Severity Adjustors
ICD-10 Diagnosis:
Z96.641 Presence of right artificial hip joint
Z95.1 CABG
Z89.611: Acquired absence of right leg above knee
What are allowable Z codes
Medical Adjustor: patient is R UE NWB and L LE partial weight bearing
What is Restricted Weight Bearing
You open a clinical note and see multiple current problems.
What is archive. There should only be 1 Current Problem in SNF setting
You made adjustments to an approved auth line, next steps...
What document in comments folder why change was made
Generate Outcome Report
What is Admission review
FCI- Primary dx: MI
PLOF: amb without AD in the home and occasionally uses SPC in the community, Independent with ADL/IADLs.
PMH: HTN, MVA 10 years ago with femur fracture.
What is FCI 3
MD review: You are completing in interim review anticipating sending to MD for NOMNC review. Actual DC plan is ALF. MD will need to know...
What has ALF assessment been completed and patient accepted to return
Document: You completed a review and sent nH Predict outcome by email but have not yet had a discussion about it
What is engagement tab- document yes shared nH Predict
Templated used for: "For Auth 1234567, the information within the Clinical Note was changed/corrected to reflect the actual clinical documentation received from the provider to support the request."
What is editing a clinical comment work instruction
"Patient continues to appear to meet CMS Chapter 8 guidelines based on their need for daily skilled therapy and/or nursing services that can only be provided in a SNF."
What is template for clinical impression of interim review.
Medical Adjustor: Any non-stageable wounds, per CMS/MDS guidelines
What is Pressure Wound IV
ULS: Patient lives home with family and has bath aid 2x/wk
What is home with family. (Confirm home health aid vs paid caregiver)
You identified a RELEVENT past medical hx condition not on the PMH list. Where to document?
What is PMH- Other
You see your patient has a DSNP plan. When you click on the Product Line hyperlink, you see “no MCO Data Available” in the description. What will your next step be?
Share with the provider that member has a DSNP plan, but no information is available. Then document it was shared in Engagement notes.
You called provider to give details on authorization and documented in the auth line details.
What is PVN
Medical Adjustors: You documented height 64 inches, 258lbs in your current problem
What is Morbid Obesity?
Medical Adjustor: Patient transitioned to swing bed/SNF stay with NG tube. On day 2 the NG tube was removed and replaced with Peg Tube.
What is Feeding Tube PEG/J
Good/Bad: Barrier detail states-Patient has 2 surgical wounds that will require daily wound care.
What is not great.
How to make it better?
You receive an alert from CSOC to complete nH| Predict Discharge assessment
What is nH MDS process
Address Barriers as resolved or not resolved
What is NOMNC review- prepping note for MD
FCI -Primary dx: AKI
PLOF: ambulates up to 30 ft with a RW, uses a power wheelchair for longer distances. MOD I with ADLs.
PMH: COPD on 2L O2 continuous, CAD, morbid obesity, CHF.
What is FCI 4
Patient has documented two stage II pressure wounds & one stage III pressure wound
What is Pressure Wound III
d/t
What is do not use list - Accepted Abbreviations for Clinicians
You see an alert (green compass) on PCP and back page.
What is health plan specific workflow- Patient connect, etc.
You've issued a NOMNC. Patient is discharging to a community setting and their health plan requires a referral to health plan case management.
What is Continuity of Care Form