Tracking, Trending and Auditing Across a Multi-State Health System
|
|
- Olivia Stokes
- 5 years ago
- Views:
Transcription
1 Tracking, Trending and Auditing Across a Multi-State Health System Fifth National Medicare RAC Summit March 10, 2011 Susan Shiflett, RHIA, CHC Director Corporate Responsibility Catholic Health Initiatives 1
2 Catholic Health Initiatives (CHI) CHI is the nation's third-largest Catholic health care system CHI operates in 18 states: 70+ hospitals; 40 long-term care, assisted living and residential facilities; two community health services organizations; and home health agencies. 65,000+ employees In FY 2010, CHI provided almost $590 million in charity care and community benefit Annual revenues of approximately $9 billion 2
3 Challenges Different Health Information Systems Meditech McKesson Different release of information tracking tools/services Manual Automated various vendors Financial resources Four RAC contractors 3
4 CHI RAC Locations WA OR ND SD NE KS CO NM IA MN AR WI OH KY TN PA MD NJ States where CHI entities are located.. \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ 4
5 CHI RAC Efforts CHI RAC Workgroup co-chaired by Director Corporate Responsibility and CHI HIM Director Local entities handle RAC requests Central reporting system Oversight through CHI s Audit and Compliance Committee Ongoing auditing based on RAC focus areas initially moving to a risk-based methodology 5
6 CHI RAC Tools Developed an internal tracking tool Integrated approach designed to track all aspects of the revenue cycle team activities Meditech McKesson Collaboration with CHI Business Intelligence (BI) Roll up reporting of entity RAC activity for entity and national oversight needs BI facilitates AHA RAC reporting 6
7 RAC Tracking Tool 7
8 RAC Tracking Tool 8
9 RAC Tracking Tool 9
10 Other Resources Executive Health Resources (EHR) contracted to handle second-level medical necessity reviews and appeals Catholic Health Audit Network (CHAN) conducted assessment of RAC target areas as part of system coding compliance audit plan Medical necessity screening criteria 10
11 RAC Activity thus far Acute Inpatient and Outpatient Denial Activity Volume Automated Review Denials 383 Complex Review DRG Validation Denials 470 Complex Review Medical Necessity Denials 133 Total Denials 986 Non-Hospital Denial Activity Volume Physician Practices 505 Durable Medical Equipment (DME) 60 Total Denials
12 RAC Focus Audits FY 2010 Purpose Identify educational opportunities Mitigate financial and compliance risks Methodology Utilize data analysis to identify potential areas of vulnerability Perform testing of a small random sample Designed as quality reviews 12
13 Internal Data Mining Efforts FY 2011 Purpose Develop internal capability to mine data Identify potential vulnerabilities Identify educational opportunities Mitigate financial and compliance risks Ability to compare data across CHI entities IPPS hospitals Critical access hospitals 13
14 Data Mining Efforts continued Methodology Risk-based auditing approach Pull from OIG/DOJ/RAC focus areas Utilize claims data from CHI data warehouse PEPPER data as benchmark Identify potential risk populations and outliers 14
15 Inpatient Risk Areas PEPPER target areas Medical and surgical short stays MS-DRG with and without complication / comorbidity Cardiac procedures (stents, defibrillators) 15
16 Sample PEPPER Target Area 16
17 Sample 3-Day Stay with SNF Transfer 17
18 Outpatient Risk Areas Inpatient-only procedures performed on outpatients Duplicate surgical procedure codes Evaluation and Management visits Observation Transfusions Injections and infusions Debridement procedures 18
19 Other Recovery Efforts Medicaid Integrity Contractors (MICs) State Medicaid RACs Zone Program Integrity Contractors (ZPICs) Office of Inspector General (OIG) Department of Justice (DOJ) And the list goes on 19
20 Next Steps Improve RAC tracking tool functionality Ability to track all audit contractor activity Enhance reporting capabilities Continue risk-based auditing Increase internal data mining efforts by utilizing CHI s enterprise patient data repository Include non-acute services Explore external data mining resources with clinical services 20
21 Questions? Susan Shiflett, RHIA, CHC Catholic Health Initiatives 21
Key Performance Indicators to Direct Audit Plans
Key Performance Indicators to Direct Audit Plans Lori Laubach, Principal MD Audit User Group June 15 17, 2014 1 The material appearing in this presentation is for informational purposes only and is not
More informationNational Medicare RAC Summit March 5, 2009 Provider Lessons From Demonstration States
National Medicare RAC Summit March 5, 2009 Provider Lessons From Demonstration States Lynn H. Grieves Chief Compliance Officer MemorialCare Medical Centers lgrieves@memorialcare.org MemorialCare Health
More informationPhysician s Compliance Guide
Physician s Compliance Guide Updates to this guide will be posted on the Optum website and can be found at: http://www.optumcoding.com/product/updates/2013pcg/pcg13 Please use the following password to
More informationAuditing the Auditors
Auditing the Auditors June 2012 A survey by the Health Care Compliance Association Health Care Compliance Association 6500 Barrie Road, Suite 250, Minneapolis, MN 55435 888-580-8373 www.hcca-info.org Auditing
More informationACO Congress Conference Pre Session Clinical Performance Measurement
ACO Congress Conference Pre Session Clinical Performance Measurement Lynne Rothney-Kozlak, MPH Interim VP, ACO Collaborative (Independent Consultant) October 25, 2010 Agenda for Presentation 1. The Framework
More informationPHARMACY COMPLIANCE RISK AREAS FOR 2014
PHARMACY COMPLIANCE RISK AREAS FOR 2014 2014 San Juan Puerto Rico Regional Compliance Conference Darrell W. Contreras, Esq., LHRM, CHC-F, CHPC, CHRC 5 Risk Areas 1. Overbilling of Herceptin 2. Quality
More informationUSA National Mental Healthcare Nonprofit Exempt Organization Financial Analysis as of December 14, 2015 January 24, 2016 ANSA-H2
USA National Mental Healthcare Nonprofit Exempt Organization Financial Analysis as of December 14, 2015 January 24, 2016 ANSA-H2 Prepared by David Yoo, HanaSoul Consulting, Omaha, Nebraska dcyoo@cox.net
More informationNASMHPD: Peer Support Services Survey
NASMHPD: Peer Support Services Survey Pillars of Peer Support Services Summit II October, 2010 Presenter: Ellie Shea-Delaney Assistant Commissioner for Program Development and Interagency Planning Massachusetts
More informationRisk Classification Modeling to Combat Opioid Abuse
Risk Classification Modeling to Combat Opioid Abuse Improve Data Sharing to Identify High-Risk Prescribers of Opioids Christopher Sterling Chief Statistician NCI, Inc. www.nciinc.com 11730 Plaza America
More informationMitigating Hot Button Risk Areas in Home Health & Hospice. Agenda. Home Health/Hospice Risk Areas 2/24/2017
Mitigating Hot Button Risk Areas in Home Health & Hospice Kathryn Krenz, RN, CPC, CHC, CHPC, Brookdale Senior Living Kimberly Hrehor, MHA, RHIA, CHC, TMF Health Quality Institute HCCA Compliance Institute
More informationMitigating Hot Button Risk Areas in Home Health & Hospice
Mitigating Hot Button Risk Areas in Home Health & Hospice Kathryn Krenz, RN, CPC, CHC, CHPC, Brookdale Senior Living Kimberly Hrehor, MHA, RHIA, CHC, TMF Health Quality Institute HCCA Compliance Institute
More informationChallenges for U.S. Attorneys Offices (USAO) in Opioid Cases
Challenges for U.S. Attorneys Offices (USAO) in Opioid Cases Overview On August 2, 2017, U.S. Attorney General Jeff Sessions announced a pilot program whereby a new federal data analysis program is being
More informationFinancial Impact of Lung Cancer in West Virginia
Financial Impact of Lung Cancer in West Virginia John Deskins, Ph.D. Christiadi, Ph.D. Sara Harper November 2018 Bureau of Business & Economic Research College of Business & Economics West Virginia University
More informationThe Affordable Care Act and HIV: What are the Implications?
The Affordable Care Act and HIV: What are the Implications? 2013 National Black AIDS Institute Webinar Series September 18, 2013 Jen Kates, Kaiser Family Foundation The Challenge Figure 1 30 years into
More informationDeveloping Your Hospice Compliance Dashboard
Developing Your Hospice Compliance Dashboard Jennifer Kennedy, MA, BSN, RN, CHC National Hospice and Palliative Care Organization 2016 Sessions Objectives Review CMS, MAC, RAC, ZPIC, MIC, OIG, and DOJ
More informationAMERICAN IMMUNIZATION REGISTRY ASSOCIATION A L I S O N C H I, P R O G R A M D I R E C T O R
AMERICAN IMMUNIZATION REGISTRY ASSOCIATION A L I S O N C H I, P R O G R A M D I R E C T O R WHAT IS AIRA A way to work together to develop standards, best practices, develop and share strategies and provide
More informationA Comprehensive Scorecard for Board and Staff Larry Hegland, MD
A Comprehensive Scorecard for Board and Staff Larry Hegland, MD System Medical Director for Recovery Audit and Appeal Services Chief Medical Officer for Ministry Saint Clare s Hospital and the Diagnostic
More informationBY-STATE MENTAL HEALTH SERVICES AND EXPENDITURES IN MEDICAID, 1999
STATE-BY BY-STATE MENTAL HEALTH SERVICES AND EXPENDITURES IN MEDICAID, 1999 James Verdier,, Ann Cherlow,, and Allison Barrett Mathematica Policy Research, Inc. Jeffrey Buck and Judith Teich Substance Abuse
More informationCase Review of Inpatient Rehabilitation Hospital Patients Not Suited for Intensive Therapy
U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES OFFICE OF INSPECTOR GENERAL Case Review of Inpatient Rehabilitation Hospital Patients Not Suited for Intensive Therapy OEI-06-16-00360 DECEMBER 2016 SUZANNE MURRIN
More informationSTATE & FEDERAL EFFORTS TO COMBAT THE OPIOID EPIDEMIC & IMPACT ON COMPLIANCE PROGRAMS GRACE E. REBLING OSBORN MALEDON P.A.
STATE & FEDERAL EFFORTS TO COMBAT THE OPIOID EPIDEMIC & IMPACT ON COMPLIANCE PROGRAMS GRACE E. REBLING OSBORN MALEDON P.A. Arizona Corporate Counsel Presentation May 8, 2018 Agenda 1. Overview of the Opioid
More informationa call to states: make alzheimer s a policy priority
a call to states: make alzheimer s a policy priority the compassion to care, the leadership to conquer Alzheimer s is a public health crisis. One in eight Americans aged 65 and older have Alzheimer s disease
More informationHow to Get Paid for Doing EBD
How to Get Paid for Doing EBD Robert D. Compton, DDS President Robert Compton, DDS Executive Director DentaQuest Institute Disclosure DentaQuest Institute President DentaQuest Benefits Senior VP & CDO
More informationAt the completion of this educational activity, the learner will be able to understand:
Claims vs. Submission: Understanding the Difference Sonia Trepina, MPA Director, Risk Adjustment & Ambulatory CDI Services Enjoin Asheville, NC Brett Senor, MD, CRC, CCDS Physician Associate, CDI Quality
More informationEvidence-Based Policymaking: Investing in Programs that Work
Evidence-Based Policymaking: Investing in Programs that Work August 4, 2015 The Policy Challenge Though policymakers want to make the best choices, the process often relies on inertia and anecdote Very
More informationHospice in ESRD: To Withdraw or Not to Withdraw
Hospice in ESRD: To Withdraw or Not to Withdraw Access to Hospice for Patients with ESRD Rebecca J. Schmidt, DO, FACP October 2005 In which scenario may the hospice benefit be engaged? ESRD patient with
More informationRECOVERY SUPPORT SERVICES IN STATES
RECOVERY SUPPORT SERVICES IN STATES An analysis of State recovery support services using the 16 17 Substance Abuse Block Grant (SABG) Behavioral Health Assessment and Plan THIS PROJECT IS BEING SUPPORTED
More informationPartial Hospitalization Program Program for Evaluating Payment Patterns Electronic Report. User s Guide Sixth Edition. Prepared by
Partial Hospitalization Program Program for Evaluating Payment Patterns Electronic Report User s Guide Sixth Edition Prepared by Partial Hospitalization Program Program for Evaluating Payment Patterns
More informationTHREE BIG IMPACT ISSUES
THREE BIG IMPACT ISSUES Tim McAfee, MD, MPH Director CDC Office on Smoking and Health Presented at the National Cancer Policy Forum Workshop on Reducing Tobacco-Related Cancer Incidence and Mortality June
More informationMedical Review Robin Leigh, R.N., B.S.N.
Medical Review Robin Leigh, R.N., B.S.N. Medical Review The List Going Beyond The List It s not what we do, it s why we do it Accuracy of Problem Identification Efficiency of Review Process Efficiency
More information2018 Cerebrovascular Reimbursement Coding Fact Sheet
The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Cordis Corporation concerning levels of reimbursement, payment,
More informationThe Age of Audits. The Age of Audits Optometry has never been targeted has that changed? What would you do??? The Age of Audits DISCLAIMER
Is this the Golden Age of audits? Joe W DeLoach, OD, FAAO CEO, Optometric Business Solutions Optometry has never been targeted has that changed? If you are filing claims, you are a target! DISCLAIMER I
More informationHospice Regulatory & Quality Reporting Update
Hospice Regulatory & Quality Reporting Update Jennifer Kennedy, EdD, MA, BSN, RN, CHC National Hospice and Palliative Care Organization April 2018 & National Hospice and Palliative Care Organization, 2018
More informationEylea (aflibercept) Document Number: IC-0026
Eylea (aflibercept) Document Number: IC-0026 Last Review Date: 3/1/2018 Date of Origin: 02/07/2013 Dates Reviewed: 03/07/2013, 06/2013, 09/2013, 12/2013, 03/2014, 06/2014, 09/2014, 12/2014, 03/2015, 04/2015,
More informationPHYSICIAN ENGAGEMENT IN THE COMPLIANCE PROCESS
PHYSICIAN ENGAGEMENT IN THE COMPLIANCE PROCESS R. Brett Short, CHC, CHPC, Chief Compliance Officer, UK HealthCare Sarah Couture, RN, CHC, Associate, Aegis Compliance and Ethics The Power of Advanced Medicine
More informationOverview of the HHS National Network of Quitlines Initiative
Overview of the HHS National Network of Quitlines Initiative Prepared for the 2005 National Oral Health Conference 6th Joint Meeting of ASTDD and AAPHD Barbara Z. Park, RDH, MPH May 2, 2005 Background
More informationPerformance Measurement: HEDIS, STARS and More. Margaret E. O Kane NCQA President CAPG Educational Series October 27, 2016
Performance Measurement: HEDIS, STARS and More Margaret E. O Kane NCQA President CAPG Educational Series October 27, 2016 Defining Quality & Performance Trends The Triple Aim and National Priorities Partnership
More informationReport to Congressional Defense Committees
Report to Congressional Defense Committees The Department of Defense Comprehensive Autism Care Demonstration Quarterly Report to Congress Second Quarter, Fiscal Year 2017 In Response to: Senate Report
More informationFederation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: Retaking NPTE
The table below lists the requirements for retaking the National Physical Therapy Exam (NPTE) for each jurisdiction. Summary Number of attempts on NPTE limited? 16 27 Number of attempts allowed before
More informationWorkforce Data The American Board of Pediatrics
Workforce Data 2009-2010 The American Board of Pediatrics Caution. Before using this report as a resource, please read the information below! Please use caution when comparing data in this version of the
More informationSelf-Audits of Part B Therapy Services
Self-Audits of Part B Therapy Services Are you looking for the right things? 2 Sponsors HPA The Catalyst Academy of Geriatric Physical Therapy Speaker Jaclyn Warshauer, PT National Clinical Director Aegis
More informationRESIDENT FALLS A Guide to Prevention, Assessment, and Response
Long-Term Care Risk Management: RESIDENT FALLS A Guide to Prevention, Assessment, and Response Carole Eldridge, MSN, RN, CNAA, BC Contents About the Author........................................ v Chapter
More informationCBR201609: Diabetic Testing Supplies
Stay Tuned for Webinar Audio dial-in: 323 920 0091; PIN: 256-7691# For technical assistance, send email to support@anymeeting.com : Diabetic Testing Supplies 3:00 P.M. ET July 27, 2016 : Diabetic Testing
More informationWhat is the Objective of the DQA in Developing Performance Measures. Robert Compton, DDS Executive Director
What is the Objective of the DQA in Developing Performance Measures Robert Compton, DDS Executive Director EBD Champions Conference May 9-10, 2014 DISCLOSURE Disclosure on DentaQuest Benefits ~ 20 million
More informationCompliance. TODAY January Improving the Medicare audit process. an interview with Gerard (Jerry) Mulcahy. See page 16
Compliance TODAY January 2017 a publication of the health care compliance association www.hcca-info.org Improving the Medicare audit process an interview with Gerard (Jerry) Mulcahy Former Director, Medicare
More informationAMERICA S OPIOID EPIDEMIC AND ITS EFFECT ON THE NATION S COMMERCIALLY-INSURED POPULATION PUBLISHED JUNE 29, 2017
AMERICA S OPIOID EPIDEMIC AND ITS EFFECT ON THE NATION S COMMERCIALLY-INSURED POPULATION PUBLISHED JUNE 29, 2017 America s Opioid Epidemic and Its Effect on the Nation s Commercially-Insured Population
More informationHIGHLY PATHOGENIC AVIAN INFLUENZA POLICY UPDATES
HIGHLY PATHOGENIC AVIAN INFLUENZA POLICY UPDATES DR. JON ZACK DIRECTOR, NATIONAL PREPAREDNESS AND INCIDENT COORDINATION U.S. DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY
More information32 CFR (a)(4), (a)(6)(iii), and (a)(6)(iv)
CHAPTER 15 SECTION 1 ISSUE DATE: November 6, 2007 AUTHORITY: 32 CFR 199.14(a)(4), (a)(6)(iii), and (a)(6)(iv) I. APPLICABILITY This policy is mandatory for the reimbursement of services provided either
More informationImproving Access to Oral Health Care for Vulnerable and Underserved Populations
Improving Access to Oral Health Care for Vulnerable and Underserved Populations Report of the Committee on Oral Health Access to Services Shelly Gehshan Director, Pew Children s Dental Campaign Committee
More informationOFFICE OF THE UNDER SECRETARY OF DEFENSE 4000 DEFENSE PENTAGON WASHINGTON, D.C
OFFICE OF THE UNDER SECRETARY OF DEFENSE 4000 DEFENSE PENTAGON WASHINGTON, D.C. 20301-4000 PERSONNEL AND READINESS The Honorable James M. Inhofe JAN - 7 ;in o Chairman Committee on Armed Services United
More informationAddressing Challenges Together, One Rock at a Time
Addressing Challenges Together, One Rock at a Time PAMELA SCHWEITZER, PHARM.D., BCACP ASSISTANT SURGEON GENERAL REAR ADMIRAL (RADM), U.S. PUBLIC HEALTH SERVICE E-MAIL: PAMELA.SCHWEITZER@CMS.HHS.GOV @USPHSPHARMACY
More informationChapter 15 Section 1
Chapter 15 Section 1 Issue Date: November 6, 2007 Authority: 32 CFR 199.14(a)(3) and (a)(6)(ii) 1.0 APPLICABILITY This policy is mandatory for the reimbursement of services provided either by network or
More informationCritical Access Hospital Medicare Reimbursement Update and Financial Improvement Tools
acumen Critical Access Hospital Medicare Reimbursement Update and Financial Improvement Tools Presented by Ann King White, CPA & Tammy Rivera, CPA BKD, LLP January 16, 2018 insight ideas attention reach
More informationJuly 25, Submitted Electronically
July 25, 2014 Submitted Electronically Ms. Marilyn Tavenner Acting Administrator Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services Room445-G, Hubert Humphrey Building
More informationObjectives. Medicare Spending per Beneficiary: Analyzing MSPB Data to Identify Primary Drivers
Medicare Spending per Beneficiary: Analyzing MSPB Data to Identify Primary Drivers August 22, 2017 Objectives Understand the basics of the hospital specific MSPB data files and reports Review the factors
More informationDeconstructing the RADV: The Past, Present, and Future of RADV
Deconstructing the RADV: The Past, Present, and Future of RADV May 24, 2016 Presented by: Kim Browning, CHRS, PMP, CHC Executive Vice President Agenda 2 PY 2007 What We ve Learned PY 2011 Expectations
More informationHospice Regulatory Update
Hospice Regulatory Update Jennifer Kennedy, MA, BSN, RN, CHC July 2016 National Hospice and Palliative Care Organization Session Objectives Review of the current hospice pertinent topics with detail such
More informationShort-term Acute Care Program for Evaluating Payment Patterns Electronic Report. User s Guide Twenty-third Edition. Prepared by
Short-term Acute Care Program for Evaluating Payment Patterns Electronic Report User s Guide Twenty-third Edition Prepared by 1 Short-term Acute Care Program for Evaluating Payment Patterns Electronic
More informationMonitoring the Accuracy of Hospital Coding (OEI )
DATE: January 21, 1999 FROM: SUBJECT: TO: June Gibbs Brown Inspector General Monitoring the Accuracy of Hospital Coding (OEI-01-98-00420) Nancy-Ann Min DeParle Administrator Health Care Financing Administration
More informationDates Reviewed: 12/2012, 3/2013, 6/2013, 9/2013, 11/2013, 12/2013, 3/2014, 6/2014, 9/2014, 12/2014,
Perjeta (pertuzumab) Last Review Date: 5/30/2017 Date of Origin: 11/01/2012 Document Number: IC-0096 Dates Reviewed: 12/2012, 3/2013, 6/2013, 9/2013, 11/2013, 12/2013, 3/2014, 6/2014, 9/2014, 12/2014,
More informationRegulations & Standards for Hospice Managers
Regulations & Standards for Hospice Managers A Level I Module of the Hospice MDP Objectives Identify the difference between regulations, standards and guidelines Describe and discuss the regulations for
More informationFederation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: License Renewal. License Renewal on Birthdays
The table below lists information on the term and renewal date for each jurisdiction. Summary License Term 1 26 2 Renewal Date One date 31 Birthdays 6 Half in even years 4 4 License Term AL AK AZ AR CA
More informationEDIBLE CANNABIS STATE REGULATIONS. Karmen Hanson, MA- Health Program
EDIBLE CANNABIS STATE REGULATIONS Karmen Hanson, MA- Health Program What s Covered Today Overview of medical, CBD and adult-use cannabis laws State program details, similarities and differences Edible
More informationHealthcare Financial Management Association
January 2010 Sample Size: 550 Undelivered E-mail: 26 Final Sample: 524 Responses Received: 106 Response Rate: 20% FY10 Overall High Satisfaction: 48% Online survey conducted by HFMA on behalf of the chapter.
More informationConsensus and Collaboration
Consensus and Collaboration John Morton, MD, MPH, FACS, FASMBS Chief, Bariatric & Minimally Invasive Surgery Stanford School of Medicine Past-President, American Society of Metabolic and Bariatric Surgery,
More informationSmartIX EMPI Taking It to the Next Level
SmartIX EMPI Taking It to the Next Level Theresa Mendoza Director of Quality, BI, and Data Services Dallas-Fort Worth Education and Research Foundation Agenda Welcome Introduction History Next Level of
More informationUroplasty, Inc. Investor Update Canaccord Genuity Conference December 6, 2011
Uroplasty, Inc. Investor Update Canaccord Genuity Conference December 6, 2011 Forward Looking Statement This presentation includes forward-looking statements, including financial projections, relating
More informationShort-term Acute Care Program for Evaluating Payment Patterns Electronic Report. User s Guide Twenty-second Edition. Prepared by
Short-term Acute Care Program for Evaluating Payment Patterns Electronic Report User s Guide Twenty-second Edition Prepared by 1 Short-term Acute Care Program for Evaluating Payment Patterns Electronic
More informationFirstCare Health Plans (FirstCare) is on track to be ICD-10 ready by the October 1, 2015 deadline.
Overview In July 2014, the U.S. Department of Health & Human Services (HHS) issued a rule finalizing October 1, 2015 as the new compliance date for health care providers, health plans, and health care
More informationAligning Quality Outcomes Data with Financial Performance
Aligning Quality Outcomes Data with Financial Performance Driving Case Mix and Revenue Improvement Susan E. Belley, M.Ed., RHIA Cleveland Clinic Garri L. Garrison, RN, CPC, CMC, CPUR 3M Health Information
More informationA Personal Story: Turning Tragedy into Triumph. Martha Lopez Anderson Chair, Board of Directors Parent Heart Watch
A Personal Story: Turning Tragedy into Triumph Martha Lopez Anderson Chair, Board of Directors Parent Heart Watch A Personal Story: Turning Tragedy into Triumph Sean Alexander, a seemingly healthy and
More informationThe Risky Business of Claims-Only Risk Adjustments
The Risky Business of Claims-Only Risk Adjustments August 3 rd & 4 th, 2016 Presented by: Kim Browning Executive Vice President Vince Bryant Vice President of Business Development Agenda 2 Plan Selection
More informationStrengthening Providers of Substance Use Treatment in Los Angeles County
Strengthening Providers of Substance Use Treatment in Los Angeles County Summary Presented by July 218 Drug overdose is the thirdranked cause of premature death in L.A. County. 1 Substance use and misuse
More information3/20/2013. "ICD-10 Update Understanding and Analyzing GEMs" March 10, 2013
"ICD-10 Update Understanding and Analyzing GEMs" March 10, 2013 1 Leola Burke MHSA, CCS AHIMA-approved ICD-10-CM/PCS Trainer Independent Coding Consultant & ICD-10-CM/PCS Expert, Raleigh, NC & Jacksonville,
More informationRegister today! Visit or call 877/
The bestselling CDI Boot Camp is now available online! Clinical Documentation Improvement Boot CampSM CDI-specific education covering: Medical record review and physician queries MS-DRGs and IPPS reimbursement
More informationConsiderations for State Obesity Policy
Considerations for State Obesity Policy Scott Kahan, MD, MPH Faculty, Johns Hopkins Bloomberg School of Public Health Director, National Center for Weight & Wellness Clinical Director, STOP Obesity Alliance,
More information2015 Cardiac Catheterization Survey. Part A : General Information. Part B : Survey Contact Information. 1. Identification UID: 2.
Part A : General Information 2015 Cardiac Catheterization Survey 1. Identification UID: Facility Name: County: Street Address: City: Zip: Mailing Address: Mailing City: Mailing Zip: Medicare Provider Number:
More informationAtrius Health Pioneer ACO: Structure, Activities and Results
Atrius Health Pioneer ACO: Structure, Activities and Results Emily Brower Executive Director Accountable Care Programs Emily_Brower@AtriusHealth.org March 2014 1 Atrius Health. 2 Atrius Health Structure
More informationNational Survey of Compensation Among Peer Support Specialists
National Survey of Compensation Among Peer Support Specialists The word cloud graphic used in this report is a visual summary of comments provided by peer support specialist respondents to this survey.
More informationCost of Diabetes. Laura Keller Director State Advocacy AK CO HI ID MT ND OR SD WA WY
Cost of Diabetes Laura Keller Director State Advocacy AK CO HI ID MT ND OR SD WA WY Christopher Stanley, MD, MBA American Diabetes Association Colorado Advocacy Chair Vice President of Population Health
More informationKrystexxa (pegloticase) Document Number: IC-0158
Krystexxa (pegloticase) Document Number: IC-0158 Last Review Date: 06/27/2017 Date of Origin: 02/07/20103 Dates Reviewed: 11/2013, 08/2014, 07/2015, 07/2016, 09/2016, 12/2016, 03/2017, 06/2017 I. Length
More informationState of California Department of Justice. Bureau of Narcotic Enforcement
State of California Department of Justice Bureau of Narcotic Enforcement Prescription Drugs in the U.S. At least half of all Americans take one prescription drug regularly, with one in six taking three
More informationShort-term Acute Care Program for Evaluating Payment Patterns Electronic Report. User s Guide Sixteenth Edition. Prepared by
Short-term Acute Care Program for Evaluating Payment Patterns Electronic Report User s Guide Sixteenth Edition Prepared by 1 Short-term Acute Care Program for Evaluating Payment Patterns Electronic Report
More informationInnovator Case Studies: Oncology Networks
Innovator Case Studies: Oncology Networks J. Ike Nicoll Chief Executive Officer Cancer Clinics of Excellence Alan Armer, Ph.D. Vice President, Research & Development Catholic Health Initiatives Cancer
More informationIntegrating HIPAA Into Your Compliance Program
Integrating HIPAA Into Your Compliance Program Fifth Annual National Congress on Health Care Compliance February 7, 2002 Glenna S. Jackson Vice President Compliance, MedStar Health Diane H. Meyer Chief
More informationReimbursement Information for Automated Breast Ultrasound Screening
GE Healthcare Reimbursement Information for Automated Breast Ultrasound Screening January 2015 www.gehealthcare.com/reimbursement The Invenia ABUS is indicated as an adjunct to mammography for breast cancer
More informationMember-centered cancer care In Georgia
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Member-centered cancer care In Georgia Ira Klein, MD, MBA, FACP GASCO Annual Meeting September 5, 2015 > One
More informationRecord Keeping and Self-Auditing. Preparing for a CMS Audit
Record Keeping and Self-Auditing Preparing for a CMS Audit Agenda Medicare Audit Overview Common Audit Findings Conducting a Mock Medicare Audit Hands-On Audit Exercise Why do we care? Medicare Chiropractic
More informationOffice of ENERGY Science
Date: April 29, 2016 U.S. DEPARTMENT OF Office of ENERGY Science SLAC Site Office SLAG National Accelerator Laboratory 2575 Sand Hill Road, MS-.8A Menlo Park, GA 94025 To: Chi Chang Kao, SLAC Laboratory
More informationThe OIG and Therapy. A Case Study. ReDoc Customer Webinar August 27, Wednesday, September 4, 13
The OIG and Therapy A Case Study ReDoc Customer Webinar August 27, 2013 Knock Knock It s the OIG! Rehab perception of investigations that led to Corporate Integrity Agreements (CIA) HealthSouth? Physio?
More informationBased on Medicare FFS Beneficiaries Assigned July 1, 2011 December 31, 2011
July 2012 Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration Medical Home Feedback Report Based on Medicare FFS Beneficiaries Assigned July 1, 2011 December 31, 2011 Practice Number Practice
More information2018 Perinatal Hepatitis B Summit. Eva Hansson, RN, MSN Perinatal Hepatitis B Prevention Coordinator
2018 Perinatal Hepatitis B Summit Eva Hansson, RN, MSN Perinatal Hepatitis B Prevention Coordinator Overview of Summit Summary of perinatal Hepatitis B in the US & Texas ACIP Hepatitis B Prevention recommendations
More informationSNAP Outreach within Food Banks: A View From The Ground
SNAP Outreach within Food Banks: A View From The Ground Shana Alford, Feeding America Colleen Heflin, University of Missouri Elaine Waxman, Feeding America FEEDING AMERICA + PARTNER NAME PARTNERSHIP DISCUSSION
More informationTHE COST OF MENTAL ILLNESS: ILLINOIS FACTS AND FIGURES. Hanke Heun-Johnson, Michael Menchine, Dana Goldman, Seth Seabury
THE COST OF MENTAL ILLNESS: ILLINOIS FACTS AND FIGURES Hanke Heun-Johnson, Michael Menchine, Dana Goldman, Seth Seabury ILLINOIS 2 INTRODUCTION Improving access to high-quality medical care for patients
More informationMEDICARE RECOVERY AUDIT CONTRACTORS
MEDICARE RECOVERY AUDIT CONTRACTORS RAC ROUND-UP SUBSCRIPTION SERVICE RACS: What Are We Learning? Newly Approved Issues: Part 2 September 1, 2009 2009 Aegis Compliance & Ethics Center, LLP 1 1 Faculty
More informationTHE COST OF MENTAL ILLNESS: PENNSYLVANIA FACTS AND FIGURES. Hanke Heun-Johnson, Michael Menchine, Dana Goldman, Seth Seabury February 2017
THE COST OF MENTAL ILLNESS: PENNSYLVANIA FACTS AND FIGURES Hanke Heun-Johnson, Michael Menchine, Dana Goldman, Seth Seabury February 2017 PENNSYLVANIA 2 INTRODUCTION Improving access to high-quality medical
More informationEnvironmental, Health and Safety
Environmental, Health and Safety Codes of Practice The Environmental, Health and Safety (EHS) Codes of Practice set forth Zimmer EHS requirements for our business functions and facilities worldwide. In
More informationIntravitreal Avastin (Bevacizumab)
Intravitreal Avastin (Bevacizumab) Date of Origin: 10/18/2018 Last Review Date: 10/18/2018 Effective Date: 10/18/2018 Dates Reviewed: 10/2018 Developed By: Medical Criteria Committee I. Length of Authorization
More information9/27/2011. Improving Revenue Capture: Best Practices in Coding, Documentation and Charge Capture. Educational Breakout Session PRESENTERS
Educational Breakout Session Improving Revenue Capture: Best Practices in Coding, Documentation and Charge Capture Becker s ASC Conference, Breakout Session, October 29, 2011 PRESENTERS Yvonda Moore Director
More informationMOLINA HEALTHCARE MEDICARE PRIOR AUTHORIZATION/PRE-SERVICE REVIEW GUIDE EFFECTIVE: 01/01/2018
MOLINA HEALTHCARE MEDICARE PRIOR AUTHORIZATION/PRE-SERVICE REVIEW GUIDE EFFECTIVE: 01/01/2018 FOR MMP MEDICAID, PLEASE REFER TO YOUR STATE MEDICAID PA GUIDE FOR ADDITIONAL PA REQUIREMENTS Refer to Molina
More information