HIM Briefings

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.

While some HIM professionals may feel a sense of relief knowing RAC audits are on hold for the remainder of 2015, that should not deter workforce members from keeping track of denials and appeals and defending code assignments.

As the industry approaches ICD-10 implementation, end-to-end testing becomes more critical. Testing allows organizations to determine the efficacy of their preparations. It also answers critical questions for ICD-10 stakeholders: Can applications accommodate ICD-10 codes correctly? Does data flow seamlessly between internal and external interfaces? Are payers able to receive, adjudicate, and pay claims correctly?

Finding themselves at the center of a tumultuous, dynamic healthcare environment, physicians are becoming increasingly frustrated and anxious, frequently questioning their career choice. Preparation to be a lifelong healthcare provider inadequately prepares clinicians for the emerging value-based healthcare world to which they are being subjected. Physicians believe that they have little control over or input into the metrics that are rapidly determining their fates with healthcare organizations, third-party payers, and inevitably patients themselves.

CMS' Conditions of Participation for UR include specific requirements for the composition of the UR committee, specifying that it must be composed of at least two doctors of medicine or osteopathy.

It's a prevailing trend?HIM directors and managers are overworked and underpaid. The results of MRB's 2015 HIM director and manager salary survey shows this trend remains firmly in place, although it does indicate these professionals' annual earnings have seen a slight uptick.

Throughout the years, this column has focused on the important role the electronic document management system (EDMS) plays as the official legal health record (LHR) within a healthcare organization, and especially as a critical workflow tool for the HIM department. I am always surprised to hear that there are still some facilities that haven't figured this out and purchased an EDMS.

The Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) have announced the release of two proposed rules designed to improve care delivery and experience and to enhance the sharing of electronic health information.

It has been a long time since The Joint Commission has published frequently asked questions (FAQ), which serve as a great resource for clarification of standards and elements of performance. Generally, FAQs originate with questions from the field that continue to be asked over time.