Payment reform is here to stay. Although reimbursement will continue to evolve over the next several years, it’s unlikely that payers, commercial or government, are going to abandon risk-based models and value-based purchasing and turn the clock back to fee-for-service and volume over value.
Data integrity and analytics, increased HIPAA enforcement, patient-generated health data, and information security emerged as the top four topics at the 2017 Health Information and Management Systems Society national conference.
The 2017 calendar year marks the beginning of a new approach to physician payment through the Quality Payment Program (QPP), an initiative created by the Medicare Access and CHIP Reauthorization Act to revise the physician payment system previously updated through the Sustainable Growth Rate.
In several recent reports, the Office of Inspector General (OIG) determined that providers are, on average, variant from expected volumes on both short stay inpatient and long stay observation cases. What was not made clear in the OIG report is the reason why it believes such variances exist. The answer to this question likely rests within the details of how hospitals have adjusted (or not adjusted) to the use and application of “new criteria” in their daily and ongoing Medicare billing compliance processes.
Accurate clinical documentation is the bedrock of the legal medical record, billing, and coding. It is also the most complex and vulnerable part of revenue cycle because independent providers must document according to intricate and sometimes vague rules.
Recently The Joint Commission implemented an initiative, Project REFRESH, to improve processes related to pre-survey, on-site survey, and post-survey activities. Simplification, enhanced relevancy to organizations, increased transparency within the accreditation process, and the utilization of innovative approaches and technology are the goals of Project REFRESH.
