Mastering hierarchical condition categories (HCC) is key to success under new reimbursement methodologies that rely on risk-adjustment, quality, and value metrics such as the Quality Payment Program (QPP). Organizations need to take a close look at their training and audit programs to ensure that valuable information isn’t being left out of documentation—and negatively impacting HCC scores.
CMS now offers an elearning opportunity on the Quality Payment Program (QPP) through the MLN Learning Management System. This course is the fifth in a growing curriculum on the QPP and will offer 0.5 AMA PRA Category 1 Credits.
RC.01.01.01 is one standard that just won’t go away. The first half of 2017 (January–June) standards compliance data was published in the September issue of The Joint Commission’s Perspectives, and RC.01.01.01 made the list again. This means that the standard has been on the top 10 list for at least the last five years, along with other frequent flyers such as Environment of Care, Life Safety, and Infection Prevention.
Having just witnessed nature wreak havoc with back-to-back hurricanes, I feel it’s important to take a few minutes to remind everyone of the importance of Plan B—the backup plan. Let’s look at some real examples of how HIM professionals can be proactive to prevent chaos when unexpected events occur.
Is your short inpatient stay review process compliant? Some organizations seem to be leaving out at least one critical step when setting up their processes.
In fiscal year 2016, 65% of providers were subject to prepayment review associated with the CMS Fraud Prevention System, according to a report by the United States Government Accountability Office (GAO).
Outsourcing some HIM functions is common at many organizations. The decision might initially be spurred by staffing shortages or budgetary concerns, but many outsourcing arrangements become long-term projects.
While healthcare professionals are optimistic about potential benefits of data analytics, many find electronic health record systems have had a low return on investment, according to a survey by analytics company Health Catalyst.
A majority (57%) of healthcare payers and providers believe predictive analytics will save their organizations 15% or more over the next five years, according to a 2017 Predictive Analytics in Healthcare Trend Forecast by the Society of Actuaries. Despite the potential for savings, there are several roadblocks in the way.
CMS is thinking about scaling back its Comprehensive Care for Joint Replacement model, a program that aimed to reduce costs related to the most common inpatient surgery for Medicare beneficiaries: hip and knee replacements.
