ICD10monitor

With good collaboration and the right team members, continual improvements are attainable.Recently I have been engaged in a project of continual improvement in our clinics, and as chief compliance officer, I am continually looking for ways we can stay compliant, deliver excellent healthcare, and fix revenue leaks.We audit our physicians…
The clinical query process is a small yet important part of any CDI initiative.By now I am confident that most in the clinical documentation improvement (CDI) industry are familiar with the lawsuit brought by data analytics firm Integra against Providence Health to recover $188 million for alleged upcoding perpetuated by…
The authors discusses the lawsuit against Providence St. Joseph Health Services for alleged upcoding. Performance with a purpose must be the driving force for business operations, personal goals, work and life accomplishments, and personal choices. The concept of performance with purpose must be a fundamental foundation governing all aspects of…
Recent FCA activity focuses on coding compliance issues Recently in healthcare news were articles about two legal actions that cause one to reflect on the need for a strong (or stronger) coding and clinical documentation improvement (CDI) compliance programs.  The first legal action cited the False Claims Act (FCA) and…
It’s not the credentials, but knowledge of the clinical validator that counts. Clinical documentation integrity (CDI) professionals come from a variety of backgrounds and skill sets. Frequently, we see health information management (HIM) coding professionals and nurses stepping into the role of CDI. Their respective education and experiences help provide…
Trends in Clinical Documentation, Past, Present, and Future – Part II EDITOR’S NOTE: This topic has solicited many comments, creating as contentious debate, since Part I was published in the ICD-10monitor e-News on July 17 and discussed the same day on Talk-Ten-Tuesdays. I want to highlight some of the comments,…
National HIV Testing Day is June 27. Wednesday is National HIV Testing Day—a day designated to highlight the importance of testing in detecting, treating, and preventing human immunodeficiency virus (HIV) infection. This special day is designed to encourage people to get tested for HIV, know their status, and get linked to…
A Pittsburgh-based MD weighs in on an emerging area of focus in the healthcare industry. EDITOR’S NOTE: The following are remarks made by the author during a recent broadcast of Talk Ten Tuesdays. Today I would like to focus on outpatient clinical documentation improvement (CDI), often referred to as the…
New hybrid CDI program blends off and on-site CDI operations. University of Pittsburgh Medical Center (UPMC) is a world-renowned healthcare provider and insurer based in Pittsburgh, Penn. that has 80,000 employees in the state. UPMC operates more than 30 academic, community, and specialty hospitals and more than 600 doctors’ offices…
Risk adjustment has been used to entice payers and providers to accept patients with multiple chronic conditions along with those patients who are relatively healthy. Is coding and billing for risk adjustment really any different than what we have been doing all along? It is different in that the codes…