3M Health Information Systems. The standard for yesterday, today and tomorrow: 3M All Patient Refined DRGs
|
|
|
- Justina Waters
- 6 years ago
- Views:
Transcription
1 3M Health Information Systems The standard for yesterday, today and tomorrow: 3M All Patient Refined DRGs
2 From one patient to one population The 3M APR DRG Classification System set the standard from the very start. Since its debut in the early 1990s, the 3M APR DRG Classification System remains the healthcare industry s leading methodology to measure inpatient severity of illness (SOI) and risk of mortality (ROM) for an individual patient or a patient population. What makes the 3M APR DRGs the methodology of choice for so many organizations? And how does 3M play a role in the move to population health?
3 First, all patients means all patients Unlike MS-DRGs, 3M APR DRGs are not limited to the Medicare population. They categorize all possible reasons for hospitalization into mutually exclusive groups, encompassing diagnoses for all patients, including children and women. That means enrollees of any type of health plan. Diagnosis related groups (DRGs) classify patients into distinct groups. The patients grouped into each DRG are similar in terms of both clinical characteristics and the hospital resources they consume. 3M APR DRGs expand the basic DRG structure by adding four subclasses to capture patient differences relating to SOI and ROM. The 3M APR DRG Classification System assigns each patient a base 3M APR DRG for the underlying condition, an SOI subclass and an ROM subclass. For both SOI and ROM, the subclass can be minor, moderate, major or extreme. Extreme SOI or ROM is usually associated with multiple co-morbid conditions involving two or more organ systems. Patients with high SOI or ROM tend to have poor outcomes in spite of receiving more frequent and intensive treatment. The subclasses within 3M APR DRGs accurately represent the health status and resource burden of patients with high SOI or ROM.
4 Fee-for-service payment Second, deployed nationwide Essentially, 3M APR DRGs allow an apples-to-apples comparison of physician and hospital performance. That is precisely what makes them useful for broad application by providers, payers, patient safety organizations and others in the healthcare industry. 3M APR DRGs are built on a clinical categorical model, so the results are clinically relevant, providing a common language that physicians, case workers, quality assurance managers and clinical documentation specialists alike can understand. In general, patients with a high SOI are expected to incur greater costs than patients with the same DRG but lower SOI. 3M APR DRGs can help improve pricing and reimbursement accuracy by capturing SOI differences among patients. By the end of 2015, nearly 30 Medicaid programs will be using 3M APR DRGs for inpatient payment, including the eight largest programs in the country. In all, more than 30 state and federal agencies use 3M to adjust for SOI and ROM in profiles comparing facilities. The results produce a more complete and accurate comparison of the type and quality of care provided to different patient populations.
5 Third, quality is key Organizations throughout the country use 3M APR DRGs to risk-adjust measures of length of stay, readmissions, complications, mortality and overall cost of care. Since 1997, U.S. News & World Report magazine has used the 3M APR DRG methodology to adjust the data it uses to rank hospitals for risk of mortality in its annual report on the top 100 hospitals in the U.S. Researchers who developed the Agency for Healthcare Research and Quality (AHRQ) Quality Indicators used 3M APR DRGs to adjust for ROM. This comprehensive set of metrics helps to flag potential quality problems, identify areas that need further study and track changes over time.
6 3M APR DRGs are the foundational logic for potentially preventable readmissions (PPRs) and potentially preventable complications (PPCs). Likewise, 3M APR DRGs complement the 3M Enhanced Ambulatory Patient Grouping (EAPG) System for measuring outpatient care. And now, payment transformation and population health As payers progress from managing individual services for individual members to managing population health, 3M APR DRGs are playing a definitive role. How? We align the care provided in the hospital with how it s paid. 3M APR DRG data helps organizations understand their population s health and care across the continuum. Commercial health plans and Medicaid agencies that use 3M APR DRGs for fee-for-service payment have made an incremental shift away from volume-based payment. By adjusting per-unit pricing for patient acuity, they have shifted payment to align with value, at the same time adopting a reliable metric to segment hospital populations for care management.
7 How does 3M design and determine clinical validity? We design our proprietary methodology and logic with: Open clinical logic. The 3M APR DRG Classification System publicly offers a detailed overview of the logic. All users receive complete definitions manuals for review and comment. Input from health professionals and academic researchers. We developed each 3M APR DRG based on separate clinical models that were tested by physicians, other health professionals and researchers against clinical hypotheses and evaluated against historical data. Categorical clinical structure. The 3M APR DRGs are a categorical clinical model. Each patient is assigned to a single, clinically meaningful category. In contrast, other SOI models based on statistical techniques such as linear or logistic regression do not result in clinically meaningful patient categories, making it difficult for physicians to interpret the data. Comprehensive pediatric logic. In collaboration with 3M, the National Association of Children s Hospitals and Related Institutions (NACHRI, now part of the Children s Hospital Association) developed the pediatric portion of the 3M APR DRGs. As a result, the system includes the complete pediatric logic essential to measuring and evaluating non-medicare populations. Continuous improvement and updating. The classification system is updated with changes in codes sets, and 3M continuously refines the clinical models.
8 All for one The 3M APR DRGs are widely available from many vendors besides 3M. In fact, many healthcare computer system users may not realize it is 3M s proprietary methodology providing functionality in their health information or EHR systems. 3M APR DRGs use the familiar DRG structure, making them easy for physicians and hospitals to recognize. 3M APR DRGs are based on readily available claims data. They don t require additional data collection or computation. Normative data sets are available for the entire country and by region, payer and hospital type to facilitate convenient comparative profiling. The 3M APR DRGs support ICD-10 and will continue to be updated as the Centers for Medicare & Medicaid Services releases new ICD-10-based rules. 3M APR DRGs are available on a wide variety of computer platforms so organizations can easily integrate them into existing systems. Most major HIS vendors already partner with 3M to embed the 3M APR DRGs within their systems and applications. So many states now use the system that they can share 3M APR-DRG-based data, methods, report formats and processing.
9 The 3M advantage 3M drives the standards with more than 30 years of experience. Nobody understands severity- and risk-adjustment methodologies better. We built them. We develop and refine them. We know how they impact your organization. And we can show you how to use them to improve quality of care, lower costs and enhance population health. With 3M APR DRGs at their core, our solutions lead the industry: 3M 360 Encompass System 3M DRG Assurance Program 3M Clinical Documentation Improvement (CDI) System 3M grouping applications, including 3M Core Grouping Software (CGS) and 3M Grouper Plus Content Services (GPCS) 3M s suite of payer-focused solutions For more information on how 3M software and services can assist your organization, contact your 3M sales representative, call us toll-free at , or visit us online at Health Information Systems 575 West Murray Boulevard Salt Lake City, UT U.S.A M, 360 Encompass and DRG Assurance are trademarks of 3M Company. The International Statistical Classification of Diseases and Related Health Problems - Tenth Revision (ICD-10) is copyrighted by the World Health Organization, Geneva, Switzerland Please recycle. Printed in U.S.A. 3M All rights reserved. Published 09/
3M Health Information Systems. 3M Clinical Risk Groups: Measuring risk, managing care
3M Health Information Systems 3M Clinical Risk Groups: Measuring risk, managing care 3M Clinical Risk Groups: Measuring risk, managing care Overview The 3M Clinical Risk Groups (CRGs) are a population
3M Health Information Systems. Real results: A profile of eight organizations boosted by the 3M 360 Encompass System
3M Health Information Systems Real results: A profile of eight organizations boosted by the 3M 360 Encompass System s in progress Every month, more and more organizations academic, non-profit, metro and
A strategy for building a value-based care program
3M Health Information Systems A strategy for building a value-based care program How data can help you shift to value from fee-for-service payment What is value-based care? Value-based care is any structure
Case-mix Analysis Across Patient Populations and Boundaries: A Refined Classification System
Case-mix Analysis Across Patient Populations and Boundaries: A Refined Classification System Designed Specifically for International Quality and Performance Use A white paper by: Marc Berlinguet, MD, MPH
CASE-MIX ANALYSIS ACROSS PATIENT POPULATIONS AND BOUNDARIES: A REFINED CLASSIFICATION SYSTEM DESIGNED SPECIFICALLY FOR INTERNATIONAL USE
CASE-MIX ANALYSIS ACROSS PATIENT POPULATIONS AND BOUNDARIES: A REFINED CLASSIFICATION SYSTEM DESIGNED SPECIFICALLY FOR INTERNATIONAL USE A WHITE PAPER BY: MARC BERLINGUET, MD, MPH JAMES VERTREES, PHD RICHARD
Paying for Outcomes not Performance
Paying for Outcomes not Performance 1 3M. All Rights Reserved. Norbert Goldfield, M.D. Medical Director 3M Health Information Systems, Inc. #Health Information Systems- Clinical Research Group Created
Population health and potentially preventable events 3M solutions for population health, patient safety and cost-effective care
3M Health Information Systems Population health and potentially preventable events 3M solutions for population health, patient safety and cost-effective care Challenge: Shifting the financial risk The
3M Health Information Systems. A case study in coding compliance: Achieving accuracy and consistency
3M Health Information Systems A case study in coding compliance: Achieving accuracy and consistency A case study in coding compliance: Achieving accuracy and consistency The challenge Coding compliance
Volume to Value Based Healthcare Dr. Thilo Koepfer, VP International, 3M Health Information Systems
Volume to Value Based Healthcare Dr. Thilo Koepfer, VP International, 3M Health Information Systems Learning Objectives 1. Explain the Triple Aim as developed by the Institute of Healthcare Improvement
Public Dissemination of Provider Performance Comparisons
Public Dissemination of Provider Performance Comparisons Richard F. Averill, M.S. Recent health care cost control efforts in the U.S. have focused on the introduction of competition into the health care
District of Columbia Medicaid Specialty Hospital Payment Method Frequently Asked Questions
District of Columbia Medicaid Specialty Hospital Payment Method Frequently Asked Questions Version Date: July 20, 2017 Updates for October 1, 2017 Effective October 1, 2017 (the District s fiscal year
OHIO MEDICAID. OHA APR-DRG Rebase & EAPG Implementation Overview Sept.14, 2017
OHIO MEDICAID OHA APR-DRG Rebase & EAPG Implementation Overview Sept.14, 2017 OHIO MEDICAID PAYMENTS Inpatient Hospital Based primarily on the All Patient Refined Diagnostic Related Grouping (APR DRG)
Clinical Documentation: Beyond The Financials Cheryll A. Rogers, RHIA, CDIP, CCDS, CCS Senior Inpatient Consultant 3M HIS Consulting Services
Clinical Documentation: Beyond The Financials Cheryll A. Rogers, RHIA, CDIP, CCDS, CCS Senior Inpatient Consultant 3M HIS Consulting Services Clinical Documentation: Beyond The Financials Key Points of
Appendix #4. 3M Clinical Risk Groups (CRGs) for Classification of Chronically Ill Children and Adults
Appendix #4 3M Clinical Risk Groups (CRGs) for Classification of Chronically Ill Children and Adults Appendix #4, page 2 CMS Report 2002 3M Clinical Risk Groups (CRGs) for Classification of Chronically
HCA APR-DRG and EAPG Rebasing Revised February 2017
HCA APR-DRG and EAPG Rebasing Revised February 2017 Inpatient and Outpatient Pricing Effective 11/01/2014 to Current Inpatient pricing From AP DRG to APR DRG HCA is using 3M Standard Weights Pricing goes
Jumpstarting population health management
Jumpstarting population health management Issue Brief April 2016 kpmg.com Table of contents Taking small, tangible steps towards PHM for scalable achievements 2 The power of PHM: Five steps 3 Case study
Carondelet Health Network APR DRG Information for Physicians September 2014
Carondelet Health Network APR DRG Information for Physicians September 2014 Introduction Changes in the reimbursement process for services rendered to AHCCCS patients will go into effect beginning on October
The ins and outs of CDE 10 steps for addressing clinical documentation excellence
The ins and outs of CDE 10 steps for addressing clinical documentation excellence What s at stake for CDE outpatient/inpatient integration? Historically, provider organizations have focused their clinical
SNOMED CT AND 3M HDD: THE SUCCESSFUL IMPLEMENTATION STRATEGY
SNOMED CT AND 3M HDD: THE SUCCESSFUL IMPLEMENTATION STRATEGY Federal Health Care Agencies Take the Lead The United States government has taken a leading role in the use of health information technologies
District of Columbia Medicaid Specialty Hospital Project Frequently Asked Questions
District of Columbia Medicaid Specialty Hospital Project Frequently Asked Questions Version Date: September 22, 2014 UPDATE: The District of Columbia Department of Health Care Finance (DHCF) is submitting
August 25, Dear Ms. Verma:
Seema Verma Administrator Centers for Medicare & Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue, S.W. Room 445-G Washington, DC 20201 CMS 1686 ANPRM, Medicare Program; Prospective
Hospital Payments and Quality Initiatives
Hospital Payments and Quality Initiatives December 2014 John McCarthy Ohio Medicaid Director Today s Overview How Ohio Medicaid pays hospitals - Prospective Payment Methods - Inpatient Hospital Payment
The Transition to Version 5010 and ICD-10
The Transition to Version 5010 and ICD-10 An Overview Denise M. Buenning, MsM Director, Administrative Simplification Group Office of E-Health Standards and Services Centers for Medicare & Medicaid Services
2015 Executive Overview
An Independent Licensee of the Blue Cross and Blue Shield Association 2015 Executive Overview Criteria for the Blue Cross and Blue Shield of Alabama Hospital Tiered Network will be updated effective January
Preventable Readmissions
Preventable Readmissions Strategy to reduce readmissions and increase quality needs to have the following elements A tool to identify preventable readmissions Payment incentives Public reporting Quality
Using APR DRGs to Verify Medicaid Payment and Improve Hospital Care: Let s Talk Methodology and Strategy
Using APR DRGs to Verify Medicaid Payment and Improve Hospital Care: Let s Talk Methodology and Strategy NJ Health Information Management Association June 22, 2018 Atlantic City NJ Our Agenda Today Overview
Session 57 PD, Care Management in an Evolving Health Care World. Moderator/Presenter: David V. Axene, FSA, CERA, FCA, MAAA
Session 57 PD, Care Management in an Evolving Health Care World Moderator/Presenter: David V. Axene, FSA, CERA, FCA, MAAA Presenters: Craig Butler, MD, MBA Richard Fuller Timothy Willard Smith, ASA, MAAA
Treating the mind and body. 3 questions to consider when linking physical and behavioral health services
Treating the mind and body 3 questions to consider when linking physical and behavioral health services Healthcare systems with a foundation of effective primary care are more likely to improve population
ICD-10/APR-DRG. HP Provider Relations/September 2015
ICD-10/APR-DRG HP Provider Relations/September 2015 Agenda ICD-10 ICD-10 General Overview Who is affected Preparation Testing Prior Authorization APR-DRG Inpatient hospital rates Crosswalks Questions 2
Total Cost of Care Technical Appendix April 2015
Total Cost of Care Technical Appendix April 2015 This technical appendix supplements the Spring 2015 adult and pediatric Clinic Comparison Reports released by the Oregon Health Care Quality Corporation
Prepared for North Gunther Hospital Medicare ID August 06, 2012
Prepared for North Gunther Hospital Medicare ID 000001 August 06, 2012 TABLE OF CONTENTS Introduction: Benchmarking Your Hospital 3 Section 1: Hospital Operating Costs 5 Section 2: Margins 10 Section 3:
UW MEDICINE ICD-10 Program UW MEDICINE ICD-10
UW MEDICINE ICD-10 Program UW MEDICINE ICD-10 There and back again INTEGRATION OF MANDATES ACO Quality Based Reimbursement Meaningful Use, P4P, etc. ICD-10 HIPAA, 5010 2 STRATEGIC OPPORTUNITIES Significant
Policies for Controlling Volume January 9, 2014
Policies for Controlling Volume January 9, 2014 The Maryland Hospital Association Policies for controlling volume Introduction Under the proposed demonstration model, the HSCRC will move from a regulatory
Measuring the Real Impact of Clinical Documentation Improvement On Value-based Reimbursement
White Paper Measuring the Real Impact of Clinical Documentation Improvement On Value-based Reimbursement June 2016 Shane Wolverton Senior Vice President of Corporate Development Quantros, Inc. Anthony
Hospital Clinical Documentation Improvement
Hospital Clinical Documentation Improvement March 2016 Clinical Documentation Improvement (CDI) is a team approach to improving documentation practices through ongoing education, concurrent chart review
3M Health Information Systems. 3M Clinical Risk Groups: At work in the real world
3M Health Information Systems 3M Clinical Risk Groups: At work in the real world 3M Clinical Risk Groups: At work in the real world Overview First released in 2000 as clinically-based classifications for
What is CDI? 2016 HTH FL Boot Camp. HIM/Documentation: Endurance in the Clinical Documentation Improvement (CDI) Race
HIM/Documentation: Endurance in the Clinical Documentation Improvement (CDI) Race Presented By: Sandy Sage Developed by Annie Lee Sallee Endurance in the Clinical Documentation Improvement (CDI) Race Learning
CARING & CODING FOR MALNUTRITION
CARING & CODING FOR MAL Sandy Routhier RHIA, CCS, CDIP, AHIMA Approved ICD-10CM/PCS Trainer CloudMed Solutions Michelle Mathura, RDN, LRD, CDE Director, Nutrition Division DM&A Our Presenters Sandra Routhier,
Clinical Documentation Improvement (CDI) Programs: What Role Should Compliance Play?
Clinical Documentation Improvement (CDI) Programs: What Role Should Compliance Play? June 17, 2016 Agenda Clinical Documentation Improvement (CDI) Perspective An Effective CDI Program Core Focus: Compliance
CMS QUALITY MEASURES, COULD MEAN TO YOU MALNUTRITION, AND WHAT IT. Part I of Nutrition Division Webinar Series
CMS QUALITY MEASURES, MALNUTRITION, AND WHAT IT COULD MEAN TO YOU Part I of Nutrition Division Webinar Series Welcome! During the webinar, the phone lines will be muted. There will be a 15 minute Q&A session
Prior to implementation of the episode groups for use in resource measurement under MACRA, CMS should:
Via Electronic Submission (www.regulations.gov) March 1, 2016 Andrew M. Slavitt Acting Administrator Centers for Medicare and Medicaid Services 7500 Security Boulevard Baltimore, MD episodegroups@cms.hhs.gov
CMS-0044-P; Proposed Rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program Stage 2
May 7, 2012 Submitted Electronically Ms. Marilyn Tavenner Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building
3M Health Information Systems Should physicians assign their own codes?
3M Health Information Systems Should physicians assign their own codes? The practical guide to striking a coding balance It started with the EHR boom The adoption of electronic health records (EHR) significantly
DA: November 29, Centers for Medicare and Medicaid Services National PACE Association
DA: November 29, 2017 TO: FR: RE: Centers for Medicare and Medicaid Services National PACE Association NPA Comments to CMS on Development, Implementation, and Maintenance of Quality Measures for the Programs
Catherine Porto, MPA, RHIA, CHP Executive Director HIM. Madelyn Horn Noble 3M HIM Data Analyst
1 Catherine Porto, MPA, RHIA, CHP Executive Director HIM Madelyn Horn Noble 3M HIM Data Analyst University of New Mexico Hospitals» The state s only academic medical center» The primary teaching hospital
Choice of a Case Mix System for Use in Acute Care Activity-Based Funding Options and Considerations
Choice of a Case Mix System for Use in Acute Care Activity-Based Funding Options and Considerations Introduction Recent interest by jurisdictions across Canada in activity-based funding has stimulated
2018 Biliary 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,
Why ICD-10 Is Worth the Trouble
Page 1 of 6 Why ICD-10 Is Worth the Trouble by Sue Bowman, RHIA, CCS Transitioning to ICD-10 is a major disruption that providers and payers may prefer to avoid. But it is an upgrade long overdue, and
INPATIENT HOSPITAL REIMBURSEMENT
HCRA CLAIMS PROCESSING Reimbursement: HCRA is not Medicaid; however, HCRA covered services are reimbursed at the hospital s outpatient or inpatient reimbursement rate allowed for Florida Medicaid. The
COMPdata ICD-10 Transition Guide
COMPdata ICD-10 Transition Guide COMPDATA Subscribers Customer Support Phone Numbers: 866.262.6222 COMPDATA Subscribers Customer Support Email: compdata@team-iha.org February 2016 1 ICD Crosswalk Tool
AHRQ Quality Indicators. Maryland Health Services Cost Review Commission October 21, 2005 Marybeth Farquhar, AHRQ
AHRQ Quality Indicators Maryland Health Services Cost Review Commission October 21, 2005 Marybeth Farquhar, AHRQ Overview AHRQ Quality Indicators Current Uses of the Quality Indicators Case Studies of
Inpatient Hospital Rates Rebasing Report
This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp Inpatient Hospital
Scottish Hospital Standardised Mortality Ratio (HSMR)
` 2016 Scottish Hospital Standardised Mortality Ratio (HSMR) Methodology & Specification Document Page 1 of 14 Document Control Version 0.1 Date Issued July 2016 Author(s) Quality Indicators Team Comments
A McKesson Perspective: ICD-10-CM/PCS
A McKesson Perspective: ICD-10-CM/PCS Its Far-Reaching Effect on the Healthcare Industry Executive Overview While many healthcare organizations are focused on qualifying for American Recovery & Reinvestment
Recommendation to Adopt a Severity-Adjusted Grouper
Recommendation to Adopt a Severity-Adjusted Grouper Health Services Cost Review Commission 4160 Patterson Avenue Baltimore, MD 21215 (410) 764-2605 Fax (410) 358-6217 June 2, 2004 This recommendation is
Clinical Documentation Improvement: Best Practice
Revenue Cycle Solutions Consulting and Management Services Clinical Documentation Improvement: Best Practice Our mission: To help you finance yours. 2 Managing Your Audio Use Telephone Use Microphone and
June 12, Dear Dr. McClellan:
June 12, 2006 Mark McClellan, MD, PhD Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1488-P PO Box 8011 Baltimore, Maryland 21244-1850 Dear
General Background of CDI
Clinical Documentation Improvement The Physician Champion ILHIMA 04/30/16 1 General Background of CDI 2 1 CMS Federal Register August 2008 Final Rule (CMS-1533-FC page 208) We do not believe there is anything
Appendix A WORK PROCESS SCHEDULE AND RELATED INSTRUCTION OUTLINE. Clinical Documentation Improvement Specialist Apprenticeship
Appendix A WORK PROCESS SCHEDULE AND RELATED INSTRUCTION OUTLINE Clinical Documentation Improvement Specialist Apprenticeship O*NET-SOC CODE: 29-2071.00 RAPIDS CODE: 2026CB Type of Training: Competency-based
Performance Measurement Work Group Meeting 10/18/2017
Performance Measurement Work Group Meeting 10/18/2017 Welcome to New Members QBR RY 2020 DRAFT QBR Policy Components QBR Program RY 2020 Snapshot QBR Consists of 3 Domains: Person and Community Engagement
ramping up for bundled payments fostering hospital-physician alignment
REPRINT May 2016 Angie Curry James P. Fee healthcare financial management association hfma.org ramping up for bundled payments fostering hospital-physician alignment AT A GLANCE When hospitals embark on
ICD-10 Frequently Asked Questions for Providers Q Updates
ICD-10 Frequently Asked Questions for Providers Q4 2012 Updates What is ICD-10? International Classification of Diseases, 10th Revision (ICD-10) is a diagnostic and procedure coding system endorsed by
Preventable Readmissions Payment Strategies
Preventable Readmissions Payment Strategies 3M 2007. All rights reserved. Strategy to reduce readmissions and increase quality needs to have the following elements A tool to identify preventable readmissions
Medicare Spending and Rehospitalization for Chronically Ill Medicare Beneficiaries: Home Health Use Compared to Other Post-Acute Care Settings
Medicare Spending and Rehospitalization for Chronically Ill Medicare Beneficiaries: Home Health Use Compared to Other Post-Acute Care Settings Executive Summary The Alliance for Home Health Quality and
Medicare Spending and Rehospitalization for Chronically Ill Medicare Beneficiaries: Home Health Use Compared to Other Post-Acute Care Settings
Medicare Spending and Rehospitalization for Chronically Ill Medicare Beneficiaries: Home Health Use Compared to Other Post-Acute Care Settings May 11, 2009 Avalere Health LLC Avalere Health LLC The intersection
Managing Patients with Multiple Chronic Conditions
Best Practices Managing Patients with Multiple Chronic Conditions Dartmouth-Hitchcock Physicians Case Study Organization Profile Headquartered in Bedford, New Hampshire, Dartmouth-Hitchcock is a large
Payments for Death-Related One-Day Inpatient Admissions. M e dicaid Progra m Department of Health
New York State Office of the State Comptroller Thomas P. DiNapoli Division of State Government Accountability Payments for Death-Related One-Day Inpatient Admissions M e dicaid Progra m Department of Health
DC Inpatient APR-DRG Payment for Acute Care Hospitals
DC Inpatient APR-DRG Payment for Acute Care Hospitals Provider Training 2014 Xerox Corporation. All rights reserved. Xerox and Xerox Design are trademarks of Xerox Corporation in the United States and/or
from disparate data to informed strategies using technology to transform quality, costs, and the patient experience
WEB FEATURE EARLY EDITION February 2018 Jennie D. Dulac Walter W. Morrissey healthcare financial management association hfma.org from disparate data to informed strategies using technology to transform
Medicaid Hospital Rate Advisory Group
Medicaid Hospital Rate Advisory Group Wisconsin Department of Health Services Division of Health Care Access and Accountability Bureau of Fiscal Management October 16, 2012 1 Agenda 1. Introduction and
BCBSM Physician Group Incentive Program
BCBSM Physician Group Incentive Program Organized Systems of Care Initiatives Interpretive Guidelines 2012-2013 V. 4.0 Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee
HIMSS 2011 Implementation of Standardized Terminologies Survey Results
HIMSS 2011 Implementation of Standardized Terminologies Survey Results The current healthcare climate, with rising costs and decreased reimbursement, necessitates fiscal responsibility. Elements of the
Quality ID #348: HRS-3 Implantable Cardioverter-Defibrillator (ICD) Complications Rate National Quality Strategy Domain: Patient Safety
Quality ID #348: HRS-3 Implantable Cardioverter-Defibrillator (ICD) Complications Rate National Quality Strategy Domain: Patient Safety 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE:
Session 6 PD, Mitigating the Cost Impact of Trends in Hospital Billing Practices. Moderator/Presenter: Sabrina H.
Session 6 PD, Mitigating the Cost Impact of Trends in Hospital Billing Practices Moderator/Presenter: Sabrina H. Gibson, FSA, MAAA Presenters: Dawna Nibert Lawrence R. Smart, FSA, MAAA Society of Actuaries
Hospital Inpatient Quality Reporting (IQR) Program
FY 2018 Inpatient Prospective Payment System (IPPS) Proposed Rule Acute Care Hospital Quality Reporting Programs Overview Questions & Answers Moderator Candace Jackson, RN Project Lead, Hospital Inpatient
Program Selection Criteria: Bariatric Surgery
Program Selection Criteria: Bariatric Surgery Released June 2017 Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies. 2013 Benefit Design Capabilities
Quality of Care of Medicare- Medicaid Dual Eligibles with Diabetes. James X. Zhang, PhD, MS The University of Chicago
Quality of Care of Medicare- Medicaid Dual Eligibles with Diabetes James X. Zhang, PhD, MS The University of Chicago April 23, 2013 Outline Background Medicare Dual eligibles Diabetes mellitus Quality
Pay-for-Performance. GNYHA Engineering Quality Improvement
Pay-for-Performance GNYHA Engineering Quality Improvement The Writing Is On The Wall IOM Report - Rewarding Provider Performance: Aligning Incentives In Medicare 9/21/06 Medicare P4P and quality improvement
Clinical Documentation Improvement
Clinical Documentation Improvement Measures, Models, and Multi-facilities Patty Dietz RN, BSN, CPHQ Midas+ Solutions Consultant Sara Wagner MHA Business Analyst The Ohio State University Wexner Medical
Emergency Department Facility Coding and Billing
Emergency Department Facility Coding and Billing The Basics of Facility Coding A Historical View of Hospital Coding and Reimbursement for ED Services E/M Visit Level Coding ED Procedure Coding Payment
Pricing and funding for safety and quality: the Australian approach
Pricing and funding for safety and quality: the Australian approach Sarah Neville, Ph.D. Executive Director, Data Analytics Sean Heng Senior Technical Advisor, AR-DRG Development Independent Hospital Pricing
Outpatient Hospital Facilities
Outpatient Hospital Facilities Chapter 6 Chapter Outline Introduce students to 1. Different outpatient facilities 2. Different departments involved in the reimbursement process 3. The Chargemaster 4. Terminology
The Center for Medicare & Medicaid Innovations: Programs & Initiatives
The Center for Medicare & Medicaid Innovations: Programs & Initiatives Rob Stone, Esq. American Health Lawyers Association Institute on Medicare & Medicaid Payment Issues March 30-April 1, 2012 CMMI Mission
Risk Adjusted Diagnosis Coding:
Risk Adjusted Diagnosis Coding: Reporting ChronicDisease for Population Health Management Jeri Leong, R.N., CPC, CPC-H, CPMA, CPC-I Executive Director 1 Learning Objectives Explain the concept Medicare
Definitions/Glossary of Terms
Definitions/Glossary of Terms Submitted by: Evelyn Gallego, MBA EgH Consulting Owner, Health IT Consultant Bethesda, MD Date Posted: 8/30/2010 The following glossary is based on the Health Care Quality
Summary and Analysis of CMS Proposed and Final Rules versus AAOS Comments: Comprehensive Care for Joint Replacement Model (CJR)
Summary and Analysis of CMS Proposed and Final Rules versus AAOS Comments: Comprehensive Care for Joint Replacement Model (CJR) The table below summarizes the specific provisions noted in the Medicare
Sharpen coding skills and reimbursement strategies during ICD-10 delay The Centers for Medicare & Medicaid Services (CMS) once again has extended the
Ambulatory Surgery Centers Sharpen coding skills and reimbursement strategies during ICD-10 delay The Centers for Medicare & Medicaid Services (CMS) once again has extended the deadline to begin using
Reimbursement for Non-Invasive Respiratory Support in Hospital Inpatient, Emergency Department and Other Outpatient Settings 1
2400 Beacon St., #203, Chestnut Hill, MA 02467 617-645-8452 Reimbursement for Non-Invasive Respiratory Support in Hospital Inpatient, Emergency Department and Other Outpatient Settings 1 The purpose of
Bundled Episode Payment & Gainsharing Demonstration
Bundled Episode Payment & Gainsharing Demonstration Tom Williams, Dr.PH, Integrated Healthcare Association (IHA) Principal Investigator AHRQ Grantees Meeting September 9, 2013 Project Objectives Test feasibility/scalability
Ongoing Professional Practice Evaluation
Office of Origin: Medical Staff Office I. PURPOSE The purpose of Ongoing Professional is to provide detailed information on the professional practice and related activities of practitioners with privileges
Reducing Readmissions: Potential Measurements
Reducing Readmissions: Potential Measurements Avoid Readmissions Through Collaboration October 27, 2010 Denise Remus, PhD, RN Chief Quality Officer BayCare Health System Overview Why Focus on Readmissions?
Surgical Care for the Underserved: US We have our own problems
Surgical Care for the Underserved: US We have our own problems Gregg Marshall Grand Rounds February 27, 2012 Outline Introduction US Statistics Underserved populations in the US Global Health Lack of infrastructure
Surgical Precision in Clinical Documentation Connects Patient Safety, Quality of Care, and Reimbursement
Surgical Precision in Clinical Documentation Connects Patient Safety, Quality of Care, and Reimbursement by Benjamin J. Kittinger, MD; Anthony Matejicka II, DO; and Raman C. Mahabir, MD Abstract Emphasis
ICD-10: Capturing the Complexities of Health Care
ICD-10: Capturing the Complexities of Health Care This project is a collaborative effort by 3M Health Information Systems and the Healthcare Financial Management Association Coding is the language of health
Fred Modell Diana Puente Vicki Modell
From genotype to phenotype. Further studies measuring the impact of a Physician Education and Public Awareness Campaign on early diagnosis and management of Primary Immunodeficiencies Fred Modell Diana
CMS 30-Day Risk-Standardized Readmission Measures for AMI, HF, Pneumonia, Total Hip and/or Total Knee Replacement, and Hospital-Wide All-Cause Unplanned Readmission 2013 Hospital Inpatient Quality Reporting
Inpatient Hospital Rates Rebasing Report
This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp Inpatient Hospital
Emerging Models of Care Delivery Christy Mokrohisky Ex. Dir. of PI & Emerging Models
Emerging Models of Care Delivery Christy Mokrohisky Ex. Dir. of PI & Emerging Models 1 Sacred Encounters Perfect Care Healthiest Communities St. Joseph Heritage Healthcare Founded in 1994 Manage 7 Medical
Frequently Asked Questions (FAQ) Updated September 2007
Frequently Asked Questions (FAQ) Updated September 2007 This document answers the most frequently asked questions posed by participating organizations since the first HSMR reports were sent. The questions
Appendix A WORK PROCESS SCHEDULE AND RELATED INSTRUCTION OUTLINE. Clinical Documentation Improvement Specialist Apprenticeship
Appendix A WORK PROCESS SCHEDULE AND RELATED INSTRUCTION OUTLINE Clinical Documentation Improvement Specialist Apprenticeship O*NET-SOC CODE: 29-2071.00 RAPIDS CODE: 2026CB Type of Training: Competency-based