Telling the Story: Utilizing Technology and Process Improvement to Enhance Quality, Reduce Clinical Risk, and Stay Compliant with Hospice Regulations

Description

Has your hospice had payment denials based on the content quality of a physician’s Certification of Terminal Illness (CTI) narrative during surveys or external audits? Since the 2016 OIG report, hospices have seen increased scrutiny of the CTI narrative based on OIG recommendations. Amedisys took a proactive approach and utilized natural language processing technology to review and audit CTI narratives. The automated audit monitored for the presence or absence of key narrative phrases and gave a pass or fail result. Failed narratives were reviewed individually by the PI team and clinical leaders provided educational feedback that engaged the team and physicians to improve CTI narrative content quality. Company-wide fail rate was monitored weekly using p-charts to follow interventions and outcomes. Outcomes include reduction in CTI narrative fail rate from 15% to 3% in 9 months, improved content quality of CTI narratives, and reduction in denials by Medicare Administrative Contractors.

Topic(s)

• 
  Quality (Hospice)

Methodology

Handout(s)

• AM23-405

Additional Info

Learning Objective 1:
Distinguish natural language processing audit parameters to create a strong and comprehensive CTI narrative from quick phrases, templates and checkbox short cuts.

Learning Objective 2:
Create a CTI narrative model to improve content quality of CTI narratives using natural language processing algorithms.

Learning Objective 3:
Develop a pre-bill process improvement workflow for their organization.

Primary Target Audience:
Hospice