Since the implementation of the Hospital Value-Based Purchasing (HVBP) Program in 2013, CMS has adjusted the MS-DRG payment for each traditional Medicare discharge. The type and amount of the adjustment, which could be a financial penalty and/or an incentive payment, is determined by the hospital's performance for defined quality measures, such as risk-adjusted mortality. Since that time, the number of pay for performance (P4P) programs and quality measures has expanded. By 2017, P4P payment adjustments will impact up to 6% of traditional Medicare revenue.
As required by The Joint Commission, a board of directors should regularly assess its performance, appropriateness of board and committee processes and charter fulfillment, adequacy of meeting structures and goals, communication with management, and other governance structures and activities. Generally, boards and their committees complete this assessment through self-surveys, internal audits, or collection of results as performed by legal services. Assessment results can lead to changes in board processes, with the goal of adapting to changing risks and environmental requirements, and improvements in governance.
Q: You are reviewing a computer-generated insurance claim before it is sent to the insurance carrier, and you happen to notice the patient's name on the claim?it's an old friend of yours. You quickly read the code for the diagnosis. Is this a breach of confidentiality?
Even before ICD-10-CM was delayed until October 1, 2015, the quality of physician documentation to accommodate the new code set was a top concern for the healthcare industry.
Organizations often struggle to finalize charts after discharge so they can be coded in a timely manner, but this process can be completed efficiently with direction from HIM professionals and coordination between departments.
