Suspects
This is what CIS are expected to do for every suspect after every patient visit.
What is "address all suspects?" (Bonus 50 points from Joshua if you can explain the ways a suspect is "addressed.")
The acronym breakdown for MEAT.
What is Monitor, Evaluate, Assess, Treat?
Must be included as part of the T2DM coding guidelines
What is "long term oral, insulin, and non-insulin medication use?"
The morning routine for the MA would read the quality measures gapping for the patient.
The name for OSH care model. (Hint: Not fee-for-service)
What is "value-based care?"
Part of the CIS Dashboard that monitors that correct actions were taken to address suspects.
What is Daily Lookback?
The letter pressed for the ROS section of the note and the letters pressed for the PFSH (MWV and PRG) respectively.
What is "H" and "C for all and B for past medical history/B for all and C for medication list respectively?"
Patient presents to visit with T2DM, CKD stage 3a and takes cardiance. These are the codes that should be used for the assessment.
What is "T2DM w/ CKD + CKD stage 3a + long term oral use of hypoglycemic drugs?"
These OSH screenings are suspect generating.
What is PHQ-9 and Audit-C?
The goal of OSH (Hint: Three H statement)
What is "to keep a patient Happy, Healthy, and out of the Hospital?"
Monthly meeting with CIS and provider to take action on suspects.
What is CDR?
This is used to allow the CIS to return to a note once a positive result is presented in the chart to address a suspect discussed during the original visit.
What is Amendable Language?
The patient presents with a BMI of 32.00. These codes should be included in the assessment but ONE of them should NOT be added to the Problem List.
These scores for PHQ-9 separates a patient from mild MDD, moderate MDD, and severe MDD
What is >=5, >=10, and >=20?
These patients will be scheduled every 6 months, 3 months, & 1 month respectively.
What are Good, Fair, Serious/VIP patients?
This Google Sheet explains all logic of almost every suspect prompted within version 28 of our model.
What is Care Report Data Dictionary Summary?
The rule for billing where "the ICD-10 that is listed in the furthest left position on the E&M row/listed as #1 on a superbill without other CPT codes."
What is "principal position for diagnosis codes?"
Patient presents to a visit with eGFR value of 32.0 (second value), an echocardiogram that shows mild mitral regurgitation, and takes amlodipine with an a1c value of 7.50 taking Jardiance. These are the codes to document for this patient.
What are "Hypertensive CKD + CKD stage 3b/ T2DM with CKD + long term oral use of hypoglycemic drugs?" (Trick: Mild mitral regurgitation does NOT qualify as Stage B. Moderate or severe does. :D )
Bonus Question (200 pts): Where can you find guidelines for what qualifies for stage B on an echo?
These two quality screenings are ideally best to close during the visit as they are quick to close via Canopy and only require a Physical Exam and a few screening questions respectively.
What is LE exam & HF Detection?
This number represents a value correlating with the suspects addressed for the patient, and it plays a factor into the patient's tier. (Hint: it is usually in decimal form on Canopy)
What is RAF (Risk-Adjusted Factor)?
a risk-adjustment model used by Medicare and insurers to group similar diagnosis codes into categories that predict healthcare costs
What is HCC (Hierarchical Condition Category (HCC))?
The two CPT codes needed to close the gaps corresponding to a Post-Discharge Visit and the two diagnosis codes that must be mapped to them.
What is "long term current drug therapy (Z79.899)/medication reconciliation (1111F) & other specified counseling (Z71.89)/post discharge visit?"
A patient presents with an ulcer of the left lower extremity. The chart shows a eGFR value of 6.0 with patient on dialysis, an echocardiogram with mild LVH, and the patient takes amlodipine. The patient has a BMI of 31.2 and completed chemotherapy for breast cancer and is no longer receiving treatment. These are the codes to document for this patient.
What is "The location and type of ulcer + the staging of the ulcer; Hypertensive CKD + CHF combo code, CKD (ESRD), Stage B CHF; Obese + BMI code 31.0-31.9; HX OF breast cancer?"
What is "New ICD-10s for Heart Failure Suspecting" or "Echocardiogram Eligibility List?"
I could not think of a question format that fits jeopardy for this haha:
Explain to someone who has never heard of OSH exactly how we profit by keeping a patient out of the hospital.
The money that is granted by the insurance to care for a patient that is NOT used by keeping a patient out of the hospital is the money "saved" for taking care of the patient. This in turn becomes OSH form of revenue which allows us to continue supporting patients to keep them out of the hospital.