*** LIMITED TIME OFFER: FREE $100 AMAZON GIFT CARD! *** REGISTER TODAY! Course Overview The is an intensive three-day course designed for CDI departments/programs looking to move to the next level of CDI not just diagnosis review and clarification, but how diagnoses impact hospital quality metrics and influence indirect revenues. This class covers publically reported quality data and how code assignment affects quality metrics, including but not limited to the Hospital Value-Based Purchasing Program. Students will learn the why and how of reviewing complex cases involving Patient Safety Indicators (PSI) and hospital-acquired infections (HAI), and leave with measurable strategies for improving their hospital profiles and positively influencing their facility s value-based incentive payments. Learning Objectives At the conclusion of the course, participants will be able to: Define payment methodologies beyond Medicare s inpatient prospective payment system (IPPS), including the Hierarchical Condition Categories (HCC) system Describe the potential advantages and documentation opportunities of expanding CDI beyond MS-DRG review/optimization and CC/MCC capture Explain the impact of principal diagnosis assignment (i.e., diagnosis sequencing) on indirect revenue, including that affected by quality metrics and medical necessity denials Define the CDI specialist s role in supporting medical necessity and working collaboratively with utilization review/case management Develop documentation strategies to enhance a hospital s quality metrics without compromising data integrity congruent with official coding guidelines Describe how additional CDI responsibilities impact individual metrics, including staffing, productivity, and workflow Discuss how physician documentation impacts various quality metrics through coded data, compared to abstracted data and surveillance data Conduct reviews and/or develop appropriate review processes to ensure accurate reporting of Patient Safety Indicator (PSI) 90 Develop strategies to leverage collaboration within the revenue cycle, including CDI, coding, infection control, quality, and case management (utilization review) to promote consistency in the reporting of metrics associated with Hospital Value-Based Purchasing (HVBP) and other quality indicators Course Outline/Agenda Day One Module 1: Introduction to Healthcare Data Uniform Hospital Discharge Data Set (UHDDS) Key definitions Key elements by setting Publically reported quality data Types of publically reported data Quality or performance data
Physician Value-Based Modifier Program Utilization data Clinical condition data Module 2: ICD-10 Code Sets Introduction to diagnosis coding Overview of Official Coding Guidelines for Coding and Reporting Introduction to hospital inpatient procedure coding Module 3: Inpatient Prospective Payment System (IPPS) and MS-DRGs Overview of the Medicare IPPS system Key terminology What is an MS-DRG? How is an MS-DRG assigned? Principal diagnosis Complications/comorbidities (CC) and major CCs Principal procedure The impact of principal diagnosis Medical necessity denials Module 4: Introduction to Quality A history of CMS quality initiatives Quality initiatives affected by the inpatient population Basic quality concepts Early quality efforts The relationship between the electronic health record and reporting quality data National Quality Initiatives (NQI) Different types/categories of quality metrics and their significance Day Two Module 5: Hierarchical Condition Categories (HCC) Introduction to CMS-HCC payment methodology How HCCs are used to adjust quality monitors Module 6: Hospital-Acquired Conditions (HAC) and Present on Admission Status Introduction to traditional HACs Significance of the present on admission (POA) indicator on CMS quality metrics CMS and OIG studies on POA accuracy Hospital-Acquired Conditions Reduction Program (HACRP) Complication of care codes as defined by coding guidelines The impact on provider documentation on assigning a complication of care code Role of ICD-10-CM codes and their associated guidelines Hospital-Acquired Conditions Reduction Program Module 7: Hospital Inpatient Quality Reporting (IQR) Program History and evolution of the Hospital IQR Program IQR as basis/foundation of other CMS quality initiatives Potential impacts of IQR Reimbursement
Organizational reputation Role of principal diagnosis assignment in IQR Role of ICD-10-CM codes Module 8: Hospital Value-Based Purchasing (HVBP) Program The HVBP program Coded data elements that impact the reporting of HVBP Impact of the principal diagnosis on HVBP Role of ICD-10-CM codes and their associated guidelines Day Three Module 9: Hospital Readmissions Reduction Program (HRRP) About the HRRP Coded data elements that can impact the reporting of HHRP measures Impact of the principal diagnosis on the HRRP Module 10: PSI 90: The Composite Patient Safety Indicators (PSI) An introduction to PSIs Impact of PSI 90 on CMS quality programs Elements of PSI 90 Pressure ulcer rate (PSI 3) Iatrogenic pneumothorax rate (PSI 6) Postoperative hip fracture rate (PSI 8) Perioperative hemorrhage or hematoma rate (PSI 9) Postoperative Acute Kidney Injury Rate (PSI 10) Postoperative Respiratory Failure Rate (PS 11) Postoperative pulmonary embolism (PE) or deep vein thrombosis rate (DVT) (PSI 12) Postoperative sepsis rate (PSI 13) Postoperative wound dehiscence rate (PSI 14) Accidental puncture and laceration rate (PSI 15) Module 11: Hospital-Acquired Infections (HAI) HAI methodology Nosocomial infections HAIs that may or may not be a HAC Surveillance data vs. coded data HAIs currently used in CMS quality metrics CLABSI CAUTI SSI VAP Adjourn *Course Outline/Agenda subject to change Please contact the event manager Marilyn (marilyn.b.turner@nyeventslist.com ) below for: - Multiple participant discounts
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