Corporate Compliance

Sneak peek: Put the focus on clinical documentation

Compliance Monitor, January 11, 2012

Contractors in the Recovery Audit Program are focusing on documentation issues and, in response, many organizations are using clinical documentation improvement (CDI) programs to make sure their documentation is accurate and appropriate. While CDI programs are well-intentioned, compliance issues lurk when CDI programs veer off track.

Compliance officers should take an active role in overseeing CDI efforts to ensure records are reviewed for clinical validation of medical conditions and that CDI specialists do not just review records with the goal of improved reimbursement, says Fran Jurcak, RN, MSN, CCDS, a director with Huron Healthcare, a division of Huron Consulting in Chicago.

Some hospitals in California and Maryland recently came under government scrutiny when they billed a large number of cases of kwashiorkor, a form of protein-related malnutrition typically found in third-world nations. HHS and the Department of Defense accused Kernan Hospital in Baltimore of overbilling. Published reports indicate that the potential overbilling could amount to as much as $1.6 million and ultimately result in $8 million in fraud charges, says Jurcak.

Read the entire article available in the January 2012 issue of the HCPro, Inc. 12-page newsletter, Strategies for Health Care Compliance.

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