Prior to 1983, Medicare reimbursed based on actual charges that inpatient healthcare facilities billed (often referred to as “fee-for-service” payments). The more tests, procedures, and services ordered by physicians, the more an organization was paid. This created the potential for unnecessary...Read More »
Although bundled payment programs have the potential to generate data that can be used to reduce costs and improve the Medicare program, the overall pool of participants and the design of voluntary bundled payment programs may reduce the value of the data and the programs overall, U.S. GAO said...Read More »
This FAQ was created by the authors of the ACDIS/AHIMA “Guidelines for Achieving a Compliant Query Practice (2019 Update),” to provide additional clarity.Read More »
Q: I have a question about DRG 963. I’ve heard that we need three different trauma diagnoses from at least two different body site categories for this DRG. The DRG Expert has a list of all diagnoses under DRG 963, but it doesn’t...Read More »
For many years now, healthcare reimbursement has been based not only on whether care was provided but on how well that care was provided and the patient’s outcome following that care.
While the premise for quality programs is largely the same across the board—measure the quality of care...Read More »
According to a recent survey conducted jointly by ACDIS and its partner 3M, 47% of 575 total respondents indicated they have a concurrent program in which CDI specialists and...Read More »
According to this year’s CDI Week Industry Survey, only 10.38% of respondents (most of whom work in inpatient settings) don’t review for quality measures, continuing a year-over-year decline. For most folks on the inpatient side of the CDI world, reviewing for quality isn’t an expansion area...Read More »
Sepsis is a common clinical finding in patients admitted to the hospital. Documenting the presence of sepsis is critical to best determine each individual patient’s needs for care. However, clinicians often vary in their definitions of sepsis or fail to note the presence of sepsis in the medical...Read More »
