It's been two years since the American Health Information Management Association joined ACDIS to offer the industry physician query instructions in Guidelines for Achieving a Compliant Query Practice, published in February 2013.
Since the implementation of the Hospital Value-Based Purchasing (HVBP) Program in 2013, CMS has adjusted the MS-DRG payment for each traditional Medicare discharge. The type and amount of the adjustment, which could be a financial penalty and/or an incentive payment, is determined by the hospital's performance for defined quality measures, such as risk-adjusted mortality. Since that time, the number of pay for performance (P4P) programs and quality measures has expanded. By 2017, P4P payment adjustments will impact up to 6% of traditional Medicare revenue.
Even before ICD-10-CM was delayed until October 1, 2015, the quality of physician documentation to accommodate the new code set was a top concern for the healthcare industry.
The ICD-10 implementation deadline is just around the corner, so hospitals must carefully assess their systems and processes to ensure things go smoothly on and after October 1.
The road to ICD-10 has been a long one, and we still have many miles ahead of us. Organizations have invested a significant amount of time and money into this venture, and even though October 1 is rapidly approaching, there’s still work to be done before and after implementation.
Coding for sepsis is often easier said than done. Obstacles range from difficulty distinguishing between documentation for sepsis and related conditions to trouble with physician queries.
At the Association of Clinical Documentation Improvement Specialists (ACDIS), questions on physician queries are never few and far between. Although AHIMA has published a couple briefs on the topic over the last decade, questions have still remained about how to implement a compliant and effective query process.
Editor's note: Medical Records Briefing (MRB) catches up this month with Monica Pappas, RHIA, president of MPA Consulting in Long Beach, Calif., and an MRB advisory board member, to discuss physician queries.
Editor's note: The commentary in this article was originally presented in the HCPro, Inc., February 7 audio conference, "The Pediatric Medical Record: Opportunities for Documentation Improvement." Learn more about the audio conference at http://tinyurl.com/bbh9yl5.
Everyone knows that CCs and MCCs are under scrutiny these days. However, that doesn't mean hospitals should err on the side of caution when reporting these conditions. William E. Haik, MD, FCCP, CDIP, director of DRG Review, Inc., in Fort Walton Beach, Fla., provides several tips that coders can employ to look for clinical evidence in the record before querying for these targeted conditions.
