Episode of Care: Heart Failure (HF) Episode Design Summary
|
|
|
- Linda Rosalyn Blake
- 7 years ago
- Views:
Transcription
1 Arkansas Department of Human Services Division of Medical Services Health Care Innovation/Episode Design and Delivery Episode of Care: Heart Failure (HF) Episode Design Summary Health Care Innovation/Episode Design and Delivery Division of Medical Services Arkansas Department of Human Services Post Office Box 1437, Slot S425 Little Rock, AR 72203
2 Page 1 of 5 EPISODE DESIGN SUMMARY EPISODE DEFINITION EPISODE SUBTYPES There are no subtypes for this episode type. EPISODE TRIGGERS Inpatient admission with primary diagnosis code for heart failure See the Appendix for a list of triggering diagnosis codes. EPISODE DURATION Episodes begin at inpatient admission for heart failure. Episodes end at the latter of 30 days after the date of discharge for the triggering admission or the date of the discharge for any inpatient readmission initiated within 30 days of the initial discharge. Episodes shall not exceed 45-day post-discharge from the triggering admission. EPISODE SERVICES The episode will include all of the following services rendered within the episode s duration: Inpatient facility and professional fees for the initial hospitalization and for all cause readmissions Emergency or observation care Home health services Skilled nursing facility care due to acute exacerbation of CHF (services not included in episode for patients with SNF care within 30 days prior to episode start) Durable medical equipment
3 Page 2 of 5 PRINCIPAL ACCOUNTABLE PROVIDER The Principal Accountable Provider (PAP) for an episode is the admitting hospital for the triggering hospitalization. EXCLUSIONS Episodes meeting one or more of the following criteria will be excluded: Beneficiaries that do not have continuous Medicaid enrollment for the duration of the episode. Beneficiaries under the age of 18 at the time of admission. Beneficiaries with any inpatient stay within the 30 days prior to the triggering admission. Beneficiaries with any of the following comorbidities diagnosed in the period beginning 365 days before the episode start date and concluding on the episode end date: 1) End-Stage Renal Disease; 2) organ transplants; 3) pregnancy; 4) mechanical or left ventricular assist device (LVAD); 5) intra-aortic balloon pump (IABP). Beneficiaries with diagnoses for malignant cancers in the period beginning 365 day before the episode start date and concluding on the episode end date. The following types of cancers will not be criteria for episode exclusion: colon, rectum, skin, female breast, cervix uteri, body of uterus, prostate, testes, bladder, lymph nodes, lymphoid leukemia, and monocytic leukemia. Beneficiaries who received a pacemaker or cardiac defibrillator within six months prior to the start of the episode or during the episode. Beneficiaries with any of the following statuses upon discharge: 1) transferred to acute care or inpatient psych facility; 2) left against medical advice; 3) expired. ADJUSTMENTS No adjustments are included in this episode type.
4 Page 3 of 5 QUALITY MEASURES QUALITY MEASURES TO PASS Percentage of patients with LVSD who are prescribed an ACEI or ARB at hospital discharge - must meet minimum threshold of 85%. QUALITY MEASURES TO TRACK Frequency of outpatient follow-ups within 7 and 14 days after discharge. For qualitative assessment of left ventricular ejection fraction (LVEF), proportion of patients matching: hyperdynamic, normal, mild dysfunction, moderate dysfunction, severe dysfunction Average quantitative ejection fraction value 30-day all cause readmission rate 30-day heart failure readmission rate 30-day outpatient observation care rate- utilization metric Qualitative assessment of LVEF, average quantitative ejection fraction value (portal derived) THRESHOLDS FOR INCENTIVE PAYMENTS The acceptable threshold is $6,644 The commendable threshold is $4,722 The gain sharing limit is $3,263 The gain sharing percentage is 50% The risk sharing percentage is 50% MINIMUM CASE VOLUME The minimum case volume is five episodes during the 12-month performance period
5 Page 4 of 5 APPENDIX EPISODE TRIGGERING PROCEDURE CODES ICD-10 Code Description I50.20 Congestive heart failure, unspecified I50.21 Congestive heart failure, unspecified I50.23 Congestive heart failure, unspecified I50.30 Congestive heart failure, unspecified I50.31 Congestive heart failure, unspecified I50.33 Congestive heart failure, unspecified I50.40 Congestive heart failure, unspecified I50.41 Congestive heart failure, unspecified I50.43 Congestive heart failure, unspecified I50.9 Congestive heart failure, unspecified I50.1 Left heart failure I50.20 Systolic heart failure, unspecified I50.21 Acute systolic heart failure I50.22 Chronic systolic heart failure I50.23 Acute on chronic systolic heart failure I50.30 Diastolic heart failure, unspecified I50.31 Acute diastolic heart failure I50.32 Chronic diastolic heart failure I50.33 Acute on chronic diastolic heart failure I50.40 Combined systolic and diastolic heart failure, unspecified I50.41 Acute combined systolic and diastolic heart failure I50.42 Chronic combined systolic and diastolic heart failure I50.43 Acute on chronic combined systolic and diastolic heart failure I50.9 Heart failure, unspecified I11.0 Malignant hypertensive heart disease with heart failure I11.0 Benign hypertensive heart disease with heart failure I11.0 Unspecified hypertensive heart disease with heart failure Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic I13.0 kidney disease stage I through stage IV, or unspecified Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney I13.0 disease stage I through stage IV, or unspecified
6 Page 5 of 5 ICD-10 Code I13.0 Description Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified
2013 ACO Quality Measures
ACO 1-7 Patient Satisfaction Survey Consumer Assessment of HealthCare Providers Survey (CAHPS) 1. Getting Timely Care, Appointments, Information 2. How well Your Providers Communicate 3. Patient Rating
Congestive Heart Failure Management Program
Congestive Heart Failure Management Program The Congestive Heart Failure Program is the third statewide disease management program developed by CCNC. The clinical directors reviewed prevalence and outcome
Healthcare Data: Secondary Use through Interoperability
Healthcare Data: Secondary Use through Interoperability Floyd Eisenberg MD MPH July 18, 2007 NCVHS Agenda Policies, Enablers, Restrictions Date Re-Use Landscape Sources of Data for Quality Measurement,
Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South
Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains
Risk Adjustment Coding/Documentation Checklist
Risk Adjustment Coding/Documentation Checklist The following list should be used to ensure that all member and diagnosis-related information is reported, and all the member s chronic conditions are documented
Scottish Clinical Coding
Scottish Clinical Coding Standards Number 3 September 2013 Scottish Clinical Coding Standards - ICD10 Factor V Leiden Factor V Leiden is the name of a specific gene mutation that results in thrombophilia
Chapter Three Accountable Care Organizations
Chapter Three Accountable Care Organizations One of the most talked-about changes in health care delivery in recent decades is Accountable Care Organizations, or ACOs. Having gained the attention of both
Table 1 Performance Measures. Quality Monitoring P4P Yr1 Yr2 Yr3. Specification Source. # Category Performance Measure
Table 1 Performance Measures # Category Performance Measure 1 Behavioral Health Risk Assessment and Follow-up 1) Behavioral Screening/ Assessment within 60 days of enrollment New Enrollees who completed
11/2/2015 Domain: Care Coordination / Patient Safety
11/2/2015 Domain: Care Coordination / Patient Safety 2014 CT Commercial Medicaid Compared to 2012 all LOB Medicaid Quality Compass Benchmarks 2 3 4 5 6 7 8 9 10 Documentation of Current Medications in
SMD# 13-001 ACA #23. Re: Health Home Core Quality Measures. January 15, 2013. Dear State Medicaid Director:
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 SMD# 13-001 ACA #23 Re: Health Home Core Quality
Diagnosis Code Crosswalk : ICD-9-CM to ICD-10-CM Cardiac Rhythm and Heart Failure Diagnoses
Diagnosis Code Crosswalk : to 402.01 Hypertensive heart disease, malignant, with heart failure 402.11 Hypertensive heart disease, benign, with heart failure 402.91 Hypertensive heart disease, unspecified,
9/23/2014. Mission To improve the health of the people in the communities we serve.
Big Data & Reduced Readmissions Chris Myers, MS, RN, CCM, Director of Care Transitions, Texas Health Harris Methodist Hospital Hurst-Euless- Bedford Anand Shah, MD, Vice President, Parkland Center for
Appendix. Costing Case Samples for OOHCA
Appendix Costing Case Samples for OOHCA The patient (ICD-1) Treatment Codes (OPCS 4) Patient 27 Admitted to ICU following percutaneous cardiac intervention (PCI) with 2 drugeluting stents following a VF
CHAPTER 9 DISEASES OF THE CIRCULATORY SYSTEM (I00-I99)
CHAPTER 9 DISEASES OF THE CIRCULATORY SYSTEM (I00-I99) March 2014 2014 MVP Health Care, Inc. CHAPTER 9 CHAPTER SPECIFIC CATEGORY CODE BLOCKS I00-I02 Acute rheumatic fever I05-I09 Chronic rheumatic heart
8/14/2012 California Dual Demonstration DRAFT Quality Metrics
Stakeholder feedback is requested on the following: 1) metrics 69 through 94; and 2) withhold measures for years 1, 2, and 3. Steward/ 1 Antidepressant medication management Percentage of members 18 years
SUMMARY TABLE OF MEASURE CHANGES
Summary Table of Measure 1 SUMMARY TABLE OF MEASURE CHANGES Guidelines for Physician Measurement Effectiveness of Preventive Care Guidelines for Physician Effectiveness of Care Adult BMI Assessment Weight
Automatic External Defibrillators
Last Review Date: May 27, 2016 Number: MG.MM.DM.10dC2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth
OBJECTIVES AGING POPULATION AGING POPULATION AGING IMPACT ON MEDICARE AGING POPULATION
OBJECTIVES Kimberly S. Hodge, PhDc, MSN, RN, ACNS-BC, CCRN- K Director, ACO Care Management & Clinical Nurse Specialist Franciscan ACO, Inc. Central Indiana Region Indianapolis, IN By the end of this session
Heart Failure & Cardiac Rehabilitation
Heart Failure & Cardiac Rehabilitation Karen Lui, RN, MS, MAACVPR SCACVPR Greenville May 3, 2014 1 I have no disclosures. 2 Outline New Professional Certification New AACVPR CR Guidelines New Heart Failure
Empowering Value-Based Healthcare
Empowering Value-Based Healthcare Episode Connect, Remedy s proprietary suite of software applications, is a powerful platform for managing value based payment programs. Delivered via the web or mobile
Physician and other health professional services
O n l i n e A p p e n d i x e s 4 Physician and other health professional services 4-A O n l i n e A p p e n d i x Access to physician and other health professional services 4 a1 Access to physician care
Reducing Readmissions with Predictive Analytics
Reducing Readmissions with Predictive Analytics Conway Regional Health System uses analytics and the LACE Index from Medisolv s RAPID business intelligence software to identify patients poised for early
FY2015 Final Hospital Inpatient Rule Summary
FY2015 Final Hospital Inpatient Rule Summary Interventional Cardiology (IC) Peripheral Interventions (PI) Rhythm Management (RM) On August 4, 2014, the Centers for Medicare & Medicaid Services (CMS) released
2013 MEDICARE FEE-FOR-SERVICE QUALITY AND RESOURCE USE REPORT
2013 MEDICARE FEE-FOR-SERVICE QUALITY AND RESOURCE USE REPORT Sample Medical Practice Last Four Digits of Your Taxpayer Identification Number (TIN): 1530 ABOUT THIS REPORT FROM MEDICARE WHAT This Quality
Advanced Heart Failure & Transplantation Fellowship Program
Advanced Heart Failure & Transplantation Fellowship Program Curriculum I. Patient Care When on the inpatient Heart Failure and Transplant Cardiology service, the cardiology fellow will hold primary responsibility
Presented by: Char Brar, ACNP, MS(Chem.), MSN, RN Cardiology Nurse Practitioner JBVAMC, Chicago
Presented by: Char Brar, ACNP, MS(Chem.), MSN, RN Cardiology Nurse Practitioner JBVAMC, Chicago 200 bed acute care facility 4 Community Based Out-patient Clinics (CBOCs) 58,000 Veterans IN FY 2008 : 768
Diagnosis-Based Clinical Decision Support Improves CHF Quality Measures
Diagnosis-Based Clinical Decision Support Improves CHF Quality Measures Jonathan P. Wanderer, MD, M. Phil 1, Yanie M. Jackson, MHS 2, and Andrew S. Karson, MD, MPH 2 (1) Department of Anesthesia, Critical
Total Cost of Cancer Care by Site of Service: Physician Office vs Outpatient Hospital
Total Cost of Cancer Care by Site of Service: Physician Office vs Outpatient Hospital Prepared by Avalere Health, LLC Page 2 Executive Summary Avalere Health analyzed three years of commercial health plan
Improving Quality of Care for Medicare Patients: Accountable Care Organizations
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Improving Quality of Care for Medicare Patients: FACT SHEET Overview http://www.cms.gov/sharedsavingsprogram On October
ATTACHMENT B Care Management Organization (CMO) Quality Incentive Payment Methodology
This attachment describes the CMO program period cost reduction guarantees as follows: 1. Fees-at-Risk; 2. Reconciliation Methodology and Holdback Calculation; 3. Operational and Reconciliation Data Requirements;
Home Health Care Today: Higher Acuity Level of Patients Highly skilled Professionals Costeffective Uses of Technology Innovative Care Techniques
Comprehensive EHR Infrastructure Across the Health Care System The goal of the Administration and the Department of Health and Human Services to achieve an infrastructure for interoperable electronic health
Empowering Value-Based Healthcare
Empowering Value-Based Healthcare Episode Connect, Remedy s proprietary suite of software applications, is a powerful platform for managing value-based payment programs. Delivered via the web or mobile
Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis
Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Methodology: 8 respondents The measures are incorporated into one of four sections: Highly
Supplemental Technical Information
An Introductory Analysis of Potentially Preventable Health Care Events in Minnesota Overview Supplemental Technical Information This document provides additional technical information on the 3M Health
VCH PHCTF EVALUATION CORE INDICATORS, DATA COLLECTION PROCESSES, TOOLS & TARGETS
OVERVIEW In alignment with VCH PHCTF deliverables, there is general agreement that our teams use the following core evaluation indicators and evaluation processes to move closer to the proposed targets
CHAPTER 2. Neoplasms (C00-D49) March 2014. 2014 MVP Health Care, Inc.
Neoplasms (C00-D49) March 2014 2014 MVP Health Care, Inc. CHAPTER SPECIFIC CATEGORY CODE BLOCKS C00-C14 Malignant neoplasms of lip, oral cavity and pharynx C15-C26 Malignant neoplasms of digestive organs
How To Reduce Hospital Readmission
Reducing Hospital Readmissions & The Affordable Care Act The Game Has Changed Drastically Reducing MSPB Measures Chuck Bongiovanni, MSW, MBA, NCRP, CSA, CFE Chuck Bongiovanni, MSW, MBA, NCRP, CSA, CFE
Medicare Advantage Risk Adjustment Data Validation CMS-HCC Pilot Study. Report to Medicare Advantage Organizations
Medicare Advantage Risk Adjustment Data Validation CMS-HCC Pilot Study Report to Medicare Advantage Organizations JULY 27, 2004 JULY 27, 2004 PAGE 1 Medicare Advantage Risk Adjustment Data Validation CMS-HCC
UCare provides case management for all UCare members not affiliated with one of the above listed care systems. 2011 UCare for Seniors
Case Requirements Updated 3/16/2011 According to the Case Society of America (CMSA), Case Model Act of 2009, Case management is a collaborative process of assessment, planning, facilitation, care coordination,
MEDICAL POLICY No. 91503-R4 BLOOD PRESSURE MONITORS & AMBULATORY BLOOD PRESSURE MONITORING
BLOOD PRESSURE MONITORS & Effective Date: December 21, 2015 Review Dates: 01/05, 12/05, 12/06, 12/07, 12/08, 12/09, 12/10, 12/11, 12/12, 12/13, 11/14, 11/15 Date Of Origin: January 19, 2005 Status: Current
Medicare Risk-Adjustment & Correct Coding 101. Rev. 10_31_14. Provider Training
Medicare Risk-Adjustment & Correct Coding 101 Rev. 10_31_14 Provider Training Objectives Medicare Advantage - Overview Risk Adjustment 101 Coding and Medical Record Documentation Requirements Medicare
2016 HEDIS & Quality Assurance Reporting Requirements Measures Provider Reference Guide
2016 HEDIS & Quality Assurance Reporting Requirements Measures Provider Reference Guide HEDIS Measure: Test/Care Needed for Compliance Adult BMI Assessment Individuals ages 18-74 Documentation of BMI and
Medicare Savings and Reductions in Rehospitalizations Associated with Home Health Use
Medicare Savings and Reductions in Rehospitalizations Associated with Home Health Use June 23, 2011 Avalere Health LLC Avalere Health LLC The intersection of business strategy and public policy Table of
MaineCare Value Based Purchasing Initiative
MaineCare Value Based Purchasing Initiative The Accountable Communities Strategy Jim Leonard, Deputy Director, MaineCare Peter Kraut, Acting Accountable Communities Program Manager Why Value-Based Purchasing
Primary Care Quality Care Indicators - Accuro EMR Prevention
Quality Indicators Primary Care Quality Care Indicators - Accuro EMR Prevention Data needs to be entered as indicated in order to auto populate the worksheet Date of colon cancer screening Exemption from
Manitoba EMR Data Extract Specifications
MANITOBA HEALTH Manitoba Data Specifications Version 1 Updated: August 14, 2013 1 Introduction The purpose of this document 1 is to describe the data to be included in the Manitoba Data, including the
Ohio Health Homes Learning Community Meeting. Overview of Health Homes Measures
Ohio Health Homes Learning Community Meeting Overview of Health Homes Measures Tuesday, March 5, 2013 Presenter: Amber Saldivar, MHSM Associate Director, Informatics Analysis Health Services Advisory Group,
Improving Quality of Care for Medicare Patients: Accountable Care Organizations
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Improving Quality of Medicare Patients: Overview The Centers for Medicare & Medicaid Services (), an agency within the Department
Hospital Value-Based Purchasing (VBP) Program
Medicare Spending per Beneficiary (MSPB) Measure Presentation Question & Answer Transcript Moderator: Bethany Wheeler, BS Hospital VBP Program Support Contract Lead Hospital Inpatient Value, Incentives,
STATISTICAL BRIEF #37
HEALTHCARE COST AND UTILIZATION PROJECT STATISTICAL BRIEF #37 Agency for Healthcare Research and Quality September 2007 Pediatric Hospital Stays for Cancer, 2005 Chaya T. Merrill, M.P.H., Mika Nagamine,
Physical and Mental Health Condition Prevalence and Comorbidity among Fee-for-Service Medicare- Medicaid Enrollees
Physical and Mental Health Condition Prevalence and Comorbidity among Fee-for-Service Medicare- Medicaid Enrollees Centers for Medicare & Medicaid Services September, 2014 i Executive Summary Introduction
SHIIP Combo Form. 1-855-408-1212 www.ncshiip.com. North Carolina Department of Insurance Wayne Goodwin, Commissioner
SHIIP Combo Form Seniors Health Insurance Information Program North Carolina Department of Insurance Wayne Goodwin, Commissioner 1-855-408-1212 www.ncshiip.com What is SHIIP? Seniors Health Insurance Information
THE EVOLUTION OF CMS PAYMENT MODELS
THE EVOLUTION OF CMS PAYMENT MODELS December 3, 2015 Dayton Benway, Principal AGENDA Legislative Background Payment Model Categories Life Cycle The Models LEGISLATIVE BACKGROUND Medicare Modernization
convey the clinical quality measure's title, number, owner/developer and contact
CMS-0033-P 153 convey the clinical quality measure's title, number, owner/developer and contact information, and a link to existing electronic specifications where applicable. TABLE 20: Proposed Clinical
Preauthorization Requirements * (as of January 1, 2016)
OFFICE VISITS Primary Care Office Visits Primary Care Home Visits Specialist Office Visits No Specialist Home Visits PREVENTIVE CARE Well Child Visits and Immunizations Adult Annual Physical Examinations
Cardiology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Cardiology
Cardiology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Cardiology Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00-E89) The diabetes mellitus codes are combination codes
See page 331 of HEDIS 2013 Tech Specs Vol 2. HEDIS specs apply to plans. RARE applies to hospitals. Plan All-Cause Readmissions (PCR) *++
Hospitalizations Inpatient Utilization General Hospital/Acute Care (IPU) * This measure summarizes utilization of acute inpatient care and services in the following categories: Total inpatient. Medicine.
Inpatient Heart Failure Management: Risks & Benefits
Inpatient Heart Failure Management: Risks & Benefits Dr. Kenneth L. Baughman Professor of Medicine Harvard Medical School Director, Advanced Heart Disease Section Brigham & Women's Hospital Harvard Medical
New Jersey Delivery System Reform Incentive Program
New Jersey Delivery System Reform Incentive Program The New Jersey Delivery System Reform Incentive Program (DSRIP) is part of New Jersey s Comprehensive Medicaid Waiver. The program provides incentive
Breaking the Code: ICD-9-CM Coding in Details
Breaking the Code: ICD-9-CM Coding in Details ICD-9-CM diagnosis codes are 3- to 5-digit codes used to describe the clinical reason for a patient s treatment. They do not describe the service performed,
MASSACHUSETTS RESIDENTS CENTRAL MA. Acute Care Hospital Utilization Trends in Massachusetts FY2009-2012
ACUTE CARE HOSPITAL UTILIZATION TRENDS I N MASSACHUSETTS FY2009-2012 MASSACHUSETTS RESIDENTS CENTRAL MA Introduction The Center for Health Information and Analysis (CHIA) is publishing these inpatient,
Explanation of care coordination payments as described in Section 223.000 of the PCMH provider manual
Explanation of care coordination payments as described in Section 223.000 of the PCMH provider manual Determination of beneficiary risk Per beneficiary amounts Per beneficiary amounts 1 For the first year
Medicare 2015 QI Program Evaluation
Color Code: Red does not meet 5 star threshold, or target. Green meets or exceeds 5 star threshold/target. Improving or Maintaining Physical Health (HOS) Improving or Maintaining Mental Health (HOS) Diabetes
V. Utilization Management (UM) Program
V. Utilization Management (UM) Program Overview Better Health Network s Utilization Management (UM) Program is designed to provide quality, cost-effective and medically necessary services while meeting
SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES
Summary Table of Measures, Product Lines and Changes 1 SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES General Guidelines for Data Collection and Reporting Guidelines for Calculations and Sampling
Improving Care Transitions using PDSA Methodology
Improving Care Transitions using PDSA Methodology Catherine Payne, MD, FHM Care Transitions Physician Champion Medical Director of Clinical Informatics Erlanger Medical Center Chattanooga, Tennessee Objectives
Using Medicare Hospitalization Information and the MedPAR. Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota
Using Medicare Hospitalization Information and the MedPAR Beth Virnig, Ph.D. Associate Dean for Research and Professor University of Minnesota MedPAR Medicare Provider Analysis and Review Includes information
ABELMed EHR-EMR/PM version 12, an ONC HIT 2014 Edition Complete EHR, has been certified for the following 42 clinical quality measures (CQMs).
ABELMed EHR-EMR/PM version 12, an ONC HIT 2014 Edition Complete EHR, has been certified for the following 42 clinical quality measures (CQMs). The information contained in this document is also available
Medicare Physician Group Practice Demonstration
Medicare Physician Group Practice Demonstration Heather Grimsley Medicare Demonstrations Program Group Center for Medicare and Medicaid Innovation Centers for Medicare & Medicaid Services April 2011 PGP
Medicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Kentucky Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization...
Section 6. Medical Management Program
Section 6. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.
Reporting Audiology Quality Measures: A Step-by-Step Guide
What is PQRS? The Physician Quality Reporting System (PQRS) is a program through the Centers for Medicare and Medicaid Services (CMS) designed to improve the quality of care to Medicare beneficiaries by
James F. Kravec, M.D., F.A.C.P
James F. Kravec, M.D., F.A.C.P Chairman, Department of Internal Medicine, St. Elizabeth Health Center Chair, General Internal Medicine, Northeast Ohio Medical University Associate Medical Director, Hospice
Mar. 31, 2011 (202) 690-6145. Improving Quality of Care for Medicare Patients: Accountable Care Organizations
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Media Affairs MEDICARE FACT SHEET FOR IMMEDIATE RELEASE
Provider Manual. Utilization Management
Provider Manual Utilization Management Utilization Management This section of the Manual was created to help guide you and your staff in working with Kaiser Permanente s Utilization Management (UM) policies
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF)
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) Key priorities Identification and diagnosis Treatment for persistent AF Treatment for permanent AF Antithrombotic
Henry Ford Health System Care Coordination and Readmissions Update
Henry Ford Health System Care Coordination and Readmissions Update September 2013 BACKGROUND Most hospital readmissions are viewed as avoidable, costly, and in some cases as a potential marker of poor
Current Renal Replacement Therapy in Korea - Insan Memorial Dialysis Registry, 2011 - ESRD Registry Committee, Korean Society of Nephrology*
Current Renal Replacement Therapy in Korea - Insan Memorial Dialysis Registry, 2011 - ESRD Registry Committee, Korean Society of Nephrology* =Abstracts= Registry committee of Korean Society of Nephrology
Welcome The AAMC, UHC and FPSC Web Conference on 2014 PQRS Proposed Changes will begin shortly.
Welcome The AAMC, UHC and FPSC Web Conference on 2014 PQRS Proposed Changes will begin shortly. Please do not place your phones on hold. If you need to leave the event, hang up and dial back into the conference.
Corporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: infusion_therapy_in_the_home 3/1998 2/2016 2/2017 2/2016 Description of Procedure or Service Home infusion
Number. Source: Vital Records, M CDPH
Epidemiology of Cancer in Department of Public Health Revised April 212 Introduction The general public is very concerned about cancer in the community. Many residents believe that cancer rates are high
Medicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6 Spending...
Moving Towards Bundled Payment
ISSUE BRIEF Moving Towards Bundled Payment Introduction The fee-for-service system of payment for health care services is widely thought to be one of the major culprits in driving up U.S. health care costs.
Group Hospitalization and Medical Services, Inc.
Group Hospitalization and Medical, Inc. doing business as CareFirst BlueCross BlueShield [840 First Street, NE] [Washington, DC 20065] [202-479-8000] An independent licensee of the Blue Cross and Blue
Risk Adjustment: Implications for Community Health Centers
Risk Adjustment: Implications for Community Health Centers Todd Gilmer, PhD Division of Health Policy Department of Family and Preventive Medicine University of California, San Diego Overview Program and
UB-04 Claim Form Instructions
UB-04 Claim Form Instructions FORM LOCATOR NAME 1. Billing Provider Name & Address INSTRUCTIONS Enter the name and address of the hospital/facility submitting the claim. 2. Pay to Address Pay to address
Atrius Health Pioneer ACO: First Year Accomplishments, Results and Insights
Atrius Health Pioneer ACO: First Year Accomplishments, Results and Insights Emily Brower Executive Director Accountable Care Programs Emily_Brower@AtriusHealth.org November 2013 1 Contents Overview of
Answer: A description of the Medicare parts includes the following:
Question: Who is covered by Medicare? Answer: All people age 65 and older, regardless of their income or medical history are eligible for Medicare. In 1972 the Medicare program was expanded to include
Arkansas Health Care Payment Improvement Initiative
Arkansas Health Care Payment Improvement Initiative Joseph W. Thompson, MD, MPH Arkansas Surgeon General Director, Arkansas Center for Health Improvement Arkansas System Transformation Strategy Workforce
NHS outcomes framework and CCG outcomes indicators: Data availability table
NHS outcomes framework and CCG outcomes indicators: Data availability table December 2012 NHS OF objectives Preventing people from dying prematurely DOMAIN 1: preventing people from dying prematurely Potential
Newark Beth Israel Medical Center Selected: DSRIP Project #8: The Congestive Heart Failure (CHF) Transition Program
Project Focus Newark Beth Israel Medical Center Selected: DSRIP Project #8: The Congestive Heart Failure (CHF) Transition Program Transitioning Into Transitional Care Program Modeled After Project RED,
Clinical Quality Measure Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW
Clinical Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW NQF 0105 PQRS 9 NQF 0002 PQRS 66 Antidepressant Medication Management Appropriate Testing for Children with Pharyngitis (2-18 years)
Heart transplantation
Heart transplantation A patient s guide 1 Heart transplantation Heart transplantation has the potential to significantly improve the length and quality of life for patients with severe heart failure.
MEDICAL ASSOCIATES HEALTH PLANS HEALTH CARE SERVICES POLICY AND PROCEDURE MANUAL POLICY NUMBER: PP 27
POLICY TITLE: RESIDENTIAL TREATMENT CRITERIA POLICY STATEMENT: Provide consistent criteria when determining coverage for Residential Mental Health and Substance Abuse Treatment. NOTE: This policy applies
1. Executive Summary Problem/Opportunity: Evidence: Baseline Data: Intervention: Results:
A Clinical Nurse Leader led multidisciplinary Heart Failure Program: Integrating best practice across the care continuum to reduce avoidable 30 day readmissions. 1. Executive Summary Problem/Opportunity:
Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.9 Case Management Services G.12 Special Needs Services
Brief Research Report: Fountain House and Use of Healthcare Resources
! Brief Research Report: Fountain House and Use of Healthcare Resources Zachary Grinspan, MD MS Department of Healthcare Policy and Research Weill Cornell Medical College, New York, NY June 1, 2015 Fountain
UnitedHealthcare Insurance Company of the River Valley Attachment D - Schedule of Benefits
UnitedHealthcare Insurance Company of the River Valley Attachment D - Schedule of Benefits Please refer to your Provider Directory for listings of Participating Physicians, Hospitals, and other Providers.
Chapter I Overview Chapter Contents
Chapter I Overview Chapter Contents Table Number Contents I-1 Estimated New Cancer Cases and Deaths for 2005 I-2 53-Year Trends in US Cancer Death Rates I-3 Summary of Changes in Cancer Incidence and Mortality
MISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY
MISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY In order to improve the efficiency of PINNACLE Registry data analytics, a missing data analysis has been conducted on PINNACLE Registry data