Download or read book The Physician Advisor s Guide to Clinical Documentation Improvement written by Trey La Charité and published by . This book was released on 2014-04-30 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Physician Advisor's Guide to Clinical Documentation Improvement Physician advisors are not just needed for case management anymore. ICD-10-CM/PCS and the changing landscape of healthcare reimbursement make their input invaluable in the realm of CDI and coding, too. This book will help your physician advisors quickly understand the vital role they play and how they can not only help improve healthcare reimbursement, but also reduce claims denials and improve the quality of care overall. This book will: * Provide job descriptions and sample roles and responsibilities for CDI physician advisors * Outline the importance of CDI efforts in specific relation to the needs and expectations of physicians * Highlight documentation improvement focus areas by Major Diagnostic Category * Review government initiatives and claims denial patterns, providing physician advisors concrete tools to sway physician documentation
Download or read book The Physician Advisor s Guide to Clinical Documentation Improvement written by Trey La Charité and published by . This book was released on 2014 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book The Physician Advisor s Guide to Clinical Documentation Integrity Second Edition written by Trey La Charité and published by . This book was released on 2020-08 with total page 212 pages. Available in PDF, EPUB and Kindle. Book excerpt: Physician advisors are not just needed for case management anymore. ICD-10-CM/PCS and the changing landscape of healthcare reimbursement make their input invaluable in the realm of CDI and coding, too. This book will help your physician advisors quickly understand the vital role they play and how they can not only help improve healthcare reimbursement but also reduce claims denials and improve the quality of care overall.
Download or read book The Clinical Documentation Improvement Specialist s Handbook Second Edition written by Heather Taillon and published by HC Pro, Inc.. This book was released on 2011-01-21 with total page 171 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Clinical Documentation Improvement Specialist's Handbook, Second Edition Marion Kruse, MBA, RN; Heather Taillon, RHIA, CCDS Get the guidance you need to make your CDI program the best there is... The Clinical Documentation Improvement Specialist's Handbook, Second Edition, is an all-inclusive reference to help readers implement a comprehensive clinical documentation improvement (CDI) program with in-depth information on all the essential responsibilities of the CDI specialist. This edition helps CDI professionals incorporate the latest industry guidance and professional best practices to enhance their programs. Co-authors Heather Taillon, RHIA, and Marion Kruse, MBA, RN, combine their CDI and coding expertise to explain the intricacies of CDI program development and outline the structure of a comprehensive, multi-disciplinary program. In this edition you will learn how to: Adhere to the latest government and regulatory initiatives as they relate to documentation integrity Prepare for successful ICD-10 transition by analyzing your CDI program Step up physician buy-in with the improved education techniques Incorporate the latest physician query guidance from the American Health Information Management Association (AHIMA) Table of Contents Chapter 1: Building the CDI Program Chapter 2: CDI and the healthcare system Chapter 3: Application of coding guidelines Chapter 4: Compliant physician queries Chapter 5: Providing physician education Chapter 6: Monitoring the CDI program What's new in the Second Edition? Analysis of new industry guidance, including: AHIMA's "Managing an Effective Query Process" and "Guidance for Clinical Documentation Improvement Programs." CMS guidance from new IPPS regulations, MLN Matters articles, Quality Improvement Organizations, and the Recovery Audit Contractor (RAC) program, among others Strategies to help you incorporate the guidance into your CDI program. Tools to help you interpret MAC initiatives and RAC focus areas to enhance your CDI program and help prevent audit takebacks New sample queries, forms, tools, and industry survey data BONUS TOOLS! This book also includes bonus online tools you can put to use immediately! Sample query forms Sample job descriptions for CDI managers, and CDI specialists Sample evaluation form for CDI staff Sample pocket guide of common documentation standards
Download or read book CDI Companion for Physician Advisors written by Trey La Charité and published by Hcpro, a Division of Simplify Compliance. This book was released on 2016-11 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: When it comes to clinical documentation, physician advisors have a range of important responsibilities, from query escalation to denials management and everything in between. With all these tasks on their plate, physician advisors are constantly pulled in different directions, making it hard to make the best use of their time. CDI Companion for Physician Advisors: Notes From the Field is designed to help physician advisors structure their time properly and carry out their CDI duties effectively and efficiently. This book will help physician advisors: Find their feet in the CDI role Identify tools to provide effective documentation education for physicians and CDI staff Engage medical staff in documentation improvement efforts Understand common documentation deficiencies for difficult diagnoses such as sepsis, heart failure, and kidney disease Work with their CDI team to tackle advanced record reviews in areas such as quality, audit defense, and outpatient HCCs Figure out how to best structure their time to carry out CDI duties
Download or read book The Documentation Improvement Guide to Physician E M written by Glenn A. Krauss and published by . This book was released on 2012-02-27 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Give physicians a crash course in the documentation of E/M services Physicians who provide E/M services must document the necessary clinical information to support their medical decision-making. This is where CDI specialists play an important role, and The Documentation Improvement Guide to Physician E/M can help. This reference guide helps CDI specialists explain to physicians how complete and accurate documentation benefits their E/M payments, prevents medical necessity denials, and provides the information they need to document correctly. This handbook offers the perfect portable reference guide for CDI specialists to educate physicians about E/M documentation. This handbook is provided in packs of 10 so CDI specialists can distribute copies to physicians during documentation improvement education sessions or in response to physician questions and requests for additional information. This reference guide will help CDI specialists: Better understand the complex guidelines that affect physician payment for E/M services Explain the importance of documentation to physicians beyond hospital reimbursement Clarify the purpose of queries and how responding to them benefits physicians' payments and public profiles Encourage physicians to provide adequate documentation that will reduce the number of denials for lack of documented medical necessity Access a comprehensive list of additional online resources to further aid them in their important role Take a look at the table of contents: Chapter 1: E/M Documentation Chapter 2: Components of E/M Chapter 3: Chief Complaint Chapter 4: History of Present Illness Chapter 5: Review of Systems Chapter 6: Past, Family, and Social History Chapter 7: Physical Examination Chapter 8: Medical Decision-Making Chapter 9: Amount and Complexity of Data Chapter 10: Critical Care Chapter 11: Medical Necessity and Clinical Documentation Appendix
Download or read book The Physician Documentation Improvement Pocket Guide Third Edition written by Cheryl Ericson and published by . This book was released on 2014-10-22 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Physician Documentation Improvement Pocket Card, Third Edition (Packs of 25) Cheryl Ericson, MS, RN, CCDS, CDIP, AHIMA-Approved ICD-10-CM/PCS Trainer Sold in packages of 25! Use the Physician Documentation Improvement Pocket Card, Third Edition, to help your physicians remember key documentation points. The six-panel card includes everything from documentation basics to severity of illness clinical indicators. Updated for 2014, this third edition simplifies tips to common documentation improvement opportunities. And it fits easily in the physician's pocket! Start your CDI physician education efforts with the accompanying online instruction manual and help physicians understand common documentation gaps. This product: Provides documentation basics for the short-term acute care inpatient setting Includes tips for discharge summary documentation Details documentation needed to establish a condition as a reportable diagnosis Presents key reminders for documentation to reflect patient acuity Offers advice for how to differentiate among acute, chronic, and resolved conditions Helps providers translate commonly vague documentation of a patient's chief complaint into a more precisely associated diagnosis Includes both printed pocket card and online PDF formats Folds for physicians to carry in their pockets and is laminated for durability and easy cleaning The latest edition of the Physician Documentation Improvement Pocket Card helps you improve patient acuity and severity by focusing on common areas of vague and nonspecific physician documentation. ACDIS Education Director and lead CDI Boot Camp instructor Cheryl Ericson brings her vast experience to bear in creating a simple to follow, easy to use tip sheet and accompanying user's guide to help improve your physicians' documentation. Online user manual will explain how to use the pocket cards and explain some CDI basics.
Download or read book The Clinical Documentation Improvement Specialist s Guide to Audit Defense written by Trey La Charite and published by . This book was released on 2017-01-30 with total page 168 pages. Available in PDF, EPUB and Kindle. Book excerpt: CDI Field Guide to Denials Prevention and Audit Defense Trey La Charit�, MD, FACP, SFHM, CCDS How can your CDI program help defend your facility's medical records and claims submissions from "recovery raiders" to ensure the facility receives the appropriate reimbursement for its patient care? The world of denials prevention and audit defense is filled with a host of watchdog agencies--an alphabet soup of acronyms--to audit claims and take back funds for inappropriate submissions. Your hospital must work to protect its reimbursement, and your CDI program can help. With more than a dozen years' experience working with CDI staff to defend claims and tighten procedures around documentation for auditor targets, author Trey La Charit�, MD, FACP, SFHM, CCDS, provides step-by-step tools to help your program improve its denials prevention efforts. This resource will help CDI professionals: Understand the scope of Recovery Auditors in private and governmental reimbursement efforts Identify various audit contractors and their respective scope of work Explain the importance of CDI and query compliance in denials prevention Identify potential documentation denial risks associated with electronic health records Establish effective appeals processes
Download or read book Clinical Documentation Reference Guide First Edition written by AAPC and published by AAPC. This book was released on 2020-03-12 with total page 13 pages. Available in PDF, EPUB and Kindle. Book excerpt: It's not the quantity of clinical documentation that matters—it's the quality. Is your clinical documentation improvement (CDI) program identifying your outliers? Does your documentation capture the level of ICD-10 coding specificity required to achieve optimal reimbursement? Are you clear on how to fix your coding and documentation shortfalls? Providing the most complete and accurate coding of diagnoses and site-specific procedures will vastly improve your practice’s bottom line. Get the help you need with the Clinical Documentation Reference Guide. This start-to-finish CDI primer covers medical necessity, joint/shared visits, incident-to billing, preventative care visits, the global surgical package, complications and comorbidities, and CDI for EMRs. Learn the all-important steps to ensure your records capture what your physicians perform during each encounter. Benefit from methods to effectively communicate CDI concerns and protocols to your providers. Leverage the practical and effective guidance in AAPC’s Clinical Documentation Reference Guide to triumph over your toughest documentation challenges. Prevent documentation deficiencies and keep your claims on track for optimal reimbursement: Understand the legal aspects of documentation Anticipate and avoid documentation trouble spots Keep compliance issues at bay Learn proactive measures to eliminate documentation problems Work the coding mantra—specificity, specificity, specificity Avoid common documentation errors identified by CERT and RACs Know the facts about EMR templates—and the pitfalls of auto-populate features Master documentation in the EMR with guidelines and tips Conquer CDI time-based coding for E/M The Clinical Documentation Reference Guide is approved for use during the CDEO® certification exam.
Download or read book Guide to Clinical Documentation written by Debra D Sullivan and published by F.A. Davis. This book was released on 2018-07-25 with total page 416 pages. Available in PDF, EPUB and Kindle. Book excerpt: Understand the when, why, and how! Here’s your guide to developing the skills you need to master the increasing complex challenges of documenting patient care. Step by step, a straightforward ‘how-to’ approach teaches you how to write SOAP notes, document patient care in office and hospital settings, and write prescriptions. You’ll find a wealth of examples, exercises, and instructions that make every point clear and easy to understand.
Download or read book Inpatient IPPS Documentation Tips for Physician Advisors Hospitalists and Providers 4th Edition written by Betty B. Bibbins and published by . This book was released on 2016-07-01 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Compliance pocket guide for inpatient clinical diagnostic, medical necessity, and quality of care documentation.
Download or read book Optimizing the Physician Advisor in Case Management written by Mark S. Michelman and published by HC Pro, Inc.. This book was released on 2008-11 with total page 172 pages. Available in PDF, EPUB and Kindle. Book excerpt: Foster effective relationships between case management and physicians with a strong physician advisor program. With increasing federal compliance regulations, there has never been a greater need to have a physician advisor (PA) on staff to provide your case management team with more support to achieve your organizational goals. Whether you're building a new PA program or want to revitalize an existing one, the new HCPro book Optimizing the Physician Advisor in Case Management: A Guide to Creating and Sustaining Measurable Program Results delivers the guidance you need to improve the chain of communication across the continuum of care. Written by Mark Michelman, MD, MBA, Sharon Mass, PhD, LCSW, ACM, and Donna Ukanowicz, MS, RN, ACM, the book combines the perspectives of a physician advisor, nursing case manager, and social work case manager. The book is the industry's first resource that provides: Easy-to-follow steps to create or revamp your program Tips to recruit and train PAs Strategies for defining measurable goals and effective PA responsibilities Analysis methods for evaluating need and justifying resources Metrics to measure your success A CD-ROM loaded with adaptable tools and forms
Download or read book The Clinical Documentation Improvement Specialist s Complete Training Guide written by Laurie L. Prescott and published by . This book was released on 2014-10-23 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Your new CDI specialist starts in a few weeks. They have the right background to do the job, but need orientation, training, and help understanding the core skills every new CDI needs. Don't spend time creating training materials from scratch. ACDIS' acclaimed CDI Boot Camp instructors have created The Clinical Documentation Improvement Specialist's Complete Training Guide to serve as a bridge between your new CDI specialists' first day on the job and their first effective steps reviewing records. The Clinical Documentation Improvement Specialist's Complete Training Guide is the perfect resource for CDI program managers to help new CDI professionals understand their roles and responsibilities. It will get your staff trained faster and working quicker. This training guide provides: An introduction for managers, with suggestions for training staff and guidance for manual use Sample training timelines Test-your-knowledge questions to reinforce key concepts Case study examples to illustrate essential CDI elements Documentation challenges associated with common diagnoses such as sepsis, pneumonia, and COPD Sample policies and procedures
Download or read book Clinical Documentation Improvement Specialist s Handbook written by Colleen Garry and published by Hcpro Incorporated. This book was released on 2014-05-14 with total page 172 pages. Available in PDF, EPUB and Kindle. Book excerpt: Improving documentation is no easy task CDI professionals have never had one easy-to-read, inclusive reference to help them implement a CDI program, understand the fundamentals of ICD-9-CM coding, query physicians, and encourage interdepartmental communication. In theory, physicians should document their entire thought process, including ruling conditions in and out. But it's not that simple, and in light of MS-DRGs, it requires significant physician education and retraining. You need a blueprint for success.. Your blueprint has arrived! At last, here is a guide for CDI specialists. The Clinical Documentation Improvement Specialist's Handbook is your essential partner for creating a CDI program, staffing your program, querying physicians, and understanding how documentation affects code selection and data quality As a CDI specialist you need answers now In light of Medicare Severity DRGs (MS-DRG), detailed documentation and accurate capture of complications and comorbidities (CCs) has made the CDI specialist's role more important and more demanding than ever. This handbook will enhance your ability to gather the right information the first time--and every time Author Colleen Garry, RN, BS, has compiled case studies that document best practices and reference several different CDI models so that you can select the one that's right for your hospital's CDI success. In addition, you'll be privy to an executive summary of HCPro's exclusive CDI survey that solicited more than 800 responses. Learn how other hospitals are handling CDI and choosing the model that works best for them. * work with physicians to obtain detailed, appropriate documentation * maintain compliance when performing physician queries * convey return on investment for a CDI program Customizable CD-ROM included Your copy of The Clinical Documentation Improvement Specialist's Handbook includes a CD-ROM loaded with all of the working tools you'll find in the book. Among them
Download or read book Clinical Documentation Improvement written by Ruthann Russo and published by American Health Information Management Association. This book was released on 2009-08-01 with total page 203 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cover title includes subtitle: "Achieving excellence."
Download or read book Clinical Documentation Specialist The Comprehensive Guide written by VIRUTI SHIVAN and published by Viruti Satyan Shivan. This book was released on with total page 232 pages. Available in PDF, EPUB and Kindle. Book excerpt: Dive into the essential world of clinical documentation with "Clinical Documentation Specialist - The Comprehensive Guide," a pivotal resource designed for healthcare professionals committed to excellence in patient care through meticulous record-keeping. This guide offers a deep dive into the principles of accurate and compliant medical documentation, highlighting its critical role in ensuring optimal patient outcomes and the seamless operation of healthcare systems. With an emphasis on practical strategies, real-world applications, and the latest compliance standards, this book serves as an invaluable tool for both aspiring and experienced clinical documentation specialists. By focusing on enhancing communication between healthcare providers and supporting the delivery of high-quality care, it addresses the challenges and complexities of modern medical documentation practices. Without relying on images or illustrations for clarity, the guide stands out for its comprehensive coverage and insightful analysis, making it a unique addition to the professional library of healthcare providers. It transcends basic instructional material by weaving in theoretical knowledge with actionable advice, empowering readers to navigate the nuanced landscape of healthcare documentation with confidence. The absence of visual elements is more than compensated for by the depth of knowledge and the engaging writing style, ensuring that readers are equipped with the knowledge and skills necessary to make a significant impact in their roles as guardians of patient information and care continuity.
Download or read book Clinical Documentation Improvement written by Pamela Carroll Hess and published by . This book was released on 2015 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
