Talk Ten Tuesday’s cohost accepts an invitation to be a guest on an Australian’s podcast series.
Have you ever played Six Degrees of Kevin Bacon?
It is a parlor game played where players pick an actor, and the other players must think of an actor who has appeared with that actor in a film, thus continuing this in an iterative process until the player find a linked actor with Kevin Bacon. The challenge is to do it in the fewest connections, but the concept is that it almost always can be done in six steps or less. It stems from the six degrees of separation theory that any two individuals on earth can be connected through their network of social acquaintances.
Almost all my opportunities and business ventures are just a few degrees from Talk Ten Tuesdays or ICD10monitor. I wrote an article entitled, “The Clinical Documentation Process has Become Longer, More Repetitive, and Less Informative,” published on ICD10monitor November 30, 2021. As a result, Dr. Felicity Sinclair-Ford, a physician employed by Clinical Documentation Improvement Australia (CDIA), contacted me, and asked if she could abridge and disseminate my article to providers in Australia. I was flattered and delighted. In my response, I told her I would be interested to hear about CDI in Australia.
Her answer was to invite me to be the inaugural guest of CDI in Conversation, a podcast her company was starting for the CDIA community. Naturally, I eagerly agreed, but I told her I wanted to be able to share the conversation with you, our readers and listeners. Felicity assented, and we recorded six hours of conversations exploring the similarities and differences between clinical documentation integrity in the United States and Australia.
It was fascinating! I had been under the misconception that the United States was the only country that based reimbursement on coding. Australia’s system is different from (or “to”, depending on whether you are Australian or American!) ours; it more resembles the All Patient Refined (APR) Diagnosis Related Group (DRG) system than the Medicare Severity (MS-DRG) system. Conditions have variable risk adjustment depending on the principal diagnosis/base DRG – the secondary diagnoses define “the split.” And funding depends on whether it is a public or a private hospital.
Felicity found the concept of clinical validation denials intriguing because that isn’t a thing there…yet. CDI is still young in Australia, and they haven’t transitioned to “Integrity” as opposed to “improvement.” One of the biggest shockers to me was that, in order to be a codable diagnosis, almost all conditions have to have resulted in initiation or adjustment of treatment. In other words, if a patient comes in with almost any chronic condition and they are on their home dosage of medications without change, that condition does not enter into the calculation of the DRG severity.
These conversations were eye-opening to me, and Felicity was a delightful partner with whom to explore this topic. I’d like to invite you all to tune in and experience it for yourself at the CDIA website. The only thing that would have made this more fun would have been an invitation to do it in person, down under. Maybe next time!
It finally happened! The Centers for Medicare & Medicaid Services (CMS) finally released the 2026 Outpatient Prospective Payment Final Rule on Friday at 4:15 pm,
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