About Me

Having a diverse clinical background gives me a well-rounded approach to evaluating charts for quality documentation and medical necessity. This has been the basis for my CDI and UM (Utilization Management) expertise. I also have leadership experience that has been invaluable in facing new challenges. I have worked at top notch hospitals: Queen’s Medical Center (the only Magnet Hospital in Hawaii) and Stanford University Hospital. Last but not least, I am experience with DRG denial appeals with a high success rate of overturned denials. I am a great team player, quick learner, and very motivated to start.

Direct Patient Care Experience
   6 years of ED, ICU, CDU, Telemetry, Med/Surg

Leadership experience

  • Hawaii Chapter Association for Clinical Documentation Improvement Specialist (ACDIS) President.
  • Acute Care Charge Nurse
  • Unit Council Chair
  • Clinical Ladder IV RN
  • Principle Investigator on an IRB approved Research study

 Clinical Documentation Improvement Experience

  • 5 years of CDI
  • Concurrent/post discharge chart reviews
    • 900 bed level 1 trauma hospital
    • 500 bed level 1 trauma hospital
    • Developed the CDI program at an 80-bed community hospital
    • Formal Physician Education on Documentation
  • Inpatient Denial experience
    • Assessed denials and generated appeals utilizing clinical references
    • Resulting in thousands of dollars per chart recouped for the facility

CDI stands for Clinical Documentation Improvement Specialist.  Traditionally, we conduct concurrent chart reviews in the inpatient realm to find gaps in documentation and educate physicians on capturing the complete clinical picture in the electronically health record (EHR).   CDI was born as a direct result of the constant changes in healthcare reimbursement requirements.  We are the bridge between physicians and coders.  Physicians are unable to keep up with the ever-changing needs of documentation, while coders do not have clinical experience to provide a deeper understanding of physicians practice both physically and electronically.  CDI specialists are able to link the clinical indicators to multiple diagnoses in the documentation.  We also identify gaps that will assist with capturing the true picture of the patient, electronically while still empowering the physician to provide care and treatment based on their own clinical judgement.

Frustrated with your Risk Adjustment Factor (RAF) Score?

  • Data- In a recent study by The Doctors Company (2018, The Future of Healthcare), 3400 physicians were surveyed and here are the results
    • 63% of the physicians surveyed believe value-based care and reimbursement will have a negative impact on their earnings.
    • 61% of the physicians surveyed believe EHRs are having a negative impact on their workflow, with many suggesting that EHRs requirement are a major cause of burnout
    • 54% of the physicians surveyed believe EHRs had a negative impact on the physician-patient relationship
  • How I can help
    • Perform a full documentation assessment to identify gaps in documentation with clinical indicators not linked to a diagnosis
    • Make recommendations for documentation
      • Formal educational process
      • Query process (case by case)
    • Clinical Validation
      • Assured that each diagnosis was supported with relevant clinical indicators
      • According to the 2017 Official Guidelines for Coding and Reporting
        • Clinical validation is performed by a clinician (RN, CMD, or therapist). Clinical validation is beyond the scope of Coding Validation, and the skills of a certified coder.  This type of review can only be performed by a clinician or may be performed by a clinician with approved coding credentials.

Medical denials keep piling up/ go unanswered? No time to appeal your denial?

  • Data- according to the 2018 The Doctors Company Survey results
    • 50% of the physicians surveyed, believe value-based care and reimbursement will have a negative impact on overall patient care
  • How I can help
    • I will assess denials utilizing clinical knowledge and CDI specialist review skills
      • Freeing up your time to be a physician to care for your patients

Medical denials being done by a non-clinician?

  • Data: according to Sam Antonios, MD, FACP, SFHM, CPE, CCDS, CDI and ICD-10 physician advisor and chief medical officer at Via Christi Health in Wichita, Kansas.
    • “Payers just use whatever criteria are convenient in that moment,” he says. “Using specific industry–accepted criteria adopted facility-wide in the appeal letter has a better chance of winning out over the inconsistent stand of the payer”
  • How I can help
    • Provide documentation assessment from a clinician point of view
      • Communicate with payers on a clinician to clinician level
      • Generate appeal letters utilizing supported clinical references.

Unable to keep up with the denial deadlines?

  • Data
    • Each payer that generates a denial will have an appeal deadline. If the deadline is not met, it results in loss of revenue for your practice.   
  • How I can help
    • I will monitor appeal process and deadlines, reassessments, and generate supplemental appeal letters with continued supportive clinical references as needed

 

  •  Documentation Support

          Provide recommendations to support increasing your RAF Scores.

  • Denial Support
    • I will assist in the recovery of potential loss of revenue.
    • I will save you time
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