Problem
At ABC Hospital, as part of the Health Information Management Department's quality initiatives, a multidisciplinary approach is being established to ensure the quality of data management and its use for organizational objectives. All activities need to emphasize one (or all) of these three areas: clinical aspects, administrative applications, and population health monitoring. Quality documentation management is essential for all of these endeavors and will be applied to the following.
Clinical documentation improvement (CDI) will address the clinical aspects with a team of nurses, ancillary staff (therapists, lab, radiology, etc.), physicians, and HIM coding staff. The increased need for clinical documentation specificity to meet ICD-10-CM/PCS requirements and quality reporting indicators for CMS, TJC, and other regulatory agencies makes this aspect to warrant more resources, time, and personnel to meet the quality objectives.
Computerized-assisted coding (CAC), working in conjunction with CDI, will help the Coding Staff better analyze documentation for more detailed ICD-10-CM/PCS and CPT code assignments in a more efficient manner. This, in turn, will facilitate the completion of grouping (inpatient and outpatient), getting the completed codes to the billing staff in an expedited manner, and statistical reporting of diagnoses and procedures as necessary.
Health information exchange (HIE) will assist in addressing population health monitoring. By strengthening the transmission of patient data to their outpatient care partners, ABC Hospital's goals are to increase the health of the community by offering additional services depending on their needs. There has been an increase in the number of retirees who have relocated to the area, the African-American population is significantly higher than the national average due to a historically black university/college located within the county, and a fluctuating student/young-adult population due to four large universities and colleges within the city limits. Health services that address cardiovascular, cerebrovascular, endocrinology, emergency services, and family practice are being analyzed and improved based on statistical trends.
a) Identify at least three questions/concerns about the CAC system that the coding staff will have.
b) Describe the role of HIM professionals in population health reporting.
c) Explain how CDI functions will improve reimbursement.