Case Management

Sneak peek: Engage case managers in document review process

Case Management Weekly, July 11, 2012

If you merely review patient charts and compare them to screening criteria, such as InterQual® or Milliman®, you’re not doing enough.

Sometimes what’s missing is more important than the details included in a chart, says Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS, CCDS, an independent health information management consultant in Madison, Wis.
Case managers need to review charts with a clinical eye to ensure that physician notes accurately reflect the severity of a patient’s condition. Doing so helps an organization document medical necessity for billing purposes and helps case managers do their jobs more effectively by providing a more accurate assessment of patient condition, says Cindy Compton, CCS, C-CDI, CDIP, FCS. Compton is director of social services at Jane Todd Crawford Hospital in Greensburg, Ky., and Casey County Hospital in Liberty, Ky.
When reviewing a patient chart, case managers should determine whether the notes accurately document a patient’s condition. For example, a chart might indicate that a patient presented with chest pains, but does the chart include additional signs and symptoms? Does it indicate that the physician thinks the signs and symptoms may indicate a more serious condition, such as possible heart attack, pulmonary embolism, or abdominal aortic aneurysm? If this information is missing, billing issues can occur down the road, says Krauss.
Editor’s note: This article is adapted from an article in the July Case Management Monthly published by HCPro, Inc.

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