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.
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.
Effective July 2016, as part of The Joint Commission’s Project REFRESH, the Medical Record Statistics form was retired for hospital accreditation surveys. Is it still important to monitor our medical records for presence, timeliness, legibility (paper or printed), accuracy, authentication, and completeness?
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.
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.
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.
Managers should not assume that they can review every guideline, every item in Coding Clinic, or every coding-related issue targeted by the Office of Inspector General or Recovery Auditor.
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.
Back in May, CMS put a hold on short-stay inpatient audits related to the 2-midnight rule. That hold was lifted effective September 12, 2016, according to a FAQ published by CMS as CMM reported last month. Our readers are wondering, however, about the latest information when it comes to these reviews. We reached out to Ronald Hirsch, MD, FACP, CHCQM, vice president of the Regulations and Education Group at Accretive Health in Chicago, to give us the latest update.
