DocuLink physicians serve as the organization’s secondary reviewer/physician advisor and ensure that the documentation supports the level of care ordered by the attending. With a DocuLink physician serving on your UR Committee, this will satisfy CMS Conditions of Participation with the use of Condition Code 44, decrease regulatory focus on inappropriate admission to the wrong setting, and improve documentation and communications with the Medical Staff.

In addition, clients may consider available adjuncts to the DocuLink Enterprise Program: DocuComp LLC provides physician-to-physician education with the medical staff to improve documentation for both the hospital and physician office. DocuEd can provide Clinical Documentation Specialist education, Denial Management and Appeals education, plus coding education for both facility and professional services.

DocuLink Enterprise Program

The DocuLink Enterprise Program goal is to “link” medical necessity and clinical documentation improvement through education and support services including Physician Advisor Secondary Review for the acute care setting.

Hospitals will be facing even greater scrutiny from the Centers for Medicare and Medicaid Services (CMS) Program Integrity Contractors and the Office of Inspector General (OIG) to ensure that the admission and/or services provided to beneficiaries for acute and post-acute settings are appropriate for the level of care as well as medically necessary. There will be a focus on the documentation within the medical record and whether it accurately reflects the severity of the patient’s illness along with intensity of the resource consumption to justify the admission to the correct level of care and the accurate MS-DRGs.

The focus on improved documentation has brought about new governmental interest in the documentation supporting the MS-DRG, insuring that the admission was medically necessary and appropriate for inpatient services. As hospitals begin to manage their one day admissions, the focus needs to shift from one day stays to the appropriateness of all admissions. Focus will be on short stay admissions, which are usually less than three (3) days, and transfers to skilled nursing facilities to ensure medical necessity is met.

The hospital’s first line of defense in preventing inappropriate/unnecessary admissions is the Utilization/Case Management Departments. Under CMS Conditions of Participation (CoPs) for hospitals, it defines the utilization review department to ensure that each Medicare or Medicaid admission is appropriate and medically necessary. In addition, the department is responsible for ensuring that all consultants and ancillary services are medically necessary for the condition in which the patient required inpatient services; therefore, validating the severity of illness and intensity of services and assigning appropriateness of the admission and/or setting.

DocuLink understands that the most vulnerable times to ensure appropriateness is over the weekends, holidays and nights, due to limited available resources at the organization.

DocuLink Enterprise will be the “Link” to ensuring that each admission to your organizations are accurate, appropriate in the correct setting at the time the decision has been made to admit and ensuring the clinical documentation to support the decision is provided to the organization and attending physician to ensure that accurate billing type.