Health Information Management

News: ACDIS/AHIMA query escalation policy released

CDI Strategies, June 6, 2013

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In the April edition of the CDI Journal, ACDIS published the joint ACDIS/AHIMA practice brief on “Guidelines for Achieving a Compliant Query Practice.” Relating to that publication, a sample query escalation process was also released this month.

The intent of the practice brief is to clarify when and how to query physicians in order to clarify documentation in the medical record. The practice brief calls on facilities to create an escalation policy to standardize processes for instances when questions regarding clinical validity arise. Because CDI specialists and coders are not part of the treating team, any such inquiries should be vetted by a manager, committee, or other supervisory position for assessment and review.
 
The practice brief addendum contains two sample policies and can be viewed in its entirety on the AHIMA website or on the ACDIS home page under the Featured Article.



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