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Some time in the next 18 months or so, four different sets of auditors could be scrutinizing the medical records at your hospital. It's all part of the Centers for Medicare & Medicaid Services' (CMS) Medicare Integrity Program initiative, mandated by the Deficit Reduction Act of 2005, which seeks to eliminate fraud, waste, and abuse in Medicare claims.
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When the Centers for Medicare & Medicaid Services (CMS) unveiled the new MS-DRG reimbursement system in 2007, a data analysis projected that Sharp Chula Vista Medical Center was likely to lose about $500,000 with the new system, based on the hospital's 2006 data.
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For professionals working in health care, it is easy to quickly become accustomed to the various presentations and stressors that accompany a patient who requires hospitalization. In fact, our efficient functioning is dependent on this to some degree.
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MLN Matters, published by the U.S. Department of Health and Human Services (HHS), provides clarification about the Privacy Rule of HIPAA, when transferring private health information to potential post-acute providers:
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Proposed state laws in Nevada in the wake of a highly publicized hepatitis C outbreak in Las Vegas include proposals to hire infection preventionists (IPs) as consultants to oversee practice in freestanding clinics.
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A series of initiatives, including automatic triggers for quality measures in the hospital's electronic medical record and concurrent review by case managers for core measures, has resulted in significant increases in quality measure scores at Russellville (AL) Hospital, a 100-bed facility.
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Faced with capacity challenges, the case management department at Harris Methodist Hospital in Ft. Worth, TX, is collaborating with representatives from local long-term acute care hospitals (LTACs) to develop ways to improve transitions of care from one facility to another.
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Of the nearly $1 billion the Recovery Audit Contractors (RACs) identified in improper payments to hospitals and other providers, nearly 40% was the result of medical necessity denial for inpatient admissions, points out Deborah Hale, CCS, president, Administrative Consultant Service LLC, a Shawnee, OK, consulting firm.
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If your hospital frequently uses Condition Code 44 to change a patient's admission status, you may need to take a fresh look at your admissions process, according to Deborah Hale, CCS, president, Administrative Consultant Service LLC, a Shawnee, OK, consulting firm.
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At DCH Health System in Tuscaloosa, AL, clinical documentation improvement efforts go far beyond just making sure the documentation supports the most appropriate MS-DRG for the purpose of Medicare reimbursement.
