Monday, June 13, 2016

Best Practices – Clinical Documentation Improvement


All healthcare facilities – irrespective of whether they are a business enterprise or a charitable institution – have to be financially viable in order to continue to provide services.  Clinical documentation improvement (CDI) programs have evolved from being an informal part of the process to becoming the backbone of the facilities financial viability.  Essential for patient safety and care, quality ratings, accurate reimbursement and reduced physician queries, CDI programs are required and necessary for consistent and complete documentation.  With the transition toICD-10, documentation integrity becomes critical as it gives an accurate image of clinical severity along with providing medical justification for MS-DRG and code assignments.
In order to enjoy the full benefits from ICD-10 and meaningful use, data collection techniques have to improve with healthcare providers looking at data collection as a comprehensive initiative to ensure effective and safe patient care.  While many large healthcare facilities have invested in automated systems to improve clinical note taking, there are a number of things that the smaller practices can follow to ensure best and accurate clinical documentation.
Create guidelines for best practice
The most important step to clinical documentation improvement is to create guidelines that match the best practices and industry standards.  The aim is to provide clarity and brevity while keeping the needs of other readers in mind.  According to the American College of Physicians, practices should define guidelines based on “consensus-driven professional standards unique to individual specialties.”
Constant training and education programs
Your staff may be familiar with documentation standards, but in this rapidly changing healthcare environment, it is important that they upgrade themselves regularly.  Training should be an ongoing process as there are constant upgrades and improvements to EHR software, changes in regulations and the requirements of payers.  Constant and regular training will definitely improve the skill level of your staff in not just documentation but also in identification and rectification of problems.
Appoint a physician advisor/champion
A good way to reduce the practice’s reliance on vendors and third party trainers is to appoint a physician advisor/champion to spearhead the CDI program.  The advisor needs to be enthusiastic about the program, complete knowledge of best documentation practices and a good role model.  The advisor is the core of the program – someone who is there to answer questions from other physicians and support staff.  The effectiveness of the CDI program will depend a lot on the advisor’s drive and commitment to the program.
Monitor performance metrics
Although CDI programs help improve the financial viability of the facility, this alone is not a metric to measure the effectiveness of the program.  To really benefit from the program, it is important that the following performance metrics are monitored.
  • Number of cases reviewed and time spent per case
  • Physician response rates
  • Agreement / disagreement rates of physicians
  • Response time to queries
  • Expected versus observed death rates
  • DRG shift rates.
The facility also needs to analyze these results to find out which physicians are queried most often and which diagnosis is queried the maximum – there may be a need for further education/training for physicians / coders.
More access to EHRs for patients
Making mistakes is human and it is inevitable that physicians will make documentation errors at times.  Allowing greater access to patients to review their medical records helps in finding these errors.  Making use of technology, to allow patients to review their medical records on an online portal can and will help the facility to improve the accuracy of its documentation.  As it is, according to the requirements of Stage 2 Meaningful Use, allowing patients access to their medical records is mandatory – why wait to implement the same.

Wednesday, June 8, 2016

3 Steps To Creating Your Clinical Documentation Improvement Program

Improving clinical documentation leads to revenue gains and most healthcare facilities are now exploring this program.  The main reason for getting into this program is to improve your reimbursements and that will happen with improved documentation and coding.  However, it is important to set specific goals when putting together a Clinical Documentation Improvement (CDI) program for your facility.
Here are some goals that you can keep in mind when building your CDI program:
  • Aim for your facility to become well-organized
  • Improve quality of patient care with reliable medical records.
  • Clarify coding and documentation with an established query process
  • Work with the provider to establish documentation expectations
  • Schedule audit and monitoring on a regular basis
It is important to understand the three processes that you need to take into consideration, in order to create an effective and manageable CDI program – assessment, implementation and maintenance.
Assessment
Healthcare facilities establishing a CDI program need to perform an objective assessment on the existing quality of documentation and coding.  It is important to understand if the deficiencies are due to ambiguous documentation, lack of physician documentation or coding interpretation issues.  Evaluate if your current system is in place for clinical documentation
  • Identify areas that may require improvement or corrections through a baseline medical record audit
  • Assess physician education and training for the CDI program
  • Analyze your payment and denial pattern and set specific goals for the providers and your staff
  • Separate audits for therapeutic and diagnostic procedures
  • Keep focus on level 1-5 visits, not just level 4 and 5
  • Choose a model based on your requirements
  • Bell curve data and practitioner utilization to be reviewed
Implementation
  • Bring your staff on board and make them aware of the importance of each task
  • Ensure that everything required for implementation – work space, tools, personnel are in place
  • Establish a training program and encourage CDI orientation for staff credentialing
  • Implement changes based on your audit
  • Work with your CDI provider to set up a customized program based on the audit results
  • Identify areas requiring further improvements or corrections
  • Develop compliant, meaningful queries and assign a staff to monitor and manage them
Maintenance
  • Set up a monitoring schedule with the provider
  • Set up regular training and education programs for the staff
  • Conduct additional audits regularly to find areas that need improvement
  • Work with the provider to make adjustments to the program, based on the audits
A successful CDI program promotes complete, accurate and compliant documentation; established through analysis and interpretation of health record documentation. This in turn leads to identification and rectification of situations where there is insufficient documentation to support the patient’s care.  Staff needs to be trained to formulate physician queries, analyze data and monitor the program’s performance.  In addition they also should be able to communicate with HIM staff, administrators and physicians successfully.
Contact us at info@medconverge.com for assistance with your clinical documentation.

Thursday, June 2, 2016

3 Financial Mistakes Made by Young Doctors


“Money makes the world go round” – and it can make you go round in circles too, if you make financial mistakes.  This is one part of our existence, where even age and experience are no guarantee for not making mistakes.  Having said that, youth and inexperience create more chances for making financial blunders than the old and wise.  Young physicians too are equally susceptible to making financial mistakes and need to be extra careful when dealing with those typical physician-specific traps.  Given below are three common mistakes that young doctors have been found to make in their initial years of practice.

Taking whatever terms are offered

The lure of making big money and the fear of not getting another offer makes young physicians agree to whatever terms the potential employer offers, without realizing the long term implications of such an offer.  What is important to you – money, work schedule, time for family – you need to prioritize your requirements.  Check whether the terms offered match your priorities before you accept the job.  However, you need to be clear about your “wants” versus your “needs” and understand the difference between the two.  While your needs require fulfillment immediately, your wants can be fulfilled in the long term. 

Depending on your needs and priorities, negotiate firmly but respectfully to ensure that you get what you deserve.

A lot of young physician’s who made the mistake of not negotiating or not setting their priorities early in their career, now rue the chance they lost.  While some of them are trying to reorganize their careers or look for a different job; some have resigned themselves to what they have.  Thus, it is important to be confident and negotiate terms that will support your priorities – this will make your career a rewarding and happy one.

Spending more than you earn

Most young physicians are already in debt by the time they graduate.  Covering the cost of tuitions and boarding, this debt could be as high as $200,000 for most.  The salary as a resident doctor (while completing your training) may not be enough to service the interest on the debt.  By the time you are starting out on your career, you are already neck deep in debt.  This is the worst time to spend money on your wants – be it a car or a house of your own. While there is no doubt that you will be earning from now on; the last thing you want to add to an already existing debt is additional mortgage payments.  This is the time to ensure that your needs are fulfilled – your wants can wait for a few more years.

The first priority for young physicians should be to pay off their student loan debt.  That would mean living the lifestyle of a resident for a few years more.  This would also allow them to increase their savings rather than getting further into debt.  While it is tempting to spend money on your wants, it adds to the pressure of making ends meet which will eventually start telling on your personal and professional life.

Investing without understanding

Money kept idle and not invested, will eventually shrink in value.  However, money invested without understanding and knowledge will definitely shrink in value.  Just because you have become a doctor does not automatically qualify you to become a knowledgeable investor too.  There are many young doctors who have made this mistake and paid heavily for it.  You are earning good money and you wish to make it better – get yourself a professional investment advisor.  However, do not blindly follow the advice; instead do your own research on his advice and educate yourself on the intricacies of financial investment.

Remember, there are no free lunches – what may be attractive as a “tax free” investment would not necessarily be “cost free”.  Cost of investment plays a major part in average and good returns – not everything that is tax free is necessarily good investment.  A good investment portfolio is a mixed bag on tax deferred products, tax free products and taxable products.  This translates to products such as 401(k) or 403(b), stocks and mutual funds.
Remember, investing wisely and keeping a leash on your spending will ensure that you are financially stress free throughout your career.

Wednesday, June 1, 2016

Increase Your Medical Practice Revenue With These 15 Tips



Times are tough – reimbursements are declining and expenses increasing.  Keeping your practice viable in this environment requires being able to identify areas in your medical practice which are bleeding money and working out a strategy to stem the bleed.  While each practice will require a different strategy to boost its bottom line, here are some tips that all medical practices can follow.
Make your entrance attractive and inviting: A visually appealing entrance will be more attractive to patients than a dingy and plain looking one.
Enliven your reception and waiting area: Brightly painted walls, current periodicals, comfortable chairs and maybe free Wi-Fi to make your patients wait comfortable.
Ask patients to write online reviews: Positive reviews from existing patients will encourage new patients to come to you.
Use social media to interact with the community: Connecting with your community through social media can make people comfortable with coming to you when they need a doctor.
Use the power of the internet: Create your webpage and publish blogs, knowledge articles etc.  Patients tend to prefer doctors who reflect authority about their profession.
Organize patient education meetings/classes: Organize meetings/classes on issues such as living with diabetes, pros and cons of dieting, ways to quit smoking etc for your patients and others.
Train your staff: The patient is the reason why your practice runs – train your staff to be courteous, efficient, helpful and caring to the patients needs.
Make your practice paperless: Automating your processes will save you money and time– bring in and implement an EHR system.
Create more appointment options: Is it feasible for you to see patients in the evenings or during weekends? Can you manage a visit to the patient’s residence if required? If yes, these will definitely add to your revenue collection.
Offer more services: Add services like alternative medicine, physical therapy, wellness spa etc. to your practice. These can bring in additional revenue; however, a thorough cost versus benefit evaluation is a must before starting them.  Take a look at this post on Ancillary Services.
Negotiate payer contracts: It is important to review your payer contracts annually.  Renegotiate contracts at the time of renewal and add new payers to your current list.
Review and analyze your bills and medical claim denials: Make it a practice to regularly review and analyze bills raised by your office, along with denials from payers. Put corrective measures in place and ensure that these are followed.
Rework prices with vendors: Talk to your vendors and ask for discounts on bundled services.
Outsource wherever possible: Outsourcing work like billing and collection will definitely be cheaper than doing them in-house.
Encourage group purchasing and avoid overstocking: Join a group purchasing organization or start one in your neighborhood with other practices to reduce cost of regular supplies. Keep an eye on your inventory to ensure that you are not overstocking supplies.

ICD-10-CM Code (M62.84) for Sarcopenia Announced



Effective October 01, 2016, the code M62.84 will be used by the healthcare community for sarcopenia, thus recognizing it as a distinctly reportable condition.  The AIM (Aging in Motion Coalition) announced this ICD-10-C code, as established by the CDC (Centers for Disease Control and Prevention.
What is Sarcopenia?
Defined as a combination of low muscle mass, coupled with weakness in older people; sarcopenia is the progressive loss of skeletal muscle that comes with aging.  While most adults begin losing some amount of muscle mass after crossing the age of 30, there is an exponential loss of strength as the person gets older.  Believed to play a major role in functional impairment and increased frailty, sarcopenia can cause problems with mobility due to decreased muscle strength, increase the chances of falls and resulting fractures, induce frailty hence reducing activity levels and bringing about a loss of independence due to impaired physical mobility.
Why is this code important for sarcopenia?
The recognition of sarcopenia as a distinctly reportable condition in the eyes of the international medical community removes a major barrier for its treatment and research.  Doctors will now be able to improve their diagnosis of this condition; while there will be more recognition by other healthcare professionals of the disease.  With more comprehensive data like EMRs, Death Certificates etc., regarding the disease, researchers will be able to establish universal guidelines for clinical diagnosis and treatment of sarcopenia.  Opening the doors to further research, this code could lead to the acceleration of new therapies for the disease.
The Aging in Motion (AIM) Coalition
A diverse group representing providers, caregivers, patients, consumers, researchers, employers, aging Americans and the health care industry, the Aging in Motion Coalition works towards pressing for higher research and innovation to develop treatments in sarcopenia and other age related functional decline amongst the old.  AIM Coalition was initiated by the Alliance for Aging Research and has been leading interactions with various stakeholders like regulators, clinicians and policy influencers to establish their goals.  One of their primary founding goals was to realize an ICD-10-CM code for sarcopenia – which lead to their submission of a proposal to the CDC in 2014.  Their efforts have resulted in the establishing of the ICD-10-CM code for this condition.
For assistance with your medical billing and medical coding requirements, contact us at info@medconverge.com