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.
