The overarching goal of a documentation improvement program is not to improve reimbursement for the hospital, but to effect a positive change in the behavior of those who document in the medical record. This change...Read More »
CMS detailed seven shortcomings, including old and inadequate policies and procedures, in its 2009 audits of healthcare organizations to determine compliance with the HIPAA Security Rule. CMS detailed the findings in its ...Read More »
by Trey La Charité, MD
Every institution reading this column has likely received its first recovery audit contractor (RAC) denials regarding the documentation and coding of excisional debridement procedures (86.22).
Our hospital is no exception. While we knew that this...Read More »
If you’ve started using your PEPPER to help you identify potential issues at your hospital, good for you! In this final entry, I’m going to suggest you take it a step further—identifying charts that may fail for lack of medical...Read More »
In my previous entry, I talked about the PEPPER process and how it can be used to help identify potential issues of errors in coding, billing, or medical necessity that are specific to each hospital. Now I want to review some target...Read More »
My analytical side is always harassing me to get it more involved in what I do. So I decided to dig into our hospital’s PEPPERs. PEPPER is the Program for Evaluating Payment Patterns Electronic Report, issued quarterly. (Calling it a...Read More »
The Medicare Learning Network released three fact sheets of interest to CDI staff:
The “Hospital Acquired Conditions (HAC) in Acute Inpatient Prospective Payment System (IPPS) Hospitals” fact sheet (revised October 2010) is now available in downloadable format at
The Hospital Compare website, updated on Dec. 11, contains three new inpatient measures. These include Surgical Care Improvement Project (SCIP) Infection 9 (urinary catheter removed on postoperative day one or two) and two new structural measures: participation in a systematic clinical data...Read More »