Physician Queries Boot CampTM
Course Outline
DAY ONE
Introductions and Course Objectives
Physician Queries
- Industry guidelines and compliance examples
- AHIMA query guidance
- OIG/QIO guidance
- Legal perspective: a case study reviewing non-compliant queries and a false claims settlement
- Examples of query policies (to be included with materials)
- Processes versus policies (examples to be included with materials)
- Query follow up
- Unanswered queries
- Query compliance, audits, and corrective action
- Clinical examples of situations requiring a query
- Clinical indicators of a diagnosis but no documentation of the condition
- Clinical evidence for a higher degree of specificity or severity
- A cause-and-effect relationship between two conditions or organism
- An underlying cause when admitted with symptoms
- Only the treatment is documented (without a diagnosis documented)
- Present on admission (POA) indicator status
- Developing your query templates
- Clinical examples with examples of query wording
Practicum
- Individual chart reviews and identification of query opportunities
- Clarification of a PDx
- CC or MCC
- Hospital-Acquired Conditions (HAC)
- Complications
- Severity condition
- Conflicting or contradictory documentation
- Clinical evidence of undocumented condition
- Condition needing greater specificity
- Other clarifications
- Development of query templates/standardized language (small group activity)
- Chronic respiratory failure
- Acute renal failure or AKI
- Malnutrition
- Sepsis
- Urosepsis
- Stroke
- Encephalopathy
- Heart failure
- Acute MI
- Free-text diagnosis
- Presentation and review of group activity query templates
- Individual activity (each student to develop queries for the opportunities identified during their individual chart reviews)
DAY TWO
Query presentation
- Review of Day One individual activity
Taking your process to the next step: What are your queries telling you?
- Evaluating your queries
- Provider response
- Sample dashboards/reports
- Evaluating non-responses and drilling down
- Developing a process to deliver a 100% response rate
- Communication of the problem
- Education
- "No response" process or policy
- Enlistment of support: VPMA, CEO, Medical Advisor
- Suggestions for enlisting support
RAC and the query process
- Updated RAC targets/diagnoses
- Examples of RAC denials and appeals
- Closing the gap: how CDI can minimize RAC risk
- Suggested processes
Practicum
- Individual chart reviews - each student to:
- Identify conditions/situations in the medical record that might pose a RAC risk
- List why it's a problem
- Identify possible solutions or actions
- If a query opportunity, write the query
Verbal queries and provider education
- Small group activity:
- Develop a 60-second "commercial" to introduce yourself to a physician educating him/her about your role as a CDS
- Develop a verbal query for one (or more) of the conditions identified in your individual chart review
- Class activity
- Provider and CDI specialist role play
- Enactment of verbal query scenarios
Evaluations and closing remarks
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