Claude La Charite MD FACP, SFHM, CCS, CCDS

Summary

• I bridge the gap between clinical practice and the documentation necessary to ensure optimal individual provider and hospital performance metrics by focusing on the most critical part of the healthcare chain—the bedside physicians. As a physician myself, I make it my mission to teach physicians, NPs, and PAs how to accurately and compliantly portray their patients' true severity of illness through improved medical record documentation leading to improved publicly available practice perceptions, mortality scores, complication rates, and hospital system finances.
  
  -Leads the CDI team responsible for addressing inconsistent, incomplete, imprecise, and conflicting clinical terminology and provider documentation practices.
  -Created and maintains house-wide diagnosis definition standards and diagnostic criteria ensuring consistent, accurate, and current terminology usage regardless of service-line or hospital location.
  -Guides the concurrent and retrospective query process through query formulation, review, and education regarding changes in coding guidelines, Coding Clinics, and by increasing understanding of clinical definitions and scenarios.
  -Actively manages hospital and provider publicly reported performance metrics through the creation and supervision through PI, PSI, and HAC surveillance and intervention processes.
  -Developed and maintains a house-wide mortality review process reviewing cases with inaccurate Severity of Illness (SOI) and Risk of Mortality (ROM) scores substantially decreasing observed-to-expected mortality rates.
  -Created and previously directed Payer/Recovery Audit Contractor (RAC) denials response program involving medical necessity, coding discrepancies, and clinical validation through appeal construction, coding error reduction, and provider documentation education.
  -Actively participates in utilization review and case management programs focusing on LOS reduction and payer peer-to-peers for appropriate status determinations.