CMS recently released its Short-Term (ST) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through the third quarter of the fiscal year 2016 for hospitals nationwide.
The PEPPER allows hospitals to compare Medicare billing practices against those of other...Read More »
You may be wondering why so many CDI departments are expanding their review processes to include consideration of how CMS quality measures will be affected by claims data.Read More »
Nearly every professional association provides some type of vocation-specific guidance regarding ethical behavior. Periodically such recommendations need to be revised or updated to meet the changing needs of the industry. Such revision now comes from the American Health Information Management...Read More »
The Hospital Readmissions Reduction Program (HRRP) allows CMS to penalize hospitals with excess readmissions, as written in Section 3025 of the Affordable Care Act, which added section 1886(q) to the Social Security Act. Specifically, the...Read More »
At a confidential agency briefing in August 2010, CMS officials outlined steps to recover more than $128 million in alleged 2007 overpayments from five Medicare Advantage insurer...Read More »
About 41% of CDI programs currently review medical records for quality improvement items, according to an online ACDIS membership poll. Although CMS implemented the VBP reimbursement model as required by the Affordable Care Act (ACA) in 2011, many CDI programs have only recently started...Read More »
Q: I can't distinguish between "code first" and "in diseases classified elsewhere.” Both are used with manifestations and both can't be sequenced as principal diagnosis, and both need etiology codes so what is the difference?
A number of inpatient prospective payment system changes in recent years, due primarily to the Affordable Care Act, have allowed CMS to adjust healthcare reimbursement based on quality metrics and data. But some providers are unaware that many quality scores for themselves and hospitals are...Read More »
