Developing a strong denial management program may be one of the best ways to minimize the productivity and financial losses anticipated with the transition to ICD-10. By determining a baseline for denials and proactively identifying denial trends, organizations can efficiently resolve issues and reduce costs. An effective denial management program will help organizations to track, trend, resolve, and ultimately prevent denials.
CMS released its proposed rule for stage 3 of the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs (https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-0668...) in March. The intention is to simplify the EHR Incentive Programs, drive interoperability, and allow providers to further focus on patient care. The rule proposed a transition to a single meaningful use stage, with stage 3 being the final stage in the program. It would incorporate portions of stages 1 and 2.
As more hospitals adopt EHRs over paper records, the amount of data stored electronically steadily increases. However, the usefulness of this data diminishes if it does not translate to meaningful information that hospitals can use for operations surrounding registration, treatment, billing, coding, and research.
Educating coders and clinical documentation improvement (CDI) specialists on CMS claims-based measures is essential in today's value-based payment environment. Empowered with an understanding of measure specifications and risk adjustment methodologies, a strong CDI program can effectively address opportunities to improve quality profiles and associated hospital revenue.
In the first article in this series, we provided an introduction and overview of the PSI 90 measure, which is included in two CMS pay-for-performance programs. Because PSI 90 is a claims-based measure, performance is largely determined by ICD-9-CM codes on the claims.
The Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) have announced the release of two proposed rules designed to improve care delivery and experience and to enhance the sharing of electronic health information.
It's a prevailing trend?HIM directors and managers are overworked and underpaid. The results of MRB's 2015 HIM director and manager salary survey shows this trend remains firmly in place, although it does indicate these professionals' annual earnings have seen a slight uptick.
Throughout the years, this column has focused on the important role the electronic document management system (EDMS) plays as the official legal health record (LHR) within a healthcare organization, and especially as a critical workflow tool for the HIM department. I am always surprised to hear that there are still some facilities that haven't figured this out and purchased an EDMS.
