What to Do Next?
Strategies for Approaching Your PPCs
Kristen Geissler, MS, PT, MBA, CPHQ
Strategic Planning & Execution
» Coordination of efforts
Finance
›
Flow and division of review
efforts
» Education & understanding
HIM
Quality
Physicians
Page 2
›
›
CMS versus HSCRC
Clinical versus coding
Case Review
» Review of historical PPC cases
› Consider a sample of top 10 PPCs with cases higher than
›
»
Page 3
expected value and driving most financial impact/weight
Review for data quality opportunities:
‒ Documentation
‒ Coding
‒ Present on admission
Review for data quality BEFORE reviewing for clinical
quality
Educate
» Education
› Coders/ Concurrent Reviewers
‒ Present on admission
‒ Coding of complications
‒ Compliant querying
› Physicians
‒ Documentation implications
› Leadership
‒ Methodology and strategy
Page 4
POA Challenges
»
»
»
»
»
Page 5
Limited training during initial rollout
Very limited early feedback on accuracy of POA data
Encoder limitations on alerts or edits
Early adoption of internal ‘policies’ difficult to change
Inherent challenges in assigning POA indicator for codes that drive
PPCs
Copyright © NCI 2009 Confidential and proprietary,
shall not be transferred or distributed
Case Review
» Review of live PPC cases starting 7/1/09
› Identification of cases with PPCs prior to submission deadlines
› Review before final tape submission to HSCRC
› Review for potential errors in
‒ Documentation
‒ Coding
‒ Present on admission
› Identify process for review and remediation
› Consider targeting top 10-15 with highest financial impact
» Review for data quality BEFORE reviewing for clinical quality
Page 6
Factors Affecting Rank
» Factors to consider
› Are diagnoses documented appropriately and timely?
‒ Documentation of condition present on admission
› Are you accurately coding PPC-driver codes?
‒ Review coding clinics associated with complication codes
› Are you accurately coding POA?
‒ Re-educate staff on POA assignment
‒ Audit records for ‘N’ and ‘U’
‒ Query and educate physicians
› Are you coding all secondary diagnoses?
‒ Some secondary diagnoses may provide exclusions for some
›
Page 7
PPCs
What’s the drill down on clinical quality?
‒ Commonalities in service, physician, floor
MHAC Checklist


Organize team to include at least: Finance, HIM, Quality, Physician
Review historical PPC cases and identify opportunities for improvement in






Documentation
Coding
POA Assignment
Quality/coordination of care
Develop process for identifying live PPC cases (‘pre-tape’)
Develop review process and flow for PPC cases
 Develop process to remediate data quality errors

Develop education plan for key stakeholders



Page 8
Coders/Concurrent reviewers
Physicians
Leadership