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Golden Circles of Medicine
- Published on July 30, 2020
Clinical documentation, patient care and the PATIENT should be inseparable. No one should think of each as independent entities. With cohesiveness comes strength and best outcomes! It should be all about the patient, first and foremost. All other agenda will fall in line. Trust me. Without unanimity, it will be a deck of cards that topples easily with the first gust of wind…
For those burdened and crippled by unrelenting payer denials, look inwards first. Analyze the areas and the root cause of the denials. Ascertain if the basis for your defense rests on criteria, guidelines and policies that are rooted in the patient’s true clinical picture. “Satisfying criteria” may not necessarily be true. There will be false positives and false negatives. Hence, do not rest your defense mainly on “criteria.” Over and beyond criteria, guidelines or internal policy is transparency of the patient record that is incontestable.
Policies and procedures should be in place to ensure transparency in the patient’s narrative that demonstrate and define your cases. This should be the focus of the CDI team, who can make sure that contestable diagnoses and procedures are unequivocal. Many times there are grey areas. Be sure that provider documentation is clear as to why the diagnosis or the procedure is appropriate. The narrative does not stop at the outset of the patient encounter. Patient course is evolving and better accounting of the true condition comes as events unfold. Let clarity lead the way. Clarity does not depend on voluminous documentation, but rather, in its conciseness.
There will always be denials, but they shouldn’t be so onerous when you are on defensible ground. When your cases are rooted in transparent documentation showing the Clinical Truth™- you will be on the winning side. You can take it all the way to the highest court of the land when there is clinical documentation integrity by your side.Report this
Status is onlineCesar M. Limjoco, M.D.Chief Medical Officer, T-Medicus LLC | CDI Physician Advisor Consultant | ACDIS Regulatory Committee | 21,000+ FollowersPublished • 1w22 articlesFollowinghashtag#clinicaldocumentationhashtag#integrityhashtag#CDIhashtag#ACDIShashtag#AHIMAhashtag#physicianadvisorshashtag#denialsmanagementhashtag#appealshashtag#revenuecyclemanagement
James S. Kennedy, MD, CCS • 1stPresident of CDIMD – ICD-10 Physician Champions3d • 3 days agoThe V2020 AHRQ PSI software is now out. ICD-10-CM code I26.93, Single subsegmental pulmonary embolism without acute cor pulmonale does not trigger PSI 12; Unspecified pulmonary embolus without acute cor pulmonale does. Interestingly, COVID-19 is not an infection in Appendix F. Tell me what you learn from reading the new definitions. https://lnkd.in/dvmsRsP.Patient Safety Indicators Overviewqualityindicators.ahrq.govAHRQ Quality Indicators, QI, use hospital inpatient administrative data to measure health care
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