DC Medicaid. Specialty Hospital Project Per Stay Training. August 20, Government Healthcare Solutions Payment Method Development
|
|
|
- Mabel Perkins
- 8 years ago
- Views:
Transcription
1 DC Medicaid Specialty Hospital Project Per Stay Training August 20, 2014 Government Healthcare Solutions Payment Method Development
2 Agenda Introductions Background APR-DRG overview Payment details System support Questions 2 August 20, 2014 Control Log No. S186
3 Disclaimer This material is solely the responsibility of the Xerox Corporation, in its capacity as a consultant to DHCF The information in this presentation is descriptive of the APR-DRG grouper version 31 The APR-DRG grouper is proprietary computer software created, owned and licensed by the 3M Company. All copyrights in and to the 3M TM Software are owned by 3M. All rights reserved 3 August 20, 2014 Control Log No. S186
4 Background
5 Background Evaluate and recommend a prospective payment method for five specialty hospitals: Psychiatric Institute of Washington (PIW) Hospital for Sick Children (HSC) National Rehabilitation Hospital (NRH) Specialty Hospital of Washington-Capitol Specialty Hospital of Washington-Hadley Replace flat-rate per diem models with a prospective payment system Allow District to better understand what is being paid for Be defensible, transparent and durable Change effective October 1, August 20, 2014 Control Log No. S186
6 Specific Issues Outpatient services at these hospitals will be included in the Outpatient Hospital Project Five hospitals are excluded from the APR-DRG project Coding quality 6 August 20, 2014 Control Log No. S186
7 Current payment method Specialty hospitals paid on a hospital specific per diem Days are paid the same without consideration of the complexity of the patient or care For the most part, each hospital s rates are re-stated annually based on cost audit process 7 August 20, 2014 Control Log No. S186
8 New Method APR-DRG adjusted per-diem Impacts rehabilitation, specialty psychiatric and pediatric LTCH: National Rehabilitation Psychiatric Institute of Washington Hospital for Sick Children APR-DRG adjusted per-stay Impacts adult LTCH Capitol Hill Hadley 8 August 20, 2014 Control Log No. S186
9 APR-DRG Overview
10 What Are APR-DRGs? All Patients Refined Diagnosis Related Groups (APR-DRG) is a classification system that classifies patients with a similar pattern of resource intensity & into clinically meaningful patient groups. Focus is expanded from resource consumption to include: Resource Intensity: the relative volume and types of diagnostic, therapeutic and bed services used in the management of a particular disease Severity of Illness: the extent of physiologic decompensation or organ system loss of function Risk of Mortality: the likelihood of dying There are a manageable number of DRGs which encompass the range of all patients seen on an inpatient basis The patient characteristics used in the definition of the DRGs are limited to information routinely collected 10 August 20, 2014 Control Log No. S186
11 What Are APR-DRGs? (cont.) APR-DRGs are a clinical model that has been extensively refined with historical data Different clinical models are developed for different types of patients Clinical models verified with data Hospitals State Agencies input New literature evaluated New code set Final decisions were always clinical with two-tier peer review Transparent criteria 11 August 20, 2014 Control Log No. S186
12 What are APR-DRGs? (cont.) 3M APR-DRGs are designed to describe the complete cross-section of patients seen in acute care hospitals 3M APR-DRGs form a clinically coherent set of severity of illness and risk of mortality adjusted patient groups Developed in early 1990s by 3M and National Association of Children s Hospitals (formerly NACHRI) Intended to be suitable for all patients, especially obstetrics, newborns, NICU babies, general pediatrics, and medically complex children Widely used for research, analysis and payment Understand the patients being treated, costs incurred, expected services and outcomes Identify areas for improvement in efficiency, documentation, and potential quality problems 12 August 20, 2014 Control Log No. S186
13 Structure of APR-DRGs DRG Base DRG - SOI APR- DRG APR-DRG Description Relative Weight Heart &/Or Lung Transplant Heart &/Or Lung Transplant Heart &/Or Lung Transplant Heart &/Or Lung Transplant Asthma Asthma Asthma Asthma Vaginal Delivery Vaginal Delivery Vaginal Delivery Vaginal Delivery High severity of illness and risk of mortality are characterized by multiple serious diseases and the interaction of those diseases. 13 August 20, 2014 Control Log No. S186
14 General Steps in Calculating the Allowed Amount Group each stay to APR-DRG and use relative weight Hospital s base rate (per diem or for the stay) Incorporate specific payment adjustments Outlier payments, transfers, etc. 14 August 20, 2014 Control Log No. S186
15 Payment details
16 Per stay method
17 Per stay payment method Each hospital stay is assigned an APR-DRG Each APR-DRG has a relative weight The allowed amount is calculated by: Hospital base rate X APR-DRG relative weight + Adjustments (e.g. outlier payments, transfer payments) 17 August 20, 2014 Control Log No. S186
18 Interim Payments Interim payments Now follow DC DRG payment rules. Interim claims are allowed for: Stays that exceed a threshold of 30 days, and/or Stays that have $500,000 in charges or more How will interim payments be applied Hospital submits interim claim (type of bill 0112 or 0113) Interim claim will be paid an interim per diem rate of $500 times the number of days Upon discharge, the hospital will void the previous interim claims and submit one claim, admit through discharge showing all charges, diagnoses and procedures Interim claims 0114 (final interim claim) and 0115 will be denied if submitted 18 August 20, 2014 Control Log No. S186
19 Outlier payments High cost outlier payment Additional payments available for high cost cases based on these rules: Did a loss occur? If there was a loss, did it exceed the high cost outlier threshold? Calculate the loss minus the threshold times the marginal cost factor Add the payment to the DRG allowed amount Adjustments made for low-cost outliers Adjustments made for low cost stays. Was there a gain on the stay? Did the gain exceed the low cost threshold? If a gain exists, process payment using the transfer policy rule. 19 August 20, 2014 Control Log No. SXXX
20 Transfer Payments Transfer adjustments are made when a patient is transferred to another acute setting. The hospital will be paid the lesser of: The DRG base payment, or A per diem amount times the actual length of stay plus one day. Per diem amount calculated by taking the base DRG payment divided by the DRG specific average length of stay 20 August 20, 2014 Control Log No. S186
21 System support
22 Where to find Information DC Medicaid Webportal Select Provider Type Specific Information from the left task panel Select Hospital Link Select Billing Manual Link Specialty Hospital FAQ is also available from the Webportal This FAQ document which provides DC Medicaid policy, payment and billing information about the new outpatient hospital payment method. FAQs are periodically updated and distributed to hospitals. From the What s Hot section on the home page, select DC Medicaid Specialty Hospital Project when presented. 22 August 20, 2014 Control Log No. S186
23 Questions
24 For Further Information For more information on Medicaid payment methods, please go to Jeff Gray Director, Payment Method Development Xerox State Healthcare Government Healthcare Solutions P Jeff.gray2@xerox.com Kathleen Martin Director, Payment Method Development Xerox State Healthcare Government Healthcare Solutions P Kathleen.martin@xerox.com Tonya Hutson Consultant, Payment Method Development Xerox State Healthcare Government Healthcare Solutions P Tonya.hutson@xerox.com
25 2014 Xerox Corporation. All rights reserved. Xerox and Xerox Design are trademarks of Xerox Corporation in the United States and/or other countries.
MEDICAID DRGS GET READY, CUZ HERE THEY COME!
MEDICAID DRGS GET READY, CUZ HERE THEY COME! TODAY S PROGRAM All about Medicaid DRGs AHCA and HP implementation plan APR-DRGs details Panel discussion on hospital implementation BACKGROUND Required by
Florida Medicaid Inpatient Prospective Payment System
Florida Medicaid Inpatient Prospective Payment System Justin Senior Deputy Secretary for Medicaid, Agency for Health Care Administration Malcolm Ferguson Associate Director, Navigant Healthcare Senate
Inpatient Transfers, Discharges and Readmissions July 19, 2012
Inpatient Transfers, Discharges and Readmissions July 19, 2012 Discharge Status Codes Two-digit code Identifies where the patient is at conclusion of encounter Visit Inpatient stay End of billing cycle
All 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
Statewide Hospital Quality Care Assessment Frequently Asked Questions
Statewide Hospital Quality Care Assessment 1. Q: Why are hospitals being assessed? A: Federal regulations, CFR 42 Part 433 - Fiscal Administration, allows states to assess 19 classes of providers under
Medi-Cal DRG Project Frequently Asked Questions
Medi-Cal DRG Project Frequently Asked Questions All Patient Refined Diagnosis Related Groups (APR-DRGs) were implemented for private hospitals on July 1, 2013, and for non-designated public hospitals (NDPHs)
Medi-Cal DRG Payment. Provider Training December 2013
Medi-Cal DRG Payment Provider Training December 2013 Darrell Bullocks, Dawn Weimar, Kevin Quinn Government Healthcare Solutions Payment Method Development 12/05/2013 Topics 1. Introduction and Background
Inpatient Hospital Prospective Payment Billing Manual
Inpatient Hospital Prospective Payment Billing Manual July 2006 INPATIENT HOSPITAL SERVICES Under West Virginia Public Payers prospective payment system (PPS), payments are made prospectively on a per-drg
3M 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
DC Medicaid EAPG Training
DC Medicaid EAPG Training Provider Training 2013 Xerox Corporation. All rights reserved. Xerox and Xerox Design are trademarks of Xerox Corporation in the United States and/or other countries. Agenda Project
Potentially Preventable Readmissions (PPRs) Policy and Calculations Illinois Department of Healthcare and Family Services July 31, 2012 (Revised)
Potentially Preventable Readmissions (PPRs) Policy and Calculations Illinois Department of Healthcare and Family Services July 31, 2012 (Revised) OVERVIEW» HFS is implementing a policy to support the reduction
Code Correlations: Inpatient Revenue Codes (Formerly Accommodation Codes)
Code Correlations: Inpatient Revenue Codes (Formerly Accommodation Codes) Medi-Cal has developed a service code set correlation table for provider use to begin to prepare for business and billing operation
Institutional Claim Billing Reimbursement. HP Provider Relations/October 2013
Institutional Claim Billing Reimbursement HP Provider Relations/October 2013 Agenda Objectives Institutional Claim Basics Inpatient Claim Payment Outpatient Claim Payment Enhanced Code Auditing Billing
Selection 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
ALASKA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION MEDICARE SUPPLEMENT PLAN F
ALASKA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION MEDICARE SUPPLEMENT PLAN F The premiums you paid, the application you complete and our reliance on your answers to the application questions have put this
Overview of Hospital Utilization Review
Overview of Hospital Utilization Review Legal Authority The Inspector General (IG) hospital utilization review function operates under guidelines and regulations contained in: Texas Administrative Code
FEB I 7 rnsa. Attachment 4.19-A Page 1
Page 1 The State has in place a public process which complies with the requirements of Section 1902(a) (13)(A) of the Social Security Act. J TN No. 97-16 Supersedes TN No. NEW Approval Date Effective FEB
Medi-Cal DRG Payment
Medi-Cal DRG Payment Provider Training Spring 2013 Darrell Bullocks, Kevin Quinn, Dawn Weimar Government Healthcare Solutions Payment Method Development 4/30/13 Topics 1. Introduction and Background 2.
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
Facilities contract with Medicare to furnish
Facilities contract with Medicare to furnish acute inpatient care and agree to accept predetermined acute Inpatient Prospective Payment System (IPPS) rates as payment in full. The inpatient hospital benefit
MUST BE SUBMITTED IN WRITING AND MUST BE RECEIVED OR POSTMARKED NO LATER THAN SEPTEMBER
Pat Quinn, Governor Julie Hamos, Director 201 South Grand Avenue East Telephone: (217) 785-0710 Springfield, Illinois 62763-0002 TTY: (800) 526-5812 August 28, 2013 The Rehab Institute ATTN: Chief Executive
MUST BE SUBMITTED IN WRITING AND MUST BE RECEIVED OR POSTMARKED NO LATER THAN SEPTEMBER
Pat Quinn, Governor Julie Hamos, Director 201 South Grand Avenue East Telephone: (217) 785-0710 Springfield, Illinois 62763-0002 TTY: (800) 526-5812 August 28, 2013 HealthSouth Tri State Rehab Hospital
August 7, 2013 Page 1
Facility: CROSSROADS COMMUNITY ID: 13297 Exhibit 1: Facility-Specific Summary Report Notes: 1. Please refer to Appendix A for definitions of each row of data. 2. Analysis is illustrative based on historical
Clarification of Patient Discharge Status Codes and Hospital Transfer Policies
The Acute Inpatient Prospective Payment System Fact Sheet (revised November 2007), which provides general information about the Acute Inpatient Prospective Payment System (IPPS) and how IPPS rates are
Preface. Summary of Changes. Table of Contents. Service Contacts. October 2014 Replaces: May 2014 S-5781 10/14
Preface Summary of Changes Table of Contents Service Contacts October 2014 Replaces: May 2014 S-5781 10/14 Preface The Wellmark Provider Guide and specialty guides are billing resources for providers doing
Inpatient/Outpatient Hospital
Inpatient/Outpatient Hospital Inpatient/Outpatient Hospital... i Inpatient/Outpatient Hospital...3 Billing Information...3 National Provider Identifier (NPI)... 3 Paper Claims... 3 Electronic Claims...
Figuring Out the Codes: Inpatient Rehabilitation Facilities and the Transfer Policy
Figuring Out the Codes: Inpatient Rehabilitation Facilities and the Transfer Policy Inpatient rehabilitation facilities (IRFs) are hospitals (or subunits of a hospital) that offer intensive rehabilitation
your 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
Office of Benefits Hospital Billing Guidelines
Office of Benefits Hospital Billing Guidelines Revised 11/1/2015 TABLE OF CONTENTS Changes... 6 New Changes for 11/1/2015... 6 1. HOSPITAL BILLING OVERVIEW... 8 1.1 Instructions for Hospital Providers...
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
2009 Medicaid Transformation Program Review Out-of-State Services
2009 Medicaid Transformation Program Review Out-of-State Services Description Kansas Medicaid maintains an out-of-state program for situations which require a Kansas Medicaid beneficiary to receive services
Office of Benefits Hospital Billing Guidelines
Office of Benefits Hospital Billing Guidelines Published 4/30/2015 TABLE OF CONTENTS 1. HOSPITAL BILLING OVERVIEW... 5 1.1 Instructions for Hospital Providers... 6 2. SPECIAL CASES BILLING INSTRUCTIONS...
NOVOSTE BETA-CATH SYSTEM
HOSPITAL INPATIENT AND OUTPATIENT BILLING GUIDE FOR THE NOVOSTE BETA-CATH SYSTEM INTRAVASCULAR BRACHYTHERAPY DEVICE This guide is intended solely for use as a tool to help hospital billing staff resolve
Comparison of the Prospective Payment System Methodologies Currently Utilized in the United States
Comparison of the Prospective Payment System Methodologies Currently Utilized in the United States 1 Can you speak the jargon of Prospective Payment Systems? MS- DRGs APCs IPF-PPS RBRVS HHRGs RUGs MS-LTC
Inpatient Services. Guide to Billing Facility Services. November 2013. Preface. Summary of Changes. Table of Contents.
Inpatient Services Preface Summary of Changes Table of Contents Service Contacts November 2013 Replaces: December 2012 S-5781 11/13 Preface The Wellmark Provider Guide and specialty guides are billing
(A) Information needed to identify and classify the hospital, include the following: (b) The hospital number assigned by the department;
3701-59-05 Hospital registration and reporting requirements. Every hospital, public or private, shall, by the first of March of each year, register with and report to the department of health the following
Coding 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
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM
Pagel STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM lntrodll(tion State of Maryland Reimbursement and payment criteria will be established which are designed to enlist
Overview of Disease Severity Measures Disseminated with the Nationwide Inpatient Sample (NIS) and Kids Inpatient Database (KID)
Overview of Disease Disseminated with the Nationwide Inpatient Sample (NIS) and Kids Inpatient Database (KID) Executive Summary Adding severity adjustment measures to the HCUP Nationwide Inpatient Sample
The PFFS Reimbursement Guide
The PFFS Reimbursement Guide SecureHorizons Direct reimburses claims based on Medicare Fee Schedules, Prospective Payment Systems (PPS) and estimated Medicare payments amounts. Payment methodologies are
Medicare Long-Term Care Hospital Prospective Payment System
Medicare Long-Term Care Hospital Prospective Payment System Payment Rule Brief PROPOSED RULE Program Year: FFY 2015 Overview, Resources, and Comment Submission On May 15, the Centers for Medicare and Medicaid
ZEPHYRLIFE REMOTE PATIENT MONITORING REIMBURSEMENT REFERENCE GUIDE
ZEPHYRLIFE REMOTE PATIENT MONITORING REIMBURSEMENT REFERENCE GUIDE Overview This guide includes an overview of Medicare reimbursement methodologies and potential coding options for the use of select remote
Unit 1 Core Care Management Activities
Unit 1 Core Care Management Activities Healthcare Management Services Healthcare Management Services (HMS) is responsible for all the medical management services provided to Highmark Blue Shield members,
NEW YORK STATE MEDICAID PROGRAM MANAGED CARE MANUAL: STOP-LOSS POLICY AND PROCEDURE
NEW YORK STATE MEDICAID PROGRAM MANAGED CARE MANUAL: STOP-LOSS POLICY AND PROCEDURE Version 2011 1 (01/31/11) Page 1 of 23 TABLE OF CONTENTS Section I Purpose Statement... 3 Section II Stop-loss Policy
Westchester Medical Center. 2014 Operating Budget
Westchester Medical Center 2014 Operating Budget December 4, 2013 WESTCHESTER COUNTY HEALTH CARE CORPORATION Operating Budget 2014 Table of Contents Page Executive Summary 1 Detailed Discussion of Revenue
Hospital Statement of Cost OHF Page 1 Illinois Department of Public Aid, Office of Health Finance, 201 S. Grand Ave. E., Springfield, IL 62763
Hospital Statement of Cost OHF Page 1 Illinois Department of Public Aid, Office of Health Finance, 201 S. Grand Ave. E., Springfield, IL 62763 General Information Name of Hospital: Provena United Samaritans
This declaration provides for the additional changes to current reimbursement policies.
Diagnosis Related Groups Part 1: APR-DRG Reimbursement Implementation Senate Bill 853 (Statutes of 2010) added Section 14105.28 to the California Welfare and Institutions Code (W&I Code), which directed
ICD-10 Strategy How to Operationalize in a Hospital Environment. HFMA Region 11 Healthcare Symposium January 21, 2014
ICD-10 Strategy How to Operationalize in a Hospital Environment HFMA Region 11 Healthcare Symposium January 21, 2014 Agenda Introduction Industry Trends for ICD 10 Implementation Panelist ICD 10 Experiences
Inpatient and Outpatient Services Billing. Presented by EDS Provider Field Consultants
Inpatient and Outpatient Services Billing Presented by EDS Provider Field Consultants October 2007 Agenda Objectives NPI New Paper Claim Form Who bills on a UB-04 Claim Form? Inpatient Claims Reimbursement
Improving Inpatient Psychiatric Payment Methods
Improving Inpatient Psychiatric Payment Methods Donald M. Steinwachs, Ph.D Professor and Director Health Services Research and Development Center Bloomberg School of Public Health Funded by NIMH Grant
8.2000: HOSPITAL PROVIDER FEE COLLECTION AND DISBURSEMENT
DEPARTMENT OF HEALTH CARE POLICY AND FINANCING MEDICAL ASSISTANCE SECTION 8.2000 [Editor s Notes follow the text of the rules at the end of this CCR Document.] 8.2000: HOSPITAL PROVIDER FEE COLLECTION
Effective Dates and Transition Information for ForwardHealth s Implementation of ICD-10 Code Sets
Update August 2015 No. 2015-39 Affected Programs: BadgerCare Plus, Medicaid, SeniorCare, Wisconsin AIDS Drug Assistance Program, Wisconsin Chronic Disease Program, Wisconsin Well Woman Program To: All
New York State UB-04 Billing Guidelines
New York State UB-04 Billing Guidelines [Type text] [Type text] [Type text] Version 2014 01 03/27/2014 EMEDNY INFORMATION emedny is the name of the New York State Medicaid system. The emedny system allows
Medicare Hospital Prospective Payment System How DRG Rates Are Calculated and Updated
Medicare Hospital Prospective Payment System How DRG Rates Are Calculated and Updated August 2001 OEI-09-00-00200 Office of Inspector General Office of Evaluation and Inspections Region IX This white paper
APPENDIX 1. Medicaid Emergency Psychiatric Demonstration Application Proposal Guidelines
APPENDIX 1 Medicaid Emergency Psychiatric Demonstration Application Proposal Guidelines INTRODUCTION Section 2707 of the Affordable Care Act authorizes a 3-year Medicaid Emergency Psychiatric Demonstration
State of Minnesota Minnesota Department of Labor and Industry
ISO 9001 Certified REPORT ON WORKERS COMPENSATION REIMBURSEMENT METHODOLOGIES State of Minnesota Pursuant to: Master Contract T-Number 11ADA Swift Master Contract Number 40490 _experience the commitment
I. Hospitals Reimbursed Under Medicare's Prospective Payment System. A. Hospital Inpatient Prospective Payment System
PROCEDURAL GUIDANCE on HOSPITAL and FACILITY REIMBURSEMENT UNDER INDIANA'S WORKERS COMPENSATION PROGRAM Effective for procedures rendered on and after July 1, 2014 by Trudy H. Struck I. Hospitals Reimbursed
health insurance Why It s Important & What You Need to Know
health insurance Why It s Important & What You Need to Know HEALTH INSURANCE: WHY IT S IMPORTANT & WHAT YOU NEED TO KNOW Worry Less: Protect Your Health and Your Wallet No one plans to get sick or hurt,
health insurance Why It s Important & What You Need to Know
health insurance Why It s Important & What You Need to Know If you do not have health insurance: Fixing a broken arm can cost up to $7,500 The average cost of a 3-day hospital stay is around Worry Less:
Appendix 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
Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System - Update for Fiscal Year Beginning October 1, 2012 (FY 2013)
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1440-N] RIN 0938-AR22 Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System - Update for Fiscal
Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge
Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge PREPARED FOR: ARA Research Institute PRESENTED BY: Al Dobson, Ph.D. PREPARED
Florida 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
Clarification Document
Clarification Document Illinois Hospital Nurse Staffing Data Collection Guidelines For Reports Submitted to the Illinois Department of Public Health Supplement March, 2012 Illinois Department of Public
Page 2 of 62. Table of Contents
ACTION: Final ENACTED Appendix 5101:3-2-23 DATE: 11/04/2011 8:59 AM Page 1 of 62 Ohio Department of Job and Family Services HOSPITAL COST REPORT (JFS 02930) INSTRUCTIONS For State Fiscal Year 2011 For
Original Medicare: An Outline of Benefits Prepared for the Alzheimer's Association
Someone to 51and hy You Original Medicare: An Outline of Benefits Prepared for the Alzheimer's Association Medicare is a federal health insurance program designed to provide affordable health insurance
MEDICARE PART B DRUGS. Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals
United States Government Accountability Office Report to Congressional Requesters June 2015 MEDICARE PART B DRUGS Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals
Glossary of Billing Terms
Glossary of Billing Terms Guide to Reading & Understanding Your Bill Account Number - number the patient's visit (account) is given by the hospital or medical provider for documentation and billing purposes.
NRH Medical Rehabilitation Network Adding Life to Years
NRH Medical Rehabilitation Network Adding Life to Years Paul R. Rao Ph.D. CCC CPHQ FACHE Vice President, Clinical Services, Quality & Compliance National Rehabilitation Hospital 102 Irving Street NW Washington
Using the Inpatient Rehabilitation Facility (IRF) PEPPER to Support Auditing and Monitoring Efforts: Session 1
Using the Inpatient Rehabilitation Facility (IRF) PEPPER to Support Auditing and Monitoring Efforts: Session 1 March, 2015 Kimberly Hrehor Agenda Session 1: History and basics of PEPPER IRF PEPPER target
Acute Medical Rehabilitation Surviving Health Care Reform
Acute Medical Rehabilitation Surviving Health Care Reform Kathleen C. Yosko, RN, MS, MBA President & CEO Marianjoy Rehabilitation & Clinics Wheaton, Illinois Marianjoy Rehabilitation and Clinics 2 1 Acute
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
eskbook Emerging Life Sciences Companies second edition Chapter 18 Medicare Reimbursement for Drugs and Devices
eskbook Emerging Life Sciences Companies second edition Chapter 18 Medicare Reimbursement for Drugs and Devices Chapter 18 MEDICARE REIMBURSEMENT FOR DRUGS AND DEVICES Coverage Coding There is no reimbursement
May 7, 2012. Submitted Electronically
May 7, 2012 Submitted Electronically Secretary Kathleen Sebelius Department of Health and Human Services Office of the National Coordinator for Health Information Technology Attention: 2014 edition EHR
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
BASIC STATISTICAL DATA USED IN ACUTE CARE FACILITIES
CHAPTER 1 BASIC STATISTICAL DATA USED IN ACUTE CARE FACILITIES KEY TERMS Autopsy Average daily census Average length of stay (ALOS) Bed count day Bed turnover rate Census Consultation Daily inpatient census
Hospital Statement of Cost BHF Page 1 Healthcare and Family Services, Bureau of Health Finance, 201 S. Grand Ave. E., Springfield, IL 62763
Hospital Statement of Cost BHF Page 1 Healthcare and Family Services, Bureau of Health Finance, 201 S. Grand Ave. E., Springfield, IL 62763 General Information Name of Hospital: Jackson Park Hospital 14-0177
BILL TYPES PAGE 1 OF 8 UPDATED: 9/13
INPATIENT HOSPITAL 111 REGULAR INPATIENT 112 FIRST PORTION: CONTINUOUS STAY INPATIENT 113 SUBSEQUENT PORTION: CONTINUOUS STAY INPATIENT 114 FINAL PORTION: CONTINUOUS STAY INPATIENT 115 INPATIENT: LATE
University of Mississippi Medical Center. Access Management. Patient Access Specialists II
Financial Terminology in Access Management University of Mississippi Medical Center Access Management Patient Access Specialists II As a Patient Access Specialist You are the FIRST STAGE in the Revenue
Lowering Costs and Improving Outcomes. Patient Engagement Issues. Nancy Davenport-Ennis President & CEO. September 8 th, 2009
The Healthcare Imperative: Lowering Costs and Improving Outcomes Patient Engagement Issues Nancy Davenport-Ennis President & CEO National Patient Advocate Foundation September 8 th, 2009 Institute of Medicine
Glossary. Adults: Individuals ages 19 through 64. Allowed amounts: See prices paid. Allowed costs: See prices paid.
Glossary Acute inpatient: A subservice category of the inpatient facility clams that have excluded skilled nursing facilities (SNF), hospice, and ungroupable claims. This subcategory was previously known
Table of Contents. This file contains the following documents in the order listed:
Table of Contents State/Territory Name: South Carolina State Plan Amendment (SPA) #: 13-002 This file contains the following documents in the order listed: 1) Approval Letter 2) CMS 179 Form/Summary Form
Breathe With Ease. Asthma Disease Management Program
Breathe With Ease Asthma Disease Management Program MOLINA Breathe With Ease Pediatric and Adult Asthma Disease Management Program Background According to the National Asthma Education and Prevention Program
Coding with. Snayhil Rana
Coding with ICD-9-CM CM Snayhil Rana ICD-9-CM CM Index Pre-Test Introduction to ICD-9-CM Coding The Three Volumes of the ICD-9-CM ICD-9-CM Coding Conventions Other ICD-9-CM Sections ICD-9-CM for Claim
Frequently Asked Questions about Fee-for-Service Medicare For People with Alzheimer s Disease
Frequently Asked Questions about Fee-for-Service Medicare For People with Alzheimer s Disease This brochure answers questions Medicare beneficiaries with Alzheimer s disease, and their families, may have
Quick Reference Information: Coverage and Billing Requirements for Medicare Ambulance Transports
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Quick Reference Information: Coverage and Billing Requirements for Medicare Ambulance Transports ICN 909008 August 2014
Care Wisconsin ICD-10 FAQs
Care Wisconsin ICD-10 FAQs 1. What are the improvements to ICD-10-CM/PCS coding? Answer: The new classification system provides significant improvements greater detailed information and the ability to
Coventry Health and Life Insurance Company PPO Schedule of Benefits
State(s) of Issue: Oklahoma PPO Plan: OI08C30050 30 Coventry Health and Life Insurance Company PPO Schedule of Benefits Covered Services Contract Year Deductible For All Eligible Expenses (unless otherwise
AMEX International Healthcare Plan Benefits schedule
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions AMEX International Healthcare Plan Benefits schedule Effective 1 April 2015 46.06.933.1-EUAM D (4/15) Your flexible
Regulatory Compliance Policy No. COMP-RCC 4.07 Title:
I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.07 Page: 1 of 7 This policy applies to (1) any Hospital in which Tenet Healthcare Corporation or an affiliate owns a direct or indirect equity interest
Purposes of Patient Records
CHAPTER 6 Documentation 1 Slide 1 Purposes of Patient Records Five Basic Purposes for Written Records Written communication Permanent record for accountability Legal record of care Teaching Research and
Aspects of Risk Adjustment in Healthcare
Aspects of Risk Adjustment in Healthcare 1. Exploring the relationship between demographic and clinical risk adjustment Matthew Myers, Barry Childs 2. Application of various statistical measures to hospital
UnitedHealthcare Medicare Solutions Readmission Review Program for Medicare Advantage Plans
UnitedHealthcare Medicare Solutions Readmission Review Program for Medicare Advantage Plans General Clinical Guidelines for Payment Review Updated May 2015 Introduction The UnitedHealthcare Medicare Solutions
Summary of Express Terms. The amendments to sections 86-1.2 through 86-1.89 of Title 10 (Health) NYCRR are
Hospital Inpatient Reimbursement Effective Date: 3/16/11 Summary of Express Terms General Summary for 86-1.2 through 86-1.89 The amendments to sections 86-1.2 through 86-1.89 of Title 10 (Health) NYCRR
Medicare Inpatient Rehabilitation Facility Prospective Payment System
Medicare Inpatient Rehabilitation Facility Prospective Payment System Payment Rule Brief FINAL RULE Program Year: FFY 2014 Overview and Resources On August 6, 2013, the Centers for Medicare and Medicaid
The Third National Medicare RAC Summit
The Third National Medicare RAC Summit Major Hospital Vulnerabilities II: Medical Necessity and Clinical Documentation Issues in Medicaid and RAC Audits Edmund L. Lafer, MD Temple University Health System
US Reimbursement Guide
US Reimbursement Guide The information with this notice is general reimbursement information only. It is not legal advice, nor is it about how to code, complete or submit any particular claim for payment.
ratio is based on the Medicaid charges as reported on the hospital's Medicaid cost report
STATE OF OHIO Supplemental Payments to Children's Hospitals for Inpatient Outliers A. B. C. D. E. F. G. ATTACHMENT 4.19 -A Page 28 Notwithstanding paragraph (CX5) of rule 5101:3 2 --07.9 of the Ohio Administrative
2012 STANDARD Medicare Supplement/ Life Insurance Plans
2012 STANDARD Medicare Supplement/ Life Insurance Plans Issued by Forethought Life Insurance Company ILLINOIS MS3000-01 IL 0112 2012 Forethought Standard Medicare Supplement Insurance Plans You can rely
Modeling the Reimbursement Implications of ICD9 to ICD10 Conversion
Modeling the Reimbursement Implications of ICD9 to ICD10 Conversion By Andrew Käser Director, Revenue PeaceHealth Southwest Medical Center Vancouver, WA Executive Summary The current uncertainty as to