ACDIS Picks by Shannon Newell, RHIA, CCS, AHIMA-approved ICD-10-CM/PCS trainer The Hospital Readmissions Reduction Program (HRRP) is a CMS pay-for-performance program that links the amount hospitals are paid to risk-adjusted readmission rates. Measures included in the program are claims based, which simply means that the ICD-10 codes we submit on our claims for payment are also used to assess our performance; our performance then impacts our payment. Many hospitals are solely focused on the reduction of the observed, or actual, number of readmissions due to a lack of understanding of measure methodology and the impact of comorbid conditions on risk adjustment. In this article, we'll review the HRRP's pneumonia measure to promote an understanding of how documentation and code assignment impacts measure performance.  Another hospital lost its attempt to push through the backlog of denied claims appeals recently. Despite calling the Administrative Law Judge (ALJ) bottleneck “grotesque,” the Fourth Circuit Court of Appeals denied a Cumberland County (North Carolina) hospital system’s request to force the Department of Health and Human Services to provide it with an ALJ hearing. In 2014, 66% of 318 hospitals surveyed by AHIMA had a CDI program in place. If all surveyed facilities that planned to implement a CDI program did so, 80% of responding hospitals would have one. These numbers are likely even higher today as CDI programs become ever more relevant. Q: I am looking for documentation or physician education tips related to ventilator management or “respiratory failure” due to combativeness for airway protection and/or toxic/metabolic encephalopathy in a drug overdose. Many of our providers document “respiratory failure,” when, in fact, they are using the ventilator to help with the work of breathing in order to prevent the patient from actually progressing to acute respiratory failure. By using the ventilator, they are attempting to protect the airway due to encephalopathy, combative nature, or altered mental status.
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