2021 ACDIS Pocket Guide: The essential CDI resource

The 2021 ACDIS Pocket Guide is your essential CDI resource. It includes updates to clinical diagnostic standards, the Official Coding Guidelines, ICD-10-CM codes, CMS-HCCs and CDI critical thinking tips! The 2021 ACDIS Pocket Guide is co-written by ACDIS’ CDI Education Director Laurie Prescott, RN, MSN, CCDS, CDIP, CRC, CCDS-O, and a practicing physician steeped in the latest physician documentation terminology, James Manz, MD, CCDS-O.

Be sure to include the #1 CDI resource in your library today!

The 2021 ACDIS Pocket Guide is divided into six sections – regulatory/coding guidance, IPPS reimbursement updates, including DRG and CC/MCC updates, compliant query best practices and standards, clinical validation and diagnostic definitions, and comorbidity and MS-DRG lists. The majority of the pocket guide is dedicated to clinical validation and diagnostic definitions, which includes an expansive listing of diagnoses significant to CDI practice.

Conditions covered in the Pocket Guide are organized by their Major Diagnostic Category (MDC), and then in alphabetical order. Each diagnosis listed is accompanied by a detailed clinical definition of the condition, clinical indicators that support the presenting condition, including diagnostic criteria and treatment protocols, ICD-10-CM chapter-specific documentation requirements, including the latest coding clinic guidance specific to the condition, CDI critical thinking tips and provider focused education advice related to the diagnoses.

What’s New:

• New section on ICD-10-PCS, including an introduction to the PCS coding system and how it works.
• 70 conditions including new listings for COVID-19, EVALI-vape related lung injuries, cytokine storm and functional quadriplegia
• New coding clinic guidance and IPPS updates.
• And more!

2021 E/M Office Visit Reference Guide

The new 2021 E/M documentation guidelines are set to take effect Jan. 1, 2021, and are expected to create a sea change in how medical practices select a level of E/M service. The revised reporting requirements mark the first significant update in more than 20 years since the release of the 1995 and 1997 documentation guidelines.

The 2021 E/M Office Visit Reference Guide delivers a comprehensive overview of the new E/M documentation guidelines and a clear, in-depth analysis of the 2021 changes, including the confusing new medical decision-making (MDM) guidelines so that you can ensure a seamless shift to the new guidelines.

Use the 2021 E/M Office Visit Reference Guide to train staff, reduce the risk of miscoding and the denials and audits that may result, and lessen the disruption to a key revenue stream. E/M office visits account for 20% of total physician fee schedule charge. In 2018, practices gained $15.6 billion in payments from Medicare for the suite of E/M office visit codes 99201-99215.

Additionally, the 2021 E/M Office Visit Reference Guide will help you:

• Guarantee a successful and smooth transition to the new system with best practices on how to revise superbills and templates; what to know about working with third-party vendors such as electronic health record (EHR) providers; and how to manage two different E/M systems simultaneously.
  
  
• Ensure your coders are accurately selecting the correct level of service for E/M office visits with office and staff training tips, including separate breakout sections for coders and clinicians; audit safeguards; and more.
  
  
• Train clinicians on the 2021 documentation changes with several dozen documentation scenarios that clearly illustrate how a coder/clinician should accurately select a Level 1, 2, 3, 4 or 5 E/M code. The book will present scenarios tailored to specific specialties.
  
  
• Understand the level of medical decision-making or time for code selection with comprehensive coverage of MDM and time elements.

2021 JustCoding Pocket Guide: The essential resource for coding professionals

Co-written by ACDIS’ CDI Education Director Laurie Prescott, RN, MSN, CCDS, CDIP, CRC, CCDS-O, and Director of HIM and Coding Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, this powerful resource provides the key information you need to accurately and efficiently code claims. Understand ICD-10 and E/M coding requirements for both inpatient and outpatient settings. Walk through diagnostic criteria, official coding guidelines and documentation requirements so that you can accurately validate and code your most common diagnoses.

The 2021 JustCoding Pocket Guide breaks down complex coding topics into easy-to-understand concepts so that coding professionals can accurately and efficiently do their job.

Effective Peer Review, Fourth Edition

Robert J. Marder, MD

Peer review continues to rate as a top challenge in healthcare organizations. Even if they are meeting regulatory standards, organizations struggle to develop a peer review program that is unbiased and meaningful, making it difficult to change physicians’ punitive view of the process.

Now in its fourth edition, Effective Peer Review has been significantly updated and revised, providing even more practical details and policies to help medical staffs reduce peer review bias and implement an approach focused on performance improvement. The book addresses ways to enhance all of the components of a successful competency assessment program, from case review to OPPE and FPPE, with entire chapters dedicated to medical staff culture, multispecialty peer review, and avoiding peer review pitfalls.

New to this edition are chapters that tackle case review from all angles, with detailed guides for peer review coordinators, physician reviewers, and peer review committees. There are also policies for successful OPPE, updated metrics to help measure the effectiveness of your program for case review and OPPE, and guidance on reporting results to the medical executive committee and the board. This edition also looks at how the changing healthcare landscape is affecting competence assessment, such as how to conduct peer review on a healthcare team or outside of the traditional hospital walls.

This book provides:

• Practical, proven techniques to eliminate bias and develop meaningful physician performance improvement opportunities
• A detailed guide to creating a dynamic multispecialty peer review committee
• Proven methods for conducting meaningful case review from case identification to committee decision and follow-up
• Case studies from the field to illustrate key concepts
• A step-by-step guide for peer review self-assessment and redesign
• Approaches to engage physicians in the peer review process
• National Practitioner Data Bank reporting requirements and other regulations related to peer review

This updated edition includes:

• How to conduct case review from every position: peer review coordinator, physician reviewer, and peer review committee
• Metrics to measure the effectiveness of your peer review program
• Information on conducting peer review with a healthcare team
• Sample policies, forms, and procedures for case review, OPPE, and FPPE
• New and expanded case studies

Take the worry out of HIPAA training reminders

Continuing the excellence of the earlier editions, h-mail, Fourth Edition: HIPAA and HITECH Privacy and Security Training Reminders for Healthcare Staff, is a creative, cost-effective solution to establish and reinforce information privacy and security awareness at your facility. This CD-ROM resource contains 52 new and unique messages - an entire year's worth of valuable educational reminders - that you send via e-mail to your facility's workforce.

Includes HITECH and breach notification training

There's no easier way to fulfill HIPAA's requirement to provide periodic reminders to staff. These realistic training exercises reinforce key HIPAA and HITECH principles and breach notification points, and reinforce the day-to-day best practices you expect your staff to follow.

Ready to use, right out of the box

Your CD-ROM includes 52 new privacy and security messages. These are divided into 13 questions and answers, 13 case scenario files, 13 tip files, and 13 five-question, multiple-choice quiz files. Mix the order in which you launch each weekly bulletin a quiz this week, a case scenario next week to keep the training and learning fun. Customize the messages to include specifics about your organization's policies.

Along with all new messages, you'll have access to an interactive Jeopardy-style game staff can play to reinforce learning and retention of important HIPAA privacy and security concepts.

You'll also receive cartoons in JPEG/GIF files to add some humor to your training e-mails, and a PowerPoint presentation for more detailed training sessions.

h-mail, Fourth Edition provides one of the easiest ways to reinforce your HIPAA training and ensure that staff understand your related policies and procedures. You have to provide HIPAA training and educate staff on the HITECH requirements.

Patient Status Training Toolkit for Medicare Utilization Review, Second Edition

Hospitals continue to struggle with applying CMS’ patient status guidelines and 2-midnight rule requirements in real-world—and often high-pressure—situations. While CMS has issued clarifications to the 2-midnight rule and changes to ease inpatient order requirements, confusion still exists. This uncertainty can leave hospitals vulnerable to audits or lead to overly conservative patient status determinations, which can inappropriately delay reimbursement and even impact patients’ financial responsibility.

Utilization review (UR) committee members are tasked with conducting patient status reviews to help identify patients who may have been assigned to the incorrect status, but even these professionals may find it difficult to navigate Medicare regulations and provide support to physicians.

The Patient Status Training Toolkit for Medicare Utilization Review, Second Edition, serves as a quick reference guide for UR committee members. The pocket card portion uses a flow chart and helpful tips to step through the process of verifying patient status determinations. If the committee member determines the patient’s status must be changed, the pocket card provides guidance on next steps. The handbook portion of the toolkit provides clear, concise information on the applicable Medicare regulations, including provision of notices and billing rules, that can be used to help support UR committee members’ patient status recommendations. In addition to an overview of regulatory requirements, the toolkit offers access to downloadable case studies and Medicare resources that will help guide committee members through real-world cases.

This book will help readers:

• Ensure correct patient status determinations in fast-paced environments
• Quickly identify the necessary steps to change a patient’s status
• Stay up to date on CMS’ latest patient status guidelines, including the 2-midnight benchmark and recent changes to inpatient order requirements
• Avoid audit and reimbursement implications due to incorrect patient status determinations

The Effective Charge Nurse Handbook: The Pocket Companion for Charge Nurse Leaders provides new charge nurses with the competency-based skills they need to act as frontline leaders and support their organization's quality of care mission.

In this invaluable and compact handbook, charge nurses will learn the essentials of leadership and their crucial role in optimizing their organization's objectives, managing the continuum of care, and promoting a safe and harmonious workplace.

The Effective Charge Nurse Handbook is designed to complement Charge Nurse Leader Program Builder: A Competency-Based Approach for Developing Frontline Leaders, for use by charge nurses themselves during orientation, in-services, or self-study. It also functions as a companion to charge nurse workshops developed through the Program Builder.

Charge Nurse Leader Program Builder and The Effective Charge Nurse Handbook support the important work of creating a better, more professional environment for nurses.

Table of Contents

Introduction
Chapter 1: Preparing Charge Nurses to Lead
Chapter 2: Coordination and Delivery of Patient Care
Chapter 3: Managing Staff Performance
Chapter 4: Quality, Data, and Continual Improvement
Chapter 5: Performance Evaluations
Chapter 6: Charge Nurses Caring for Oneself and Others

This resource will help you:

- Equip charge nurses in training with the skills they need to provide leadership to staff on their unit
- Train hundreds of charge nurses using one resource
- Provide customizable training materials and handouts
- Reduce the time spent developing training materials for charge nurses

The Guide for Graduate Medical Education Offices and Program Coordinators

The Guide for Graduate Medical Education Offices and Program Coordinators provides the office of graduate medical education (GME) and program coordinators the guidance need to successfully run a GME program together. Author Vicki Hamm, C-TAGME, provides how-to guidance and tools for implementing ACGME Institutional Requirements, institutional policies, crafting resident/fellow contracts, managing evaluations, maintaining program accreditation, and other daily duties. This book contains sample policies and forms to customize for your institution.

This book will guide your GME operations so that you can achieve compliance with ACGME requirements; support your program directors, and faculty; and most importantly, produce trainees who become skilled physicians as they move from the educational continuum to the independent practice of medicine.

This handbook will help you:

• Meet ACGME Institutional Requirements through solid policies and procedures
• Develop strategies for protecting the time of program directors, coordinators, and faculty
• Keep up with continuous accreditation requirements, including CLER visits and the 10-year self-study
• Manage evaluations and report program performance measures
• Conduct special internal reviews to help underperforming programs
• Establish a competent and confident GME committee

Verify & Comply: Credentialing, Medical Staff, and Ambulatory Care Standards, 9th Edition

Get the latest version of the medical staff services industry’s most trusted compliance manual.

For 20 years, Verify & Comply: Credentialing, Medical Staff, and Ambulatory Care Standards, 9th Edition, has been of HCPro’s most popular credentialing and accreditation resources. Credentialing and medical staff standards and regulations are covered in one easy-to-navigate side-by-side crosswalk, giving medical staff services and credentialing professionals one book that answers all their accreditation questions.

Updated for 2021, this guide includes ambulatory care, acute care, and managed care standards for the most popular regulators and accreditors: CMS, The Joint Commission, NCQA, DNV, HFAP, and AAAHC. This book allows you to compare what each accreditor states about initial appointment, reappointment, and other medical staff functions, and provides tips and best practices to help you meet the most challenging standards. Use this resource to study for the NAMSS certification exam and to keep up to date with regulators’ and accreditors’ credentialing and medical staff standards.

This book will help you: 

• Determine which verifications are necessary to obtain in the credentialing process
• Understand the differences between the appointment, reappointment, and ongoing assessment stages of the credentialing process
• Implement best practices in your medical staff services department that ensure compliance with your accreditor’s standards
• Identify the appropriate areas in medical staff governance documentation to include specific items required by accreditation standards and regulations
• Adopt expert processes for complying with telemedicine and ambulatory accreditation standards