HIM Briefings

Organizations are generally keeping up due diligence when it comes to HIPAA compliance training and essential auditing, despite an increasingly challenging array of threats directed at them. However, confusion still holds sway on risk analysis and more robust audit functions.

Many hospitals find that their Patient Safety Indicator (PSI) ratios remain high despite doing a spectacular job of addressing these events and exclusions. That may be because they fail to realize that the Agency for Healthcare Research and Quality has a risk-adjustment methodology that predicts each of these PSIs and is dependent upon the documentation and coding of PSI-sensitive risk factors.

Preventive care is an essential component of rural health clinic services, but Medicare's coverage and billing rules for these services—including annual exams and vaccines—can be complicated to navigate.

In today’s uncertain regulatory environment, establishing an internal audit process is more important than ever to ensure proper billing and reimbursement. Follow these eight steps to establish an efficient internal audit and compliance program.

Coding and documentation can make or break providers’ success under the Quality Payment Program. An examination of specific measures reveals coding and documentation areas to focus on.

Efficient, correct, and compliant release of information (ROI) processes are necessary to support patient care, legal processes, reimbursement, and patients’ rights. Give ROI staff and leaders a shot of energy with targeted training that adapts to their needs. Succinct modules, interaction, and a positive attitude can have a ripple effect on the department.

CMS, the Veterans Health Administration, and some states measure our care quality based on risk-adjusted readmission rates after inpatient admissions. In fact, up to 3% of our hospital’s Medicare inpatient revenue (used to pay physician subsidies) is at risk if we don’t manage our patients’ readmissions in concert with Medicare’s algorithms.

In advance of ICD-10-CM/PCS, many institutions implemented computer-assisted coding (CAC) hoping to mitigate the anticipated productivity losses, but research has confirmed suspicions that there is an inverse relationship between coding productivity and accuracy.

The implementation of an EHR is a multifaceted, comprehensive project for healthcare organizations. To avoid coding issues during EHR implementation and ensure discharged-not-final-coded is not adversely impacted, dedicated HIM focus and detailed project planning are paramount.