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Documentation to Avoid Denials The Search for A Methodology Physicians Can Accept

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Page 1: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

Documentation to Avoid DenialsThe Search for A Methodology Physicians Can Accept

Page 2: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

YOUR LOGO

Making Physician Documentation

Survive Audit & Review

Page 3: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

YOUR LOGO

How We Solve Problems...

Known:Radius of Circle = 3

3

Find the Area of the Circle.This is how you get

the answer.

And you know the formula because

you took Geometry.

Page 4: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

YOUR LOGO

Why do we still get denials?

Page 5: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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Two Reasons:1. We’ve yet to attack or solve the Core Problem

2. There is a basic conflict between stakeholders

Page 6: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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Example of a Conflict Cloud, adapted from Thinking for a Change: Putting the TOC Thinking Processes to Use by Lisa J. Scheinkopf

Page 7: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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Complete Example of a Current Reality Tree, adapted from Thinking for a Change: Putting the TOC Thinking Processes to Use by Lisa J. Scheinkopf

Page 8: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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Partial Example of a Current Reality Tree, adapted from Thinking for a Change: Putting the TOC Thinking Processes to Use by Lisa J. Scheinkopf

Page 9: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

YOUR LOGO

Page 10: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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So What Is The Core Problem?

Auditors/Reviewers are not Physicians, cannot INFER

Physicians write for Physicians, expect them to INFER

Providers have no way to affect the Auditors

We must find a way to change the Documentation

Now we can look for a Direction of a Solution...

Page 11: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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What Obstacles Must Be Overcome?(must list them, to later check for sufficiency of the solution)

Denials are inconsistent, seem difficult to predictIt’s a burden to document even more“I don’t need something more to memorize”“I don’t know what I don’t know”Not motivated to document for audit/review“Tell me how you’ll measure me, and I’ll tell you how

I’ll perform”

Page 12: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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Defining a Possible Direction of a Solution

- Identify Obstacles- Set Intermediate Goals- Define Actions to reach those- Check Logic & Sufficiency

Page 13: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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Requirements For A New Method

Must provide what auditors are looking for

Must work for every DRG

Must work for any DRG

Must be easily learned & understood

Must be adaptable to new regulations

Must allow for outside local assistance & advice

Page 14: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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Teaching with A New Method... Adapted from Theory of Constraints for Education

Know Something New• Conclusion

• New Knowledge

Some Givens• Definition• Number

• Condition

Reasons •Formula•Rule

Page 15: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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A Clinical Example

Admitting DiagnosisDx

Known:presentingsymptoms

Question:Why do those presenting

symptoms mean Dx?

Question:If you know those

symptoms, how did youarrive at Dx ?

ANSWER

Page 16: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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A Documentation Example

Survived AuditMedical Necessity

was supported

Known:Physician

Documentation

Question:WHY did this documentation

survive the audit/review?

Question:HOW does this documentation

support medical necessity for audit?

ANSWER

Page 17: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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What Is A Physician’s Motivation to Do This?

Page 18: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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A Glimpse Into A “Future Reality”

18

Fewer DenialsFewer Denials

More RevenueMore Revenue

Survives AuditSurvives Audit

Learn More & Write BetterLearn More & Write Better

Ask Why & HowAsk Why & How

Does Not Survive AuditDoes Not Survive Audit

Learn Method & Write BetterLearn Method & Write Better

Page 19: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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… WHAT IF the New Method allowed for LESS TIME spent documenting?

19

I bill more claimsI bill more claims

More RevenueMore Revenue

I treat more patientsI treat more patients

I spend more time treating patientsI spend more time treating patients

I spend less time on documentationI spend less time on documentation

I learn New Method & write better documentationI learn New Method & write better documentation

Page 20: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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Review What We Covered

We identified the problem: DocumentationNeed to write documentation for auditors

We defined the Direction of a SolutionObjections must be overcome with our defined actions

We defined how to affect the changesNew Method must be easy to use & understand

New Method can motivate them to change behavior

Page 21: Documentation to Avoid Denials - Global Health Care to Avoid Denials The Search for A Methodology Physicians Can Accept YOUR LOGO Making Physician Documentation Survive Audit & Review

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Now for the Best News...

We know a New Method that fits the bill.


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