Conference Update: Speaker Q&A

We’re less than six weeks away from our annual conference! As the countdown continues, we’re previewing a handful of speakers to give you a feel for the educational sessions being offered. This week, we spoke with Lynn H. Lowery, CPC, CFPC, who, along with Trey A. La Charité, MD, will present “Medicare Risk Adjustment, the New Payment Methodology: What Your Physicians Need to Know.”

Q: Why is it important to educate physicians on Medicare risk adjustment?

A: Medicare Advantage plans have been using this type of reimbursement for years, and now it’s expanding into the private sector. Medicare risk adjustment uses diagnoses to determine a patient’s risk, or likelihood of illness, which  in turns allows Medicare to estimate how much medical care will cost. Diagnoses are grouped into a Hierarchical Condition Category (HCC) and assigned a numeric value that represents the relative expenditures a plan is likely to incur for an enrollee with a given category of medical diagnoses. This information is abstracted from claims data. So, for physicians it is now important that they document the severity of all the illnesses validated in the medical record. Documentation and severity of illness will affect their reimbursement. As plans look for ways to improve the bottom line, this will affect physician practices.

Q: How is your topic important for everyone in the CDI role, regardless of professional background?

A: Documentation needs to be complete and specific for these diagnosis codes to be abstracted to the insurance form. This is important for physicians, clinicians, coders, the CDI specialists, and the revenue cycle department. Physicians need to understand how important documentation and severity of illness has become. If done correctly, the CDI department won’t have to send queries, and coders will have the correct information for specificity of coding.

Q: How did you become interested in CDI?

A: I have been a CDI manager for two years now. I “crossed over” from the coding arena to the documentation side. I heard a physician speak on CDI and it really spiked my interest. I was intrigued that this physician was so involved in both documentation and coding. I was working with a family practice residency program at the time, teaching residents how to code, and thought this would be a natural progression to the documentation side. As a coder you cannot assume, and can only code what the physician documented. If the documentation is correct and specific, it makes the coder’s job easier.

Q: What do you think is the most important quality for a CDI professional to have?

A: Knowledge. Knowledge is power. I feel this applies to any profession, especially in the medical landscape. Tenacity and perseverance also apply as you work through the flood of medical information that assaults you every day.

Q: What are you personally most looking forward to about the ACDIS conference?

A: I look forward to educating attendees that may not be familiar with Medicare risk adjustment and HCC coding. Most CDI professionals work on the inpatient side, and now CDI is expanding to the outpatient arena. I also enjoy networking and identifying new processes that I can apply to my facility.