Skip to content

CDS-Coder Reconciliation Work Flow process

============================================================================

Basic work flow

  1. Patient Will admit to the facility ( Initial Account Status will be "In Process")
  2. CDS will assign Account and start working on this ( " In process" )
  3. In the Process CDS may be raise query and wait for facility response ( " In process" )
  4. Patient will get discharged after some time, then Coder start look into this account
  5. CDS May have option to put account on Hold status based on (Query not posted, Query Response Pending,Missing Documentation)
  6. Before account billing, Coder will look into KPAI CDS-Coder Reconciliation Interface for CDS Status on this account
  7. The account may be in IN process, On Hold, COmplete status, Coder should do only Complete Accounts for billing, for other he will wait for CDS to put in Complete status
  8. In process of coder work, he may find some mismatches between CDS and COder (Possible Mismatches: PDX Change, MCC/CC Code Missing, Query Missing, POA Mismatch)
  9. Then he will raise mismatch on account, and wait for CDS response on this account 10.CDS will look in to the Miss match and may he agree with coder or Not Agree With coder
  10. IF CDS agree with coder, then both will reconcile their data and coder will reconcile and close the account in KPAI
  11. IF CDS Not Agree With COder then Mismatch will be Escalate to CDSAdmin, then CDS Admin Sort out the issue and will close the Miss match.

At the end before billing/reconciliation account,

A. First CDS should place Account in Complete Status (otherwise if it is in (In Process, or On Hold) coder should not touch the account)

B. The DRG Should be matched both sides (DRG Number, And DRG Type)

C. There should not be any pending Mismatches on current account

Final Option parameters

CDS Account Status: In Process, On Hold, Complete

CDS On Hold Type: Query not posted, Query Response Pending,Missing Documentation

Mismatch Type: PDX Change, MCC/CC Code Missing, Query Missing, POA Mismatch

CDS Mismatch Agreement: Agreed, Not Agreed

Mismatch Status: In Process, Escalated to CDS Admin, Closed

Final Account Status: In Process, Closed

Conditions to check

CDS-Coder reconciliation Interface will be displaced same to all users

  1. All CDS and Coders can see all Pending accounts under Current Accounts Tab

  2. Coder can only Change the Account FInal status as Reconciled or closed (Only when 1. CDS Account Status is In COmplete Status, 2. DRG Should be same 3. No Pending Mismatches on Account )

  3. Coder can only raise mismatch on Account

  4. CDS can comment Miss match and can change CDS Agreement Status (Agreed, not Agreed)

  5. CDS Don't have access to change Mismatch status (In Process, Escalate, Close), only can change this

Need Clarification on

  1. what we should do when mismatch sent to Escalate status

  2. Suppose Mismatch is not correct by coder then how it will be closed

  3. Coder want to Know the Why CDS Status is still in (In Process, Hold Status), is he raise mismatch regarding CDS status pending or what?