Note from the Associate Editorial Director: Alphabet soup: Five CMS acronyms every CDI should know

by Melissa Varnavas

Okay, I know there are ton of other acronyms that clinical documentation improvement specialists need to know, not the least of which include CC, MCC, DRG, POA, HAC, CHF, CKD, ARF, (don’t forget about the biggy—CMS!) and so on...

On the tail of my last post regarding recovery audit contractors I noticed a number of other data collection government groups associated with CMS that clinical documentation folks may or may not be aware of. I thought maybe you’d find a quick rundown of these acronyms helpful. A note of caution, however, I pulled the definitions from various helpful public Web sites so consider these more like Grandma’s recipes than the combination to the safe that hides the list of well-guarded Campbell’s  ingredients.

1. Quality Improvement Organizations (QIO): The mission of the QIO is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. In August 2008, work began on the QIO Program’s 9th Statement of Work, which extends through July 31, 2011.
2. Comprehensive Error Rate Testing (CERT): One of two CMS programs to monitor and report Medicare payment inaccuracies.  CERT measures the error rate for claims submitted to Carriers, Durable Medical Equipment Regional Carriers (DMERCs), and Fiscal Intermediaries (FIs).
3. Hospital Payment Monitoring Program (HPMP): The second of two CMS programs to monitor and report Medicare payment inaccuracies.The HPMP measures the error rate for the Quality Improvement Organizations (QIOs).
4. Program for Evaluating Payment Patterns  Electronic Report (PEPPER): An electronic data report containing hospital-specific data for a number of target areas specific Diagnosis Related Groups (DRGs) and discharges that have been identified as at high risk for payment errors.
5. Recovery Audit Contractors (RACs): The Recovery Audit Contractor (RAC) program was created through the Medicare Modernization Act of 2003 to identify and recover improper Medicare payments paid to healthcare providers and will become permanent for all states by January 1, 2010.

You should be ready to take the CMS quiz now. . . either that or you’re longing for the days when such ABC mashups meant merely another bowl of soup. Nevertheless, this Scrabble-esque snap shot illustrates just how many ways the government uses data to monitor healthcare services from both a quality perspective and a financial perspective. Where data meets documentation. . . that’s where CDI comes in.

Editor's note: Varnavas is the associate editorial director of ACDIS. Contact her at mvarnavas@acdis.org.