Symposium Agenda
Day 1
7:00 AM-8:00 AM Registration and Continental Breakfast
Session 1 and Pre-Test (1.0 hour)
8:00 AM-8:50 AM Intro to Clinical Documentation: Historical Perspective of Third Party Payers in Healthcare
Objectives:
- Communicate the evolution of the business of medicine from the perspective of reimbursement, beginning with the self-pay model, the third party payer reimbursement system and the strict business model of medicine today followed by most payers today.
Session 2 (1.25 hours)
9:00 AM-10:15 AM ICD-9 and DRGs to MS-DRGs
Objectives:
- Understand the History of ICD, the development of version nine (9) and it’s affect of Clinical Modification
- Conceptualize the general principles and workings of ICD-9CM coding and its relationship to DRG assignment under the CMS DRGs and transition into MS-DRGS effective October 1, 2008.
- Apply general coding guidelines to case studies including recognition of principal and secondary diagnoses.
- Specify the difference between Complications/Comorbidities and Major Complications/Comorbidities and know the definition of each for DRG coding and reporting perspective.
- Explain the rationale for Medicare’s decision to implement Medicare Severity DRGS and the intended role of MS-DRGs in the Medicare Value Based Purchasing initiative slated for implementation October 1, 2008.
- Compare the similarities and differences between the CMS DRG and MS-DRG system and the expansion of DRGs from 538 to 746 under MS-DRGs is an asset to best explaining variations in severity of illness, risk of mortality and morbidity, and measures of quality of care outcomes and physician efficiency measures.
10:15 AM-10:30 AM Break
Session 3 (1.25 hours)
10:30 AM-11:45 AM Outpatient Observation Service vs. Inpatient Designation Documentation Requirements. What you need to know to stay on the right course.
Objectives:
- Delineate the differences between Outpatient Observation and Inpatient designation in the hospital setting.
- Define what Medicare rules and regulations govern inpatient versus outpatient designation and billing.
- Identify what admission and discharge criteria govern observation versus inpatient designation.
- Explain the role of observation versus inpatient designation as a financial versus clinical tool.
- Apply general medical necessity criteria and guidelines to case studies including recognition of diagnoses, documentation, and clinical care information to support the patient status.
- Define and practically apply the documentation requirements for supporting a patient observation status.
- Understand the Condition Code 44 - what it means to you and how to implement it appropriately.
- Identify the role of the Medicare Comprehensive Error Review Testing Contractor, Recovery Audit Contractors and their expansion, Hospital Payment Monitoring Program (PEPPER Program), and the OIG’s Work Plan, in reducing the hospital error rate in designating outpatient observation versus inpatient admission encounters.
11:45 AM-1:00 PM Lunch to be provided
Session 4 (1.5 hours)
1:00 PM-2:30 PM RACs, CERTS, FIs, Quality Improvement Organizations and Peer Review Organizations- What they are & where they are going.
Objective:
- Identify the goals, objectives, and focus of each organization, and how these are changing as value based purchasing, pay for performance, and quality outcome and efficiency initiatives take hold and become more prominent.
Session 5 (1.25 hours)
2:30 PM-3:45 PM Private and Public Sector Documentation Similarities & Differences
Objective:
- Distinguish the similarities and differences between private and public medical record documentation requirements, including the roles of documentation beyond strict reimbursement components.
- Identify and explain the role of medical record documentation to physician profiling, economic credentialing, adherence to clinical best practice guidelines and standards, and achievement of success and overcoming of challenges associated with the business of medicine and the increasing regulatory environment.
3:45 PM-4:00 PM Break
Session 6 (1.0 hours)
4:00 PM-5:00 PM Pitfalls to Avoid in Becoming an Effective Change Agent
Objectives:
- Define the role of the change agent in your facility including realistic expectations.
- State the pitfalls that may lie in your organization that will be a detriment to becoming an effective change agent in your facility.
- Explain how to become an effective change agent through sharing of knowledge gained in keeping up with and maintaining relevance in changing third party payment regulations with physicians and other staff in the hospital.
- Establish strategies to overcome typical downfalls and other perils introduced through the hospital political environment, turning a negative into a positive.
Day 2
7:15 AM-8:00 AM Registration and Continental Breakfast
Session 7 (1.25 hours)
8:00 AM-9:15 AM Evaluating your Clinical Documentation: The Seven Element Approach
Objectives:
- Communicate each of the 7 elements from the Federal Sentencing Guidelines.
- Explain how the 7 elements can be used to evaluate your clinical documentation.
Session 8 (1.0 hour)
9:15 AM-10:15 AM Fraud and Abuse: Legal Liabilities
Objectives:
- Summarize the False Claims Act and the impact documentation errors can have on an organization.
- Communicate the other tools regulatory agencies use to enforce the regulations.
10:15 AM-10:30 AM Break
Session 9 (1.5 hour)
10:30 AM-12:00 AM The Hospital’s Perspective
Objective:
- Understand the impact of today’s economy on the hospitals.
- Identify the impact of MS-DRGs on acute care hospitals.
- Understand the role of Clinical Documentation Specialist in ensuring Program Integrity
12 PM-1:00 PM Lunch to be provided
Session 10 and 11 (Total: 3.25 hours from Part 1 and Part 2)
1:00 PM-2:45 PM Communicating to MDs and Getting “Buy-in” Part 1
Objectives:
- Communicate the role of medical record documentation, its direct relationship to DRG assignment and application in administrative data, to promote physician buy-in of the Clinical Documentation Improvement Program
- Outline how what physicians currently report through medical record documentation translated into administrative data through ICD-9 code assignment will serve as Pay-for-Performance baseline measures for Medicare and other payers.
2:45 PM-3:00 PM Break
3:00 PM-4:30 PM Communicating to MDs and Getting “Buy-in” Part 2
Activities: Vignettes & role playing from participant experiences within small groups.
Day 3
7:15 AM - 8:00 AM Continental Breakfast
Session 12 (2.25 hours)
8:00 AM-10:15 AM How to Implement and Improve the Effectiveness of your Clinical Documentation Improvement Program: Bridging Medical Necessity and Clinical Documentation Improvement to Establish and Ensure Appropriateness, Accuracy and Compliance
Objectives:
- Develop structure and implement your Clinical Documentation Improvement Program, taking into account the makeup of your medical staff, political process environment of the hospital, clinical coder competencies/skill sets, and overall strategic planning of the organization.
- Develop the skill set for screening for medical necessity, ensuring the appropriate level of care and properly crafting clinical queries without leading the physician to an improper answer. Learn to recognize when a clinical query is needed for clarification purposes.
- Build and expand upon time tested proven strategies that contribute to the development and implementation successes of Clinical Documentation Improvement Programs.
- List pitfalls to avoid in the development and implementation phases of your program that will jeopardize the probability of success and buy-in from your medical staff.
- Effectively communicate with physicians teaching points for immediate and future clinical case studies. Learn the basis for discussing succinct points with physicians, capitalizing upon the opportunity to present teaching points that stress the application of medical records documentation beyond claims data into administrative data.
- Explain the role of administrative data in today’s business of medicine - and the future of medicine.
10:15 AM-10:30 AM Break
10:30 AM-11:00 AM Conclusion, Wrap Up, and Q&A
Clinical Documentation Specialist Certification Examination - (2 hours) -
Optional
No CE credit associated
