HIM Briefings

Reconciliation is a noun meaning "the process of finding a way to make two different ideas, facts, etc. exist or be true at the same time." In the world of clinical documentation improvement (CDI), "reconciliation" typically refers to diagnosis-related group (DRG) reconciliation, which is the process of adjusting DRGs when those assigned by the CDI specialist do not match those assigned by the coder.

Reconciliation is a noun meaning "the process of finding a way to make two different ideas, facts, etc. exist or be true at the same time." In the world of clinical documentation improvement (CDI), "reconciliation" typically refers to diagnosis-related group (DRG) reconciliation, which is the process of adjusting DRGs when those assigned by the CDI specialist do not match those assigned by the coder.

Q: Can I leave a patient a voicemail about an MRI procedure, including the time and date? What should I do if someone else at the patient's home answers the phone? How much info can I leave with the other person, and how can I verify that person's identity and relation to the patient?

Observation services are an ongoing point of confusion for hospitals and patients, many of whom have become fearful of out-of-pocket costs and SNF coverage eligibility associated with outpatient observation services. Developing a workflow to comply with the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act and the Medicare Outpatient Observation Notice (MOON) is essential and is intended to help hospitals ease patients' concerns by clearing up the implications of observation.

It's no secret that hospitals struggle with assigning the most appropriate status for patients, and this challenge is compounded by CMS' frequent changes to its regulations and guidance. To combat incorrect patient status assignments, one hospital has developed a system that rewards employees for speaking up when they suspect a patient's status is incorrect.

So many people struggle early in their careers with finding a perfect fit for their talents and passion. My story is exactly the opposite. My entire family is in healthcare, so I chose my career quite naturally. Though I had a bit of a circuitous route into my final landing place, I cannot say I'm surprised to have landed here.

When compared to data from past surveys, HCPro's 2016 HIM director and manager salary survey revealed a harsh truth that many HIM professionals already know: There has been little movement in HIM manager and director salaries over the years.

The FY 2017 IPPS proposed rule released April 27 is replete with modifications and expansions to claims-based quality and cost outcome measures. Although many of these proposed changes are for future fiscal years, ICD-10 codes reported for current discharges will impact the future financial performance for our organizations.

Cost measures

Two new payment measures are proposed as additions to the efficiency and cost reduction domain beginning in FY 2021:

• Hospital Level, Risk-Standardized Payment Associated with a 30-Day Episode-of-Care for Acute Myocardial Infarction
• Hospital Level, Risk-Standardized Payment Associated with a 30-Day Episode-of-Care for Heart Failure

CMS cites the following site for full measure specifications: www.cms.gov/Medicare/Quality-Initiatives-Patient-assessment-Instruments/HospitalQualityInits/Measure-Methodology.html.

The risk adjustment methodologies used for these measures are similar to those used for risk-adjusted mortality. The payment measure is intended to be paired with the 30-day mortality measures, thereby directly linking payment to quality by the alignment of comparable populations and risk adjustment methodologies to facilitate the assessment of efficiency and value of care.

The baseline period for these measures is July 1, 2012, through June 30, 2015. The performance period for these measures is July 1, 2017, through June 30, 2019. Performance for these new measures will be scored using the methodology used for the Medicare Spending Per Beneficiary measure.

CMS expands on its interest to further integrate quality and cost measures to reflect value, and is seeking public input on potential approaches. Underlying present challenges in reflecting value are noted as follows:

• Currently, the HVBP assesses quality and efficiency separately through distinct performance measures in different domains, which as of FY 2018 are equally weighted to create the overall Total Performance Score. The four domains include:
  • Safety
  • Efficiency and cost reduction
  • Clinical care
  • Personal and community engagement
• The current scoring approach can permit a hospital to earn a higher payment adjustment relative to other hospitals by performing well on quality-related domains without performing well in the efficiency and cost reduction domain, or vice versa.
• Without a measure or score for value that reflects both quality and costs, the ability to assess value is limited.

My HIM career began like many others?in frank conversation with a high school guidance counselor regarding career direction. I wanted to pursue a career in healthcare, but wasn't interested in direct patient care. Focused exploration led me to discover a degree in health information technology at my local college. Now, 30 years later, I'm celebrating a long and successful HIM career.