The multiple benefits that could be obtained from

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learn from the results and become more adept at discovering potential fraud. The multiple benefits that could be obtained from implementing CAC software including increased coding accuracy and productivity along with the potential compliance gains would make this a worthwhile investment. Your consideration of the purchase of CAC technology would be much appreciated. (AHIMA 2005; Eramo 2011, 28–30) References American Health Information Management Association. 2005. Automated coding software: Development and use to enhance anti-fraud activities. Eramo, Lisa A. 2011. Stopping fraud: Detecting and preventing fraud in the e-Health era. Journal of AHIMA 82(3):28–30.
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Copyright ©2017 by the American Health Information Management Association. All rights reserved. 239 5.11 Struggling CDI process Subdomain V.D.2 Develop appropriate physician queries to resolve data and coding discrepancies Subdomain V.D.2 Create method to manage present on admission, hospital-acquired conditions, and other CDI components There is one physician at your organization that has seven outstanding queries over the past month, several more than three weeks old. These are all regarding the clinical validity of an acute blood anemia diagnosis that he has listed on the chart. As revenue cycle manager, you want to get these issues resolved as quickly as possible so you propose an internal escalation policy. Formulate a proposal to share with your CDI and HIM directors for feedback. Answer Proposal: Students may have slightly different versions, including one that may involve a multi- disciplinary committee to review these types of cases on an individual basis. Terms in the policy below may vary, but the important concepts are identified in bold . Internal Escalation Policy Queries for clinical validity should immediately be forwarded to the CDI manager for initial review. If the CDI manager finds documentation to support the diagnosis, it is sent back to the coder for completion. If the CDI manager supports the query, it will be forwarded to the CDI Physician Liaison for review . If the CDI Physician Liaison identifies supporting documentation for the diagnosis and agrees with the physician of record, the case is referred back to the CDI manager along with conclusions and from there back to the coder for completion. If the CDI physician liaison does not identify supporting documentation for the diagnosis, he or she will speak with the physician of record to resolve the conflict. The physician of record will be required to provide additional supporting documentation for the diagnosis within twenty-four hours of meeting. The case will then be referred back to the CDI manager to route to coding for completion. If the CDI physician liaison and the physician of record cannot resolve the issue, the CDI physician liaison will take the case to the Medical Staff Director.
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  • Summer '14
  • Electronic health record, American Health Information Management Association

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