2/1/2016. Clinical Documentation: The Key to Unlocking Your VBP Opportunity. Today s Speakers. Goals and Objectives
|
|
- Willa Barker
- 7 years ago
- Views:
Transcription
1 Clinical Documentation: The Key to Unlocking Your VBP Opportunity Today s Speakers Bill Hannah, Principal Wayne Little, Partner Michelle Wieczorek RN RHIT CPHQ, Senior Manager February 2, Goals and Objectives At the conclusion of today s webinar, the participant will: Understand the importance of having a robust clinical documentation program Be introduced to the mandatory government programs impacting payment reform Understand and articulate the importance of clinical documentation in VBP and other risk adjusted alternative Payment Models Define and understand Key Process Considerations for CDI programs built for success under alternative payment models. 3 1
2 The Importance of a Robust Clinical Documentation Program Bill Hannah, Principal 4 Expanded focus on Clinical Documentation Clinical Care Reimbursement Coordination of Care Continuity of Care Complete Patient Story Foundation for Compliant Coding Consumption of Resources Risk Adjustment in both MS and APR DRG s Statutory/Regulatory Required for Licensure Accreditation Third party reviews Research Disease Tracking Comparative Data Used for Quality Improvement 5 CMS Accelerates the Timeline for Payment Tied to Quality and Value Metrics HHS goal of 30 percent traditional FFS Medicare payment through alternative payment models by the end of percent by the end of 2018 HHS Press Office % of payment tied to 70 quality and value metrics 60 (ex. Hospital Value Based 50 Purchasing, Hospital Readmission Reduction 40 Program) Traditional, Fee for Service Alternative Payment Models 2
3 Mandatory Elements Reform Timeline January 2016, hospitals and physicians are affecting performance criteria that will impact payments for 2017, 2017, 2018 and beyond 7 Clinical Documentation and Risk-Adjusted Alternative Payment Models Wayne Little, Partner 8 Key Considerations CMS uses a different DRG grouper for payment () than for alternative payment programs such as HVBP and Readmissions. Many legacy CDI Programs are focused upon capturing of secondary diagnoses that impact the only. There are many secondary diagnoses that are not classified as comorbid conditions or complications for purposes of the MS DRG assignment however, they may still have a significant impact on risk adjustment for the alternative payment programs. Many of these secondary diagnosis may go un coded even if documented if they do not impact the based upon coding norms. 9 3
4 Risk-Adjustment Attribute Intended Population Approach to Severity Maintained by 3M Medicare (age 65+ or under age 65 with disability) Secondary Diagnoses include Complications and Comorbid Conditions applied to some base DRG s to tier them into with or without CC or MCC designations. 3M TM APR DRG s Maintained by 3M and NACHRI All patient refined (based upon the Nationwide Inpatient Sample) Base DRG s each have 4 severity levels. No CC or MCC list. Instead, severity depends on both the number and the interrelationship of the secondary diagnoses. Number of DRG s 746 1,256 Newborn DRGs 7 DRG s; no use of 28 base DRG s each with 4 levels birthweight of severity (total of 112) February 2, Importance of Diagnosis Coding Depth Category Diagnosis ICD 10 Code Amputation Status, Lower Limb Status amputation, toes, foot, ankle Z below/above knee Congestive Heart Failure CHF I50.9 Pulmonary Heart Disease I27.9 COPD COPD J44.9 Emphysema J43.9 Chronic Bronchitis J42 Diabetes Diabetes, uncontrolled E11.65 Major Depressive Disorders Major Depression F32.9 Schizophrenia Schizophrenia F20.9 Vascular Diseases Peripheral Vascular Disease I73.9 Aortic Atherosclerosis I70.0 Aortic Aneurysm I71.9 Abdominal Aoristic Aneurysm I73.9 History of CABG Presence of coronary bypass graft Z95.1 Diagnosis Having the Greatest Impact in Risk Adjusted Reimbursement Programs (Mortality and Readmissions) That Are NOT a CC or MCC Under System February 2, Diagnosis Coding & Trends 12 4
5 CDI Example Patient with dysuria, fever and altered mental status: Urosepsis documented in progress notes. Lab reports showed serum creatinine and BUN levels of 4.5 & 50, respectively. Low urinary output. Physician ordered 1L of IV NS wide open with maintenance IV fluids of 150 cc/hr to follow. Serial creatinine and BUN levels declined over the next 3 days to 1.2 & 2.4, respectively. Patient maintained on Symbicort and Lipitor at home. 13 Legacy CDI Program Before 690 KIDNEY & URINARY TRACT INFECTIONS W/O MCC Relative Weight.7823 PDX Urinary Tract Infection SDX Coronary Artery Dx APR DRG 463 APR Weight.5768 SOI Level 2 Risk of Mortality 2 Expected Mortality.3% After 871 SEPTICEMIA OR SEVERE SEPSIS W MV 96+ HOURS With MCC Relative Weight PDX Sepsis SDX Coronary Artery Dx APR DRG 720 APR Weight.8206 SOI Level 2 Risk of Mortality 2 Expected Mortality 3.1% The CDI Specialist queried the physician based upon lab values and presence of SIRS Criteria to verify an alternate principal dx. of Sepsis, achieving an improved DRG and Reimbursement. 14 Future State CDI Program Before 690 KIDNEY & URINARY TRACT INFECTIONS W/O MCC Relative Weight.7823 PDX Urinary Tract Infection SDX Coronary Artery Dx APR DRG 463 APR DRG 720 APR Weight.5768 APR Weight SOI Level 2 SOI Level 4 Risk of Mortality 2 Risk of Mortality 3 Expected Mortality.3% Expected Mortality 6.3% The CDI Specialist sought clarity in the presence of COPD a secondary diagnosis not impacting the through reviewing of the medication list and noting Symbicort. The CDI Specialist also noted the presence of clinical indicators indicative of ATN; and queried the physician to clarify the diagnosis. The combination of the additional secondary diagnosis moved the SOI, ROM and Expected Mortality. After 871 SEPTICEMIA OR SEVERE SEPSIS W MV 96+ HOURS With MCC Relative Weight PDX Sepsis SDX Acute Renal Failure with ATN COPD 15 5
6 Key Performance Considerations and The Future State Requirements of CDI Programs Michelle Wieczorek, Senior Manager 16 Impacts to Legacy CDI Programs Preparing for Future State Requirements Data Analytics Collaboration Technology Operations Workflow 17 Data Management and Analytic Considerations based metrics are no longer sufficient for measuring the impact of the CDI Program on the documentation and coding processes. As a result, different metric dashboards and reports are required. An APR DRG and an is stored on all patients upon each review. (DRG Progression) Acuity Measures for SOI and ROM are stored on all patients upon each review. Reporting solution accommodates Provider, Patient and Population Centric data. 18 6
7 Sample Key Process Indicator: Coding Depth Secondary Diagnosis Capture Per IP Case Q2 Linear (Q4) Q1 Q3 Q4 19 Sample Key Process Indicator: Severity of Illness Distribution 100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Severity of Illness Distribution for Inpatient Admissions Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q SOI 1 SOI 2 SOI 3 SOI 4 20 Technology Considerations Because the CDI Specialist is doing more reviews, assessing for severity and APR DRG impacts, and consequently creating more queries for the provider, the technology considerations for the CDI program are heightened. APR DRG Grouper is Licensed for use by CDI Specialists and Coders Software Solution Supports CDI Workflow Structured Data from CDI Solution Available for Reporting New Reporting Metrics Electronic Query Solution for Providers Integrated with EHR 21 7
8 Sample: Impact of Electronic Query Response Tool Query Response Rate within 24 Hours Cardiology Percent Query Response Tool Implemented Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q Dr. G Dr. A Dr. B Dr. C Dr. D Dr. E Dr. F GOAL 22 Workflow Considerations CDI Workflow must be adapted to accommodate deeper severity based reviews, more coaching with providers, and prioritization of cases for initial, subsequent and reconciliation reviews. The CDI Specialist has access to an encoder and a Working DRG ( and APR DRG) is assigned as part of CDI Workflow Concurrent Workflow includes Verbal Queries and Face Time with Providers Workflow is driven by worklists to aid in prioritization The Working DRG is Concurrently Available to Care Management and Quality 23 Operational Considerations Transforming the CDI Function from a legacy or focused program to a future state acuity and quality outcome program requires several operational considerations for training and staffing. The Workforce is trained and knowledgeable in Risk Adjustment There is a DRG Reconciliation Process for all DRG Mismatches CDI Peer Physician Advisor Roles are Implemented 24 8
9 Collaboration Compelling providers to improve clinical documentation can no longer be accomplished without an ongoing, systematic process which includes hospital departments combining their data and skills to support their providers. There are regularly occurring opportunities to share Provider, Patient and Population Centric reports with the Medical Staff The CDI Program and Coding Program utilize the same standard query tools There is a regularly occurring opportunity to share CDI program information with Coding, Revenue Cycle, Care Management, and Finance 25 Recommended Next Steps Think about your organizational preparedness for alternative payment methods. Is your organization ready for managing your revenue at risk? Think about how well your CDI Program is prepared for meeting the challenges of payment reform. Review the CDI Program Checklist which will be ed to you in follow up to today s presentation. Contact Information Bill Hannah, Principal Atlanta, Georgia P: Wayne Little, Partner Atlanta, Georgia P: Michelle Wieczorek, Sr. Manager Atlanta, Georgia P:
Key Strategies for Ensuring Clinical Revenue Integrity with ICD-10
Key Strategies for Ensuring Clinical Revenue Integrity with ICD-10 Angela Carmichael, MBA, RHIA, CDIP, CCS, CCS-P Pyramid Healthcare Solutions, Clearwater, FL Melinda Tully, MSN, CCDS, CDIP J. A. Thomas
More informationSee 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.
More informationAll Patient Refined DRGs (APR-DRGs) An Overview. Presented by Treo Solutions
All Patient Refined DRGs (APR-DRGs) An Overview Presented by Treo Solutions Presentation Highlights History of inpatient classification systems APR-DRGs: what they are, how they work, and why they are
More informationSupplemental 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
More informationThe Why and How of a CDI Program. Deb Neville, RHIA, CCS-P, Elsevier/MC Strategies Donna Bonno, CPC- CPC-I, QuadraMed September 12, 2012
The Why and How of a CDI Program Deb Neville, RHIA, CCS-P, Elsevier/MC Strategies Donna Bonno, CPC- CPC-I, QuadraMed September 12, 2012 Objectives Understand the reasons behind a Clinical Documentation
More informationThe Top 20 ICD-10 Documentation Issues That Cause DRG Changes
7th Annual Association for Clinical Documentation Improvement Specialists Conference The Top 20 ICD-10 Documentation Issues That Cause DRG Changes Donna Smith, RHIA Project Manager, Consulting Services
More informationPatient Criteria: Modeling in LTRAX
Patient Criteria: Modeling in LTRAX Mary Dalrymple Managing Director, LTRAX Kristen Smith, MHA, PT Senior Consultant Overview Objectives Review background on upcoming LTCH patient criteria Examine LTRAX
More informationSpecialty Excellence Award and America s 100 Best Hospitals for Specialty Care 2013-2014 Methodology Contents
Specialty Excellence Award and America s 100 Best Hospitals for Specialty Care 2013-2014 Methodology Contents Introduction... 2 Specialty Excellence Award Determination... 3 America s 100 Best Hospitals
More informationFY2015 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
More informationPhysician Scorecards. Clinical Documentation and Coding Improvement. Team Goals Metrics. Data Benchmarks Compliance.
Health Solutions Clinical Documentation and Coding Improvement Physician Scorecards Individual physician performance has a direct impact on a health system s financial, patient safety, and care quality
More informationHome 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
More informationWith New Models of Value-Based Care. September 1, 2015
With New Models of Value-Based Care September 1, 2015 Using Community Care Coordination and Mobile Technology to Impact Health Outcomes and Reduce Avoidable Hospital Encounters Presenters: Chris Parsons,
More informationEstimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments
Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments ICD-10 Coordination and Maintenance Committee March 18, 2015 Objective To estimate the impact on aggregate IPPS
More informationMedicare 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
More informationUW MEDICINE ICD-10. DRG Root Cause Analysis June 2014
UW MEDICINE ICD-10 DRG Root Cause Analysis June 2014 INTRODUCTION As medical charts are coded in ICD-10 and ICD-9, sometimes the DRG will shift. It is important to understand the cause of these shifts
More informationCertified Clinical Documentation Specialist Examination Content Outline - 2016
Certified Clinical Documentation Specialist Examination Content Outline - 2016 1. Healthcare Regulations, Reimbursement, and Documentation Requirements Related to the Inpatient Prospective Payment System
More informationyour EHR s 3M Core Grouping Software
Delivering value-added software to your EHR s revenue cycle and analytic workflows 3M Core Grouping Software Healthcare IT systems are the heart and soul of revenue cycle workflows. But often they depend
More informationCLINTEGRITY 360 COMPUTER ASSISTED PHYSICIAN DOCUMENTATION
WHITE PAPER CLINTEGRITY 360 COMPUTER ASSISTED PHYSICIAN DOCUMENTATION Technology to Help Your Physicians with the Transition to ICD-10 In the changing world of healthcare reform, let Nuance Healthcare
More informationThe Impact of Value- Based Purchasing in the Healthcare Industry
The Impact of Value- Based Purchasing in the Healthcare Industry Presented By: Kim Charland, BA, RHIT, CCS Senior Vice President Clinical Innovation for Panacea Healthcare Solutions and Editor of VBPmonitor
More informationImportance of Revenue Cycle Continuous. Presentation Outline
Importance of Revenue Cycle Continuous Education EHR EMR ICD-10 Presented by: Gloria Doehling, Consultant, ICD-10 SME Encore Health Resources 21 September 2012 1 Presentation Outline Definitions Best Practice
More informationAGENDA WHAT IS COMPUTER-ASSISTED CODING, REALLY? J03.0 F43.0 I10 A78 R52
R06.2 F43.0 I10 06BY3ZC J03.0 A78 03HK0MZ R52 0SG1430 COMPUTER-ASSISTED CODING AGENDA Evaluating and Understanding the Technology Review of Lessons Learned from Early Adopters Workflow and Analytics with
More informationTony Matejicka, DO, MPH, FACP Medical Director Coding and Utilization August 20, 2012
Tony Matejicka, DO, MPH, FACP Medical Director Coding and Utilization August 20, 2012 Understand the history of CMS to appreciate our clinical disconnect from Medicare reimbursement. Recognize terms from
More informationDescription of the OECD Health Care Quality Indicators as well as indicator-specific information
Appendix 1. Description of the OECD Health Care Quality Indicators as well as indicator-specific information The numbers after the indicator name refer to the report(s) by OECD and/or THL where the data
More information3M Health Information Systems. Potentially Preventable Readmissions Classification System. Methodology Overview GRP 139 05/08
3M Health Information Systems Potentially Preventable Readmissions Classification System Methodology Overview 3 GRP 139 05/08 Document number GRP 139 05/08 Copyright 2008, 3M. All rights reserved. This
More informationSurvey on Coding Quality Measurement: Hospital Inpatient Acute Care
Survey on Coding Quality Measurement: Hospital Inpatient Acute Care In November 2007, the AHIMA e-him Quality Work Group on Coding Performance Measures and the Foundation of Research and Education (FORE)
More informationBreaking 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,
More informationTable 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
More informationDocumentation Proliferation Effect in Electronic Medical Records. Adele Towers, MD and Mark Morsch, MS
Documentation Proliferation Effect in Electronic Medical Records Adele Towers, MD and Mark Morsch, MS DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not
More informationInterventional Cardiology Peripheral Interventions Rhythm Management
FY2016 Hospital Inpatient Final Rule (IPPS) Interventional Cardiology Peripheral Interventions Rhythm Management On July 31, 2015, the Centers for Medicare and Medicaid Services (CMS) released the Final
More informationAbu Dhabi Clinical Coding Audit
Abu Dhabi Clinical Coding Audit 1 st January, 2014 Clinical Coding Steering Committee v4 1 Contents Section or Table 1. Objective 3 2. Who May Ask for an Audit? 3 3. Who May Conduct the Audits? 3 4. Payers
More informationStroke Coding Issues Presentation to: NorthEast Cerebrovascular Consortium
Stroke Coding Issues Presentation to: NorthEast Cerebrovascular Consortium October 30, 2008 Barry Libman, RHIA, CCS, CCS-P President, Barry Libman Inc. Stroke Coding Issues Outline Medical record documentation
More informationHCIM ICD-10 Training Online Course Catalog August 2015
HCIM ICD-10 Training Online Course Catalog August 2015 Course/Content Duration Quiz Duration CME Credits Assessments: Assessment: Provider - Baseline - E/M Emergency Department 45 5/1/2015 Assessment:
More informationPatient to Person. Transitions of Care. Colby Bearch, MA-SF, MA-M, BA, RN, CDONA Sharyn King, RN, BSN, CCM
Patient to Person Transitions of Care Colby Bearch, MA-SF, MA-M, BA, RN, CDONA Sharyn King, RN, BSN, CCM Transitions of Care Transitioning from school to adult services (vocational, medical day, etc.)
More informationSupercharged CDI: NLP, intelligent workflow and CAC revolutionize CDI program at UPMC
White Paper Supercharged CDI: NLP, intelligent workflow and CAC revolutionize CDI program at UPMC In today s healthcare environment, information is the engine that drives activity and care delivery. But
More informationMedicare Risk Adjustment and You. Health Plan of San Mateo Spring 2009
Medicare Risk Adjustment and You Health Plan of San Mateo Spring 2009 Background CMS reimburses health plans on a risk-adjusted basis: The sicker a member is expected to be, the more CMS pays a plan, which
More informationComputer-assisted coding and documentation for a changing healthcare landscape
Computer-assisted coding and documentation for a changing healthcare landscape Reality is, in this new ICD-10 environment, providers will have two options: a) work harder; or b) find a new way to do things.
More information2.b.vii Implementing the INTERACT Project (Inpatient Transfer Avoidance Program for SNF)
2.b.vii Implementing the INTERACT Project (Inpatient Transfer Avoidance Program for SNF) Project Objective: Skilled nursing facilities (SNFs) will implement the evidence based INTERACT program developed
More informationInsights and Best Practices for Clinical Documentation Improvement Programs
Insights and Best Practices for Clinical Documentation Improvement Programs In the face of alarming predictions about ICD-10 s administrative impact and its veritable explosion of new codes to wrangle
More informationClinical Documentation Improvement Program Inpatient Setting Our Implementation Journey
Clinical Documentation Improvement Program Inpatient Setting Our Implementation Journey Linda Dubiel, RHIA, Coding Director Mayo Clinic Health System NW WI Region WHIMA Conference May 2013 2011 MFMER slide-2
More informationMASSACHUSETTS RESIDENTS WESTERN MA. Acute Care Hospital Utilization Trends in Massachusetts FY2009-2012
ACUTE CARE HOSPITAL UTILIZATION TRENDS I N MASSACHUSETTS FY2009-2012 MASSACHUSETTS RESIDENTS WESTERN MA Introduction The Center for Health Information and Analysis (CHIA) is publishing these inpatient,
More informationTHE AFFORDABLE CARE ACT ITS EFFECTS ON RESPIRATORY CARE & SLEEP DEPARTMENTS
THE AFFORDABLE CARE ACT ITS EFFECTS ON RESPIRATORY CARE & SLEEP DEPARTMENTS SHANE KEENE, DHSC, RRT- NPS, CPFT, RPSGT, RST DEPARTMENT HEAD, ANALYTICAL AND DIAGNOSTIC SCIENCES UNIVERSITY OF CINCINNATI Mr.
More information2016 PERITONEAL DIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE
2016 PERITONEAL DIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE Contents Overview of Peritoneal Dialysis 2 Physician Reimbursement for Peritoneal Dialysis s Under Resource-based Relative Value Scale
More informationThe electronic health record (EHR) has been a game-changer for CDI specialists.
Physician queries and the use of prior information: Reevaluating the role of the CDI specialist WHITE PAPER Summary: The following white paper examines the issue of whether to use information from a prior
More informationHow To Get A Blue Cross Code Change
OVERVIEW 1. What is an ICD Code? The International Classification of Diseases (ICD) code set is used primarily to report medical diagnosis and inpatient procedures. ICD codes are mandated by the Centers
More informationCMS Progress Toward Implementing Value-Based Purchasing
Centers for Medicare & Medicaid Services CMS Progress Toward Implementing Value-Based Purchasing Thomas B. Valuck, MD, JD Medical Officer & Senior Adviser Center for Medicare Management 1 CMS Quality Improvement
More informationMedicare 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
More informationPanacea Healthcare Solutions, Inc.
Panacea Healthcare Solutions, Inc. The Impact of Value-Based Purchasing in the Healthcare Industry Kim Charland, BA, RHIT, CCS Senior Vice President Clinical Innovation, Panacea Healthcare Solutions and
More informationThe Value Quadrant of Healthcare Reform. 2008 Pharos Innovations, LLC. All Rights Reserved.
The Value Quadrant of Healthcare Reform ACOs in PPACA Provider Organizations or networked groups Accountable for quality, cost and overall care of defined population of Medicare FFS benes Key metrics to
More informationChapter Seven Value-based Purchasing
Chapter Seven Value-based Purchasing Value-based purchasing (VBP) is a pay-for-performance program that affects a significant and growing percentage of Medicare reimbursement for medical providers. It
More informationThe Future of Population-Based Reimbursement
Thomas Jefferson University Jefferson Digital Commons Jefferson College of Population Health Forum Jefferson College of Population Health 11-12-2014 The Future of Population-Based Reimbursement David Chin,
More informationContinuous Quality Monitoring
Continuous to Maximize ICD-10 Proficiency and Organizational Benefits 1 2 The New Role of 3 Continuous ! A common strategy to maintain coding accuracy, continuous quality reviews have taken on greater
More informationSpeaking ICD-10-CM. The New Coding Language. COPD documented with a more specific respiratory condition falls under one code category: J44.0-J44.
Speaking : Chronic Obstructive Pulmonary Disease (COPD) COPD documented with a more specific respiratory condition falls under multiple code categories: 491.20-491.22 Obstructive chronic bronchitis 493.20-493.22
More informationMASSACHUSETTS 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,
More informationAppendix A WORK PROCESS SCHEDULE HIM (HEALTH INFORMATION MANAGEMENT) HOSPITAL CODER O*NET-SOC CODE: 29-2071.00 RAPIDS CODE: TBD
Appendix A WORK PROCESS SCHEDULE HIM (HEALTH INFORMATION MANAGEMENT) HOSPITAL CODER O*NET-SOC CODE: 29-2071.00 RAPIDS CODE: TBD This schedule is attached to and a part of these Standards for the above
More informationSECTION 4 COSTS FOR INPATIENT HOSPITAL STAYS HIGHLIGHTS
SECTION 4 COSTS FOR INPATIENT HOSPITAL STAYS EXHIBIT 4.1 Cost by Principal Diagnosis... 44 EXHIBIT 4.2 Cost Factors Accounting for Growth by Principal Diagnosis... 47 EXHIBIT 4.3 Cost by Age... 49 EXHIBIT
More informationRisk Adjustment Factor (RAF) RADV June 1 st 2016
Risk Adjustment Factor (RAF) RADV June 1 st 2016 Disclaimer The information presented herein is for information purposes only. HIMS BMG Coding and Compliance Education has prepared this education using
More informationCoding Specialty Track HIM Curriculum Competencies
Coding Specialty Track HIM Curriculum Competencies Concepts to be interwoven throughout all levels of the curricula include: CRITICAL THINKING: For example the ability to work independently, use judgment
More informationThe Changing Landscape of Healthcare and What it means to you!
The Changing Landscape of Healthcare and What it means to you! Marc Leighton Imagination at work. How do hospitals/providers get paid? Introduction to Payment Mechanisms DRG- or APDRG-based mechanisms
More informationUCare 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,
More informationHealthcare Financial Management Association Southern California. Implementation of MS-DRGs. November 20, 2008
Healthcare Financial Management Association Southern California Implementation of MS-DRGs November 20, 2008 John Valenta, CPA, MBA, Director Health Sciences Regulatory Practice Deloitte & Touche LLP Agenda
More informationNote: This is an authorized excerpt from 57 Population Health Management Metrics. To download the entire report, go to
Note: This is an authorized excerpt from 57 Population Health Management Metrics. To download the entire report, go to http://store.hin.com/product.asp?itemid=4817 or call 888-446-3530. 57 Population Health
More informationRemodeling Your Organization with the ICD-10 Catalyst
Remodeling Your Organization with the ICD-10 Catalyst ICD-10 and Other Regulatory Changes as Catalyst for Transformation John W. Stanton (Senior Healthcare Consultant, Dell Global Healthcare Services)
More informationInterventional Cardiology Peripheral Interventions Rhythm Management
FY2016 Hospital Inpatient Rule (IPPS) Interventional Cardiology Peripheral Interventions Rhythm Management On April 17, 2015 the Centers for Medicare and Medicaid Services (CMS) released the Hospital Inpatient
More informationMDC 1 DISEASES AND DISORDERS OF THE NERVOUS SYSTEM Implantation of chemotherapeutic agent Intracranial stents
To assist the readers in identifying all changes that were made to the MS-DRGs as a result of comments, we developed the attached table that summaries those changes. MS-DRG Summary Table PRE-MDC Intestinal
More informationSelection of a DRG Grouper for a Medicaid Population
Selection of a DRG Grouper for a Medicaid Population Introduction The goal of diagnosis related groupers is to define patients into categories based on similar clinical conditions and on similar levels
More informationEpisode-based Payment System
Response to Request for Information Prepared for: ARKANSAS DEPARTMENT OF HUMAN SERVICES DIVISION OF MEDICAL SERVICES Table of Contents Component A: Episode Design 3 Clinical Guidance 3 Episode Definition
More informationMASSACHUSETTS RESIDENTS NORTHEAST MA. Acute Care Hospital Utilization Trends in Massachusetts FY2009-2012
ACUTE CARE HOSPITAL UTILIZATION TRENDS I N MASSACHUSETTS FY2009-2012 MASSACHUSETTS RESIDENTS NORTHEAST MA Introduction The Center for Health Information and Analysis (CHIA) is publishing these inpatient,
More informationWhat is Data Analytics and How Does it Help Prepare Providers for ICD-10?
What is Data Analytics and How Does it Help Prepare Providers for ICD-10? June 2013 Kim Charland, BA, RHIT, CCS Senior Vice President of Clinical Consulting Services Panacea Healthcare Solutions, Inc.
More informationLong term care coding issues for ICD-10-CM
Long term care coding issues for ICD-10-CM Coding Clinic, Fourth Quarter 2012 Pages: 90-98 Effective with discharges: October 1, 2012 Related Information Long Term Care Coding Issues for ICD-10-CM Coding
More informationFY2015 Proposed Hospital Inpatient Rule Summary
FY2015 Proposed Hospital Inpatient Rule Summary Cardiac Rhythm Management (CRM) Electrophysiology (EP) Interventional Cardiology (IC) Peripheral Intervention (PI) On April 30, 2014, the Centers for Medicare
More informationData Analytics. Data Analytics: Next Step for Coding Specialists? 3/18/2016
Data Analytics: Next Step for Coding Specialists? AAHIM April 2016 Joy King Ewing, RHIA, CCS, CCDS Data Analytics Science of examining raw data to draw conclusions about that information. It is distinguished
More informationSupport: Andrew Gardner Clinical Data manager Mount Auburn Hospital Email: agardner@mah.harvard.edu Tel: 617-441-1625 Pager: 6707
Support: Andrew Gardner Clinical Data manager Mount Auburn Hospital Email: agardner@mah.harvard.edu Tel: 617-441-1625 Pager: 6707 Mount Auburn Hospital Case Management Department PROCESS STEP See page...
More informationHow CDI is Revolutionizing the Transition to Value-Based Care
How CDI is Revolutionizing the Transition to Value-Based Care How CDI is Revolutionizing the Transition to Value-Based Care Creating a state-of-the-art clinical documentation improvement (CDI) program
More informationRisk 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
More informationQuality and Performance Improvement PATRICK SCHULTZ MS RN ACNS BC DIRECTOR OF QUALITY AND PATIENT SAFETY SANFORD MEDICAL CENTER FARGO
Quality and Performance Improvement PATRICK SCHULTZ MS RN ACNS BC DIRECTOR OF QUALITY AND PATIENT SAFETY SANFORD MEDICAL CENTER FARGO Crossing The Quality Chasm: A New Health System For The 21st Century
More informationPresented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION
Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION At the end of this session, you will be able to: Identify ways RT skills can be utilized for
More informationCoding in the Long Term Acute Care Setting
Coding in the Long Term Acute Care Setting Audio Seminar/Webinar October 18, 2007 Practical Tools for Seminar Learning Copyright 2007 American Health Information Management Association. All rights reserved.
More informationICD-10 Implementation: No Margin, No Mission
ICD-10 Implementation: No Margin, No Mission October 6, 2014 Subtitle: ICD-WHEN? Page 0 Agenda ICD10 Background ICD9 ICD10 Transition ICD10 Assessment Tasks ICD10 Assessment Considerations ICD-10 Areas
More informationIntroduction to the GLPTN Program. Provider Office & Physician Organization Briefing
Introduction to the GLPTN Program Provider Office & Physician Organization Briefing What is the GLPTN? The GLPTN is one of 29 Practice Transformation Networks (PTNs) funded under the brand new CMS Transforming
More informationAn Introduction to HealthInfoNet s HIE Reporting & Analytics. 6th Annual APS Healthcare Maine Conference May 14, 2015
An Introduction to HealthInfoNet s HIE Reporting & Analytics 6th Annual APS Healthcare Maine Conference May 14, 2015 Presentation Outline HealthInfoNet Background Current Status of health information exchange
More informationIntelligent Monitoring Report
Intelligent Monitoring Report Report on Sandwell and West Birmingham Hospitals NHS Trust 21 October 2013 (Revised) Sandwell and West Birmingham Hospitals NHS Trust Intelligent Monitoring: Report on 21
More informationPopulation Health and
Population Health and Potentially Preventable Events 3M solutions for population health, patient safety and cost-effective care Challenge: Shifting the financial risk The healthcare industry seems to change
More informationBuilding a Post Acute Network: Care Management and ACOs
Building a Post Acute Network: Care Management and ACOs A high level summary of proposed rules for ACOs and the shared savings program most relevant to post acute providers. Prepared By: Kathleen M. Griffin,
More informationEmerging g Trends in Home Care
Emerging g Trends in Home Care Dana Sheer, ACNP, MSN Susan Beausoliel, BSN, MS, DNP 1 The Triple Aim Goals Quality Improve Patient Outcomes Goal Readmissions Cost Reduce costs/penalties associated w/ readmissions
More informationGame Changer at the Primary Care Practice Embedded Care Management. Ruth Clark, RN, BSN, MPA Integrated Health Partners October 30, 2012
Game Changer at the Primary Care Practice Embedded Care Management Ruth Clark, RN, BSN, MPA Integrated Health Partners October 30, 2012 Objectives To describe the recent evolution of care management at
More informationFlorida Center for Health Information and Policy Analysis
Florida Center for Health Information and Policy Analysis Data Overview for the Commission on Healthcare and Hospital Funding May 20, 2015 1 Office of Data Collection and Quality Assurance Collection of
More informationCoding & Alan L. Plummer, MD Editor
Coding & Billing Quarterly july 2014 EDITOR ALAN L. PLUMMER, MD ATS RUC Advisor ADVISORY BOARD MEMBERS: KATINA NICOLACAKIS, MD Chair, ATS Clinical Practice Committee ATS Alternate RUC Advisor STEPHEN P.
More informationIn the second of a quarterly series of articles available to ACDIS members,
Coding Clinic update Conditions documented at the time of discharge, diabetes opportunities highlight important updates for CDI specialists W h i t e p a p e r Editor s note: The following article is provided
More informationArkansas 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
More informationReducing 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
More informationICD 10 ESSENTIALS. Debbie Sarason Manager, Practice Enhancement and Quality Reporting
ICD 10 ESSENTIALS Debbie Sarason Manager, Practice Enhancement and Quality Reporting October 29, 2015 CHANGING FROM 1CD 9 TO ICD 10 IN 2015 Rest of world has been using ICD 10 for decades World Health
More information2015 HIM Educational Summit ICD-10-CM Discussion Panel
2015 HIM Educational Summit ICD-10-CM Discussion Panel PRESENTED BY Karen Scott, MEd, RHIA, CCS-P, CPC, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer KScottSeminars@Comcast.net Brian Boyce, BSHS, CPC, CPC-I,
More informationHow Hospitals Can Arm Themselves in the War on Waste By Helen Blumen, MD, MBA, and Tiffanie Lenderman, MBA, MSHA
Hospitals How Hospitals Can Arm Themselves in the War on Waste By Helen Blumen, MD, MBA, and Tiffanie Lenderman, MBA, MSHA In this article What can physician executives do to combat inefficiency and poor
More informationAccountable Care Organization
Accountable Care Organization April 13, 2011 The Indianapolis Association of Health Underwriters Drivers of Payment Reform Increased attention to regional variation in costs and quality Payment for care
More informationPatient Optimization Improves Outcomes, Lowers Cost of Care >
Patient Optimization Improves Outcomes, Lowers Cost of Care > Consistent preoperative processes ensure better care for orthopedic patients The demand for primary total joint arthroplasty is projected to
More informationImproving the Compliance of the Annual Foot Examination and Monofilament Testing in
Improving the Compliance of the Annual Foot Examination and Monofilament Testing in Diabetic Patients at Centromed Principal Investigator: Velen Tat, Physician Assistant Student 2016, University of Southern
More informationNational Council for Behavioral Health
National Council for Behavioral Health Preparing your Organization for ICD-10 Implementation Presented by: Michael D. Flora, MBA, M.A.Ed, LCPC, LSW Senior Operations and Management Consultant David R.
More informationPCMH and Care Management: Where do we start?
PCMH and Care Management: Where do we start? Patricia Bohs, RN, BSN Quality Assurance Manager Kelly McCloughan QA Data Manager Wayne Memorial Community Health Centers Honesdale, PA Wayne Memorial Community
More information