DocuComp LLC 2012 Educational Seminar Catalog

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Physician Advisor in Clinical Documentation Improvement & Integrity Program Certification in Clinical Documentation Improvement & Integrity Program Certified Professional in Denials & Appeals Management Program

“Provided the how-to’s of effective communication & collaboration, as well as, the development of clinical documentation strategies with multidisciplinary healthcare professionals. Will recommend to my clients for their CDI specialists who will benefit from this informative program by helping them to remain compliant, get buy-in from physicians and improve documentation to increase their bottom line.”

Tara Ruane, AA, RHIT, CCS, CCS-P, C-CDI, COO Clinical Coding Solutions, Inc

“Dr. Betty Bibbins has a vast knowledge of not only the Health Information Management (HIM) aspect, but the importance of physician documentation in particular. Physician documentation impacts all aspects of coding and billing, which Dr. Bibbins clearly understands and strives to encourage her colleagues to understand. She has a great ability to comprehend coding guidelines and the relationship physician documentation plays when applying these guidelines.

Dr. Bibbins is very approachable, which is very conducive, when in the role of liaison between coding and physicians. She is outstanding when it comes to educating HIM professionals and physicians on the importance of working together to accurately paint the picture of the patient’s hospital stay.”

Lori A. Miller, RHIA

DocuComp LLC

2012 Educational

Seminar Catalog

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DocuComp LLC presents

Certificate Programs conducted

by leading industry experts.

The Healthcare Industry is experiencing the most radical and transforming change to date, with emphasis on physician documentation. In this era of Value Based Purchasing, RAC audits, Quality Initiatives and the imple-mentation of ICD 10, the need for explicit docuimple-mentation depicting efficiency and quality, that captures the patient’s true Severity of Illness and Medical Necessity, has never been greater. Proactively addressing the documentation of Present on Admission (POA), Medicare Severity-Diagnostic Related Groups (MS-DRG’s) and the significant risk factors involved in each and every diagnosis with specificity has become imperative, espe-cially in meeting appropriateness of patient care and justifying consumption of resources.

DocuComp LLC is committed to empowering healthcare professionals through innovative education and is pleased to offer educational solutions that meet your facilities goals, budgets and time constraints.

These 2- and 3-Day Certificate Programs give you the essential knowledge, practiced techniques, and sound theories you need to become (and remain!) a top performer in your field. In the end you'll jumpstart your career and enhance your professional know-how.

Certificate Programs

CT01 Clinical Documentation Improvement & Integrity (C-CDI) Institute The C-CDI Program is the premier educational seminar dedicated to explicit Clinical Documentation Improvement. The program addresses the

evolving educational needs that are adherent to the significant changes emerging in health care, especially as they relate to the Medicare Severity-Diagnostic Related

Group (MS-DRG), Value Based Purchasing, Recovery Audit Contractors (RAC), Quality Initiatives and ICD-10-CM. Our approach is evidence-based and combines engaging instruction with interactive case studies and resource materials.

CT02 Certified Professional in Denial & Appeal Management (CPDAM) Program

Certified Professional in Denial & Appeal Management (CPDAM) focuses on identifying effective techniques to communicate with both clinicians and non-clinical staff in order to appeal current denials and prevent future denials. Your professionals are taught how to apply techniques to develop and implement a structured Denial Management and Appeals Improvement Program within hospitals. Evidence Based Case studies, InterQual criteria and practical instruction are provided in developing and/or enhancing your compliance methods on auditing, monitoring, and evaluating the implementation & effectiveness of your denial management program. Our extensive professional experience and training in clinical care, case management, medical necessity, coding guidelines, and regulatory compliance are the foundation for our highly successful recovery audit defense and appeals process.

CT03 Physician Advisor in Clinical Documentation Improvement & Integrity (PAC-CDI) Program

The Physician Advisor Clinical Documentation Improvement & Integrity Specialist is a physician serving the hospital through teaching, consulting, and advising both the case management/utilization review department and the hospital on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer rules and regulations, and working in collaboration with payers and the community. The Physician Advisor is a key member of the organization’s leadership team charged with meeting goals of cost and quality of care.

The Physician Advisor acts as a liaison to the Medical Staff for Case Management/Utilization Review operations and conducts clinical reviews on cases referred by Case Management (CM) staff and/or other healthcare professionals, in accordance with the hospital’s established Utilization Management (UM) Plan. The Physician Advisor meets the hospital objectives for assuring quality patient care and effective, efficient utilization of health care services.

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Certification in Clinical Documentation Improvement & Integrity Program

The Certification in Clinical Documentation Improvement & Integrity (C-CDI) Program is dedicated to significantly improving the competency in clinical documentation

within health care to capture the complete severity-of-illness being managed and appropriately justify the consumption of resources within today’s regulatory environment.

The C-CDI Program provides the premier educational seminar dedicated to explicit Clinical Documentation Improvement. The program addresses the evolving

educational needs that are adherent to the significant changes emerging in health care, especially as they relate to the Medicare Severity-Diagnostic Related Group (MS-DRG), Value Based Purchasing, Recovery Audit Contractors (RAC), Quality Initiatives and ICD-10-CM. Our approach is evidence based and combines engaging instruction with interactive case studies and resource materials.

The C-CDI Program focuses on:

 Clinical acumen & Explicit documentation  Medical Necessity

 Coding guidelines  Compliance

 Proactive preparation for the integrity regulatory agencies.

The C-CDI Program recognizes and builds on your past experience, and prepares you for future healthcare challenges in medical necessity and clinical documentation. The C-CDI Program is for professionals at varying levels of health care including:

 Physicians

 Physician Assistants  Nurses

 Nurse Practioners

 Clinical Documentation Specialists  Case Managers/Utilization Reviewers

 Health Information Managers/Coding Professionals  Quality Assurance Professionals

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Certified Professional in Denial & Appeal Management Program

The Certified Professional in Denial & Appeal Management (CPDAM) Program focuses on identifying effective techniques to communicate with both clinicians and non-clinical staff in order to appeal current denials and prevent future denials. Your professionals are taught how to apply techniques to develop and implement a structured Denial Management and Appeals Improvement Program within hospitals. Evidence Based Case studies, InterQual criteria and practical instruction are provided in developing and/or enhancing your compliance methods in auditing, monitoring, and evaluating the implementation & effectiveness of your denial management program. Our extensive professional experience and training in clinical care, case

management, medical necessity, coding guidelines, and regulatory compliance are the foundation for our highly successful recovery audit defense and appeals process.

Overall Learning Objectives

At the completion of this program, participants should be able to:

 Identify the challenges inherent in interpreting the payer payment systems, denial management and how to have your facilities prepared for success with appeals.

 Understand the changing state of today’s healthcare system, as related to the important trends toward required compliance activities to prevent future claims denials.

 Identify the diverse educational needs for healthcare personnel regarding the significant changes in the healthcare reimbursement field and how these impact the denials that an organization will confront.

 Identify important methods of (and how to manage) administrative & provider organizational acceptance and “buy-in” to improve the denial management and appeals processes.

 Describe the goals, key benefits, and strategies of having an on-site based denial management and appeals program.

 Identify effective techniques to communicate with both clinicians (physicians, mid levels, nurses, care managers) and non-clinical (coding & billing) staff in order to appeal current denials and prevent future denials.

 Apply techniques to develop and implement a structured Denial Management and Appeals Improvement Program within acute care hospitals.

 Identify compliance methods on auditing, monitoring, and evaluating the effectiveness of your denial management program.

Process Requirements

 Accurate, precise and explicit medical records documentation

 Effective case management processes including level of care assignment

 Correct and compliant coding that reflects the true severity of illness and complexity of care

Our approach

 Evidence-based  Incorporating InterQual

clinical criteria and regulatory requirements  Concise, focused,

rapid-response strategy  Evaluate demand letters

and denials for likelihood of successful appeals

 Prepare comprehensive responses to RAC, MAC and other auditors designed to maximize the chances of successful reversals as quickly as possible  Identify your denial and

recovery audit vulnerabilities and implement corrective action strategies to preempt future assessment risks

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Physician Advisor Certified in Clinical Documentation Improvement Integrity Program

The Physician Advisor Clinical Documentation Improvement & Integrity Specialist is a physician serving the hospital through teaching, consulting, and advising both the case management/ utilization review department and the hospital on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer rules and regulations, and working in collaboration with payers and the community. The Physician Advisor is a key member of the organization’s leadership team charged with meeting goals of cost and quality of care.

The Physician Advisor acts as a liaison to the Medical Staff for Case Management/Utilization Review operations and conducts clinical reviews on cases referred by Case Management (CM) staff and/or other healthcare professionals, in accordance with the hospital’s established Utilization Management (UM) Plan. The Physician Advisor meets the hospital objectives for assuring quality patient care and effective, efficient utilization of health care services.

Overall Program Learning Objectives:

 Define Medicare Conditions of Participation and the Utilization Review (UR) Committee

 Physician Advisor (PA) and the UR Committee involvement  Chair, co-chair, educator or facilitator

 Extensive knowledge of Medical Necessity appropriateness  Admission

 Continued stay  Discharge parameters

 Understanding Severity of Illness (SI) and Intensity of Service (IS) Guidelines

 Identify and assist with compliant documentation of severity of illness as it relates to disease pathophysiology and acuity for the hospitalized patient

 Identify and demonstrate knowledge related to treatment modalities directly related to severity of illness and assist with the appropriate relationship between appropriateness of disease and standard treatment plans (for over-utilization and under-utilization of resources)

 Define an Inpatient Admission and help the Case Manager’s (CM) identify compliant physician documentation necessary for the inpatient admission

 Define an Outpatient Observation Service and identify hospitalized patients whose diagnosis and treatment plan meet medical necessity for outpatient observation services  Define extended Post-Operative care not appropriate for

observation services and assist the CM’s to determine appropriateness

 Condition Code 44

 When an inpatient admission for a Medicare beneficiary does not meet medical necessity for inpatient admission and the attending physician agrees  Physician to physician case reviews

 UR Committee decision

 Concurrent discussion of cases where care does not meet nationally recognized or facility supported standards of care

 Peer to Peer review to third party payers

 Physician discussion with the insurance companies is needed to medically support the level of care and treatment for an inpatient to prevent a potential denial  Assisting with written appeal processes when required

by the UR Committee

 Hospital Issued Notices of Non-Coverage

 Pre-Admission/Admission–Determination assisted by PA when SI and/or IS does not support patient ad mission

 HINN-10 (Hospital Requested Review)-Determined by PA support when IS is not met for continued stay and the attending does not agree

 HINN-12 (Continued Stay Review)-Determined with assist of the PA when attending refuses to discharge a patient that does not meet medical necessity for IS after HRR is returned by QIO

 Review of Medicare One Day Stays after discharge for Provider Liability

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Course Locations & Dates

Below is the current course schedule for upcoming DocuComp LLC

certification programs.

Registrations are processed in the order received, and class size is

limited.

C-CDI Certification in Clinical Documentation Improvement & Integrity Program

CP-DAM Certified Professional in Denial & Appeal Management Program

PAC-CDI Physician Advisor Certified in Clinical Documentation Improvement Integrity Program

Register FOR 2012 CLASSES today!

Visit www.docucompllc.com/seminars.aspx, or call 740-968-0472.

C-CDI CP-DAM PAC-CDI

September 5 –7 Orlando, FL

September 19 - 21 East Brunswick, NJ (New York City area)

September 21- 22 East Brunswick, NJ (New York City area)