PPT-The Importance of Documentation

ARIZONA TREAT AND REFER PROGRAM A monitored community specific and clinically grounded effort to enhance the healthcare continuum for Arizonans Documentation is not generally viewed as glamorous but instead is viewed as BORING. Day, Egusquiza, President. AR Systems, Inc . Lori Rathbun, VP Finance. Mercy Network, IA. . 1. Why have Clinical Documentation Improvement?. A consistent ‘set of eyes’ on the record . Concurrent review, with direct feedback-fragmented. Cheryl Bernknopf R.N., BScN. Assistant Director Centauri Summer Camp. Co- Chair OCA Healthcare Committee. Board Member of the ACN. PURPOSE. To provide the multidisciplinary team with a structured note format for documenting. Telana . Fairchild. Nurse Practitioner Students. UMass - Worcester, . Graduate School of Nursing. N/NG . 603B. 1. Narrative. Focused. Flow-sheet. By exception. Problem . oriented. Types of Documentation. 1. Please turn your cell phones off or to vibrate mode.. Welcome to.... ICD-10 Coding. No Recording of ANY TYPE allowed. . Mind expansion in process.... About Dr. Mario Fucinari, DC, CCSP, MCS-P. Certified Chiropractic Sports Physician (CCSP). EMS Documentation Uses. Legal record. Continuity of care with hospital. Internal quality assurance. Billing record. Today’s Environment. Government focus on fraud. Increased audits. Legally collecting every dollar . For Charter Educators . Sara . Hardner. Leon. Powell & Leon, LLP. Austin, Texas. The Objectives of Effective Documentation. The primary objective for creating effective employee documentation is to:. Dr. Andrew Wallace PhD . BEng. (hons) . EurIng. andrew@cs.umu.se. Overview. Documentation. Javadoc. More documentation. Documentation. Document your program. For others. For yourself. Programs change over time. Laura Triplett, Director, HIM. Roseann Kilby, Clinical Informatics Analyst. Becky Crane, Clinical Risk Manager. 367 Bed Community Health System in Quincy, Illinois . 2,000 Employees. 240+ Physicians. California Department of Aging. Documentation Rule #1. Documentation. Utilizing the Participant Form Checklist. Official Document or . Business Record. Confirmation of . Signature and Date. Make sure that forms are . Documentation tells a story. Quality documentation tells a story that everyone can understand. What does your documentation say about you? . Financial implications. Documentation is a receipt, warranty and guarantee for payments received.. Case . Examples & . Highlights. When Documentation Gets in The Way of the Defense. Presented By: . Joanne . Gulliford Hoban. Morrison . Mahoney, LLP. Case #1 – Emergency Department . Example of documentation in ED by both MD & RN. Jan Malone 8. th. floor Nurse Educator. Importance of Documentation. Helps us track our patient’s progress. Conveys information between disciplines and shifts. Can determine therapy. Is part of the permanent record. ICD 10 Documentation Specialty Introduction ICD 10 is being mandated by CMS. Compliance date is set at October 2015. ICD-9 Diagnosis Codes = 14,000 ICD-10 Diagnosis Codes = 69,000 ICD-9 Procedure Codes = 3,800 AHEAD Equity and Excellence in . Higher Education Conference. Boston, MA. July 13, . 2019. 6/19/2019. Loring Brinckerhoff, Ph. D. . Director, Office of Disability Policy. ETS. lbrinckerhoff@ets.org. .