Three major types of payer record reviews are conducted every year: The Healthcare Effectiveness Data and Information Set (HEDIS), Medicare Risk Adjustment, and Commercial Risk Adjustment. As the volume of payer and health plan reviews continues to climb, millions of patient records are requested.
Coding experts take a look at changes to ICD-10-PCS, including guideline updates, the addition of “other devices” characters, and new tables added for root operation Replacement.
This month's security Q&A answers readers' questions on incidental disclosures, sending protected health information in the mail, and addressing vulnerabilities identified in a risk analysis.
Most physicians are familiar with the MIPS quality models: These are the Physician Quality Reporting System (PQRS) measures that we’ve been reporting for years with the old Medicare value-based purchasing program. What we don’t know much about are the new cost efficiency models in MIPS, which are based solely on hospital and physician ICD-10-CM/CPT claims data rather than a clinical abstraction of our medical records.
The general rules for security, risk analysis, and risk management implementation specifications, and evaluation standards are key directives for ongoing compliance assurance. Although risk analysis concepts guidance appears in the Security Rule, many organizations use it for auditing Privacy Rule processes as well.
