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Posts Tagged ‘ICD-10’

Medicare Audit Improvement Act of 2015 Proposes Revised RAC Audits Just in time for ICD-10

Tuesday, May 19th, 2015

Both sides of the isle in Washington DC believe that the current approach of auditing health care providers needs to be changed.   Recently, representatives Sam Graves (R-MO) and Adam Schiff (DCA) introduced HR 2156, the Medicare Audit Improvement Act of 2015.  This legislation proposes changes to the Recovery Audit Contractor (RAC) program from a bounty hunter approach to a flat fee.  Auditors would also be held accountable for poor performance.  The hope is that this will make RAC audits more reasonable instead of being overly invasive and overzealous.  The RAC audit practice combined with Meaningful Use audits has been a doubly serious audit process for many providers.

The bill would, if passed accomplish these changes:

  • Require RACs to make inpatient claims decisions using exactly the same information the physician had when treating the patient, not information that becomes available after the patient leaves the hospital.
  • Hold RACs more accountable by setting payments to RACs at lower rates if there is poor RAC performance due to high rates of incorrect denials;
  • The bill would eliminate the current RAC contingency fee structure. Instead, the bill would direct the Centers for Medicare & Medicaid Services (CMS) to pay RACs flat fees to reduce the financial incentive for overzealous auditing practices;
  • Set an improved and more transparent method to calculate RACs total appeal overturn rates;
  • Fix CMS’s unfair rebilling rules by allowing hospitals to rebill claims when appropriate;

This bill is timely.  The shift to ICD-10 will create more opportunities for audits in documenting the patient condition and entering diagnosis and procedure codes, and may cause some shifts in reimbursement.  Therefore RAC auditors would be incentivized to do what is reasonable rather than opportunistic.

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HIMSS 2015 Conference Announces Nursing Informatics Study Results

Monday, April 13th, 2015

Nursing informatics (NI) is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. NI supports consumers, patients, nurses, and other providers in their decisionmaking in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology.

Today April 13th, at the HIMSS Annual Conference and Exhibition in Chicago, HIMSS released the results of the 2015 Impact of the Informatics Nurse Survey – a survey of nearly 600 participants including C-suite executives, clinical analysts and informatics nurses. The survey examined the growing technology-driven healthcare ecosystem and the role nursing informatics – a specialty that integrates knowledge, data and wisdom – is playing in this evolving environment. The results indicated that the role of informatics nurses has expanded greatly and is having immense impact on patient safety and overall care, as well as notable workflow and productivity improvements.

This year’s survey, supported by the HIMSS Nursing Informatics Community, found that 60 percent of respondents believe that informatics nurses have a high degree of impact on the quality of care provided to patients. The survey also showcased that the majority of respondents claim that their organization had hired an informatics professional in a leadership capacity. Moreover, 20 percent of respondents reported employing a Chief Nursing Information Officer (CNIO) at the leadership helm.  

“The 2015 Impact of the Informatics Nurse Survey showcases the positive influence informatics nurses are having on improved quality and efficiency of patient care,” said Joyce Sensmeier, Vice President of Informatics for HIMSS. “We are going to continue to see the role and use of technology expand in healthcare and the demand for nurses with informatics training will grow in parallel. As clinicians further focus on transforming information into knowledge, technology will be a fundamental enabler of future care delivery models and nursing informatics leaders will be essential to this transformation.”

As healthcare provider organizations look to build upon their electronic health record (EHR) solution in order to leverage data analytics and population health management tools to transition to a true learning health system, nurses will continue to play an important role in the process. Key findings from the survey reinforce that participants believe that informatics nurses bring value to the implementation phase (85 percent) and optimization phase (83 percent) of clinical systems processes. These numbers are a clear indicator that the informatics specialty is a critical part of evolving healthcare organizations.     

The survey results also found that informatics nurses are beginning to play a critical role in ensuring user acceptance (75%) and the appropriate adoption of emerging technologies. In fact, 70 percent of respondents agreed that nurses play an important role in medical device integration. It is clear that informatics nurses will continue to be instrumental players in the analysis, implementation, and optimization of advanced information systems and emerging technologies that aim to improve the quality of patient care, while reducing costs.

Nursing informatics will be increasingly important to help manage and communicate new information regarding quality measures and data standards such as HITECH Act mandated Clinical Quality Measures (CQMs), ICD-10 diagnosis and procedure codes and HCC codes used for risk adjustment of Medicare Advantage and Accountable Care Organization populations.

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