Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Practice Exam

CPC Practice Exam and Study Guide Package

Practice Exam

What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

CPC Exam Review Video

Laureen shows you her proprietary “Bubbling and Highlighting Technique”

Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page

Practice Exam

2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

MIPS Performance Feedback Errors Will Cost Clinicians Dearly

Clinicians have until October 1 to review their 2017 Merit-based Incentive Payment System (MIPS) final score and performance feedback and, if applicable, request a targeted review by the Centers for Medicare & Medicaid Services (CMS). Immediate Action Required Eligible clinicians who participated in MIPS should review their MIPS final score and performance feedback, available on […]
AAPC Knowledge Center

2019 Performance Requirements for 2021 Medicare Payments

Medical professionals and other stakeholders have until September 10 to make a difference in the course of future healthcare reforms. Tucked into a proposed rule to update the Medicare Physician Fee Schedule for 2019, released for public inspection on July 12, the Centers for Medicare & Medicaid Services (CMS) proposes policy changes for Year 3 of the Quality Payment Program […]
AAPC Knowledge Center

Has your CDI program shifted its focus for optimal PSI 15 performance?

Has your CDI program shifted its focus for optimal PSI 15 performance?

by Shannon Newell, RHIA, CCS, and AHIMA-approved ICD-10-CM/PCS trainer

The recent adoption of a refined version of the Patient Safety Indicator (PSI) 90 composite by the Agency forHealthcare Research and Quality (AHRQ) has a significant impact on what discharges are included in PSI 15 (Unrecognized Abdominopelvic Accidental Puncture Laceration Rate).

Your clinical documentation improvement (CDI) program has likely focused on this measure due to the well-established challenges associated with accurate reporting of procedure-related accidental puncture/lacerations. Given the changes to PSI 15, should your CDI team shift its focus to promote and support accurate data integrity for this measure? Let’s take a look.

A fundamental understanding of patient safety indicator measures

Optimal data integrity for PSIs requires that we have the appropriate clinical documentation and reported ICD-10 codes to accurately reflect the following:

  • The numerator: The numerator for PSI 15, also called the "outcome of interest," reports the actual number of cases which experienced the accidental puncture/laceration.
  • The denominator: The denominator for PSI 15, also called the "cohort," establishes the population which is screened to identify the outcome of interest.
  • Risk adjustment: Denominator comorbidities, which have a statistically demonstrated impact on the likelihood of a patient incurring the patient safety event. The risk adjustment methodology establishes the expected number of discharges with the outcomes of interest.

 

The inputs above?numerator, denominator, risk adjustment?are used to calculate our observed over expected performance. CMS compares our performance to that reported by other hospitals, and our reimbursement may be then impacted if we do not appear to manage patients well.

For example, in the Hospital Acquired Condition Reduction program, if our performance for PSI 90 does not meet established thresholds, then our Medicare fee-for-service reimbursement is reduced by 1% the next CMS fiscal year (October 1?September 30) for every claim we submit.

 

The new PSI 15?what counts?

The revised measure specifications for PSI 15 have altered the numerator (outcome of interest). The denominator, or cohort?which represents the population at risk?has also undergone a noteworthy change).

The revised numerator and denominator greatly narrow the pool of discharges screened for accidental punctures or lacerations as well as those flagged with outcomes of interest.

From a CDI perspective, the likelihood of incorrectly reporting accidental puncture or laceration for the discharges included in the newly defined measure is greatly diminished.

 

PSI 15: Are you focused on risk adjustment?

Given that our performance for PSI 15 is assessed using our observed over expected rate of procedure related accidental puncture or lacerations, the CDI team’s focus may be better spent on strengthening the capture of comorbidities relevant to risk adjustment.

The AHRQ risk adjustment methodology looks for multiple comorbidities to calculate the predicted likelihood of accidental punctures/lacerations for each discharge.

The revision to the discharges included in the narrowed cohort has also impacted which comorbidities affect risk adjustment. This makes sense given that these comorbidities must be clinically relevant to the numerator and denominator. The number of comorbid categories has been reduced from 13 to 11. Some of the categories remain the same, some have been deleted, and new ones have been added.

 

Summary

Keeping abreast of revisions to claims-based measures is an expanded responsibility for today’s CDI program. These measures impact both reimbursement and quality profiles. Positioned with this information, the CDI program can then shift efforts to promote and support clinical documentation capture and accurate reporting of codes associated with areas of the greatest vulnerability and impact.

 

 

Editor’s note:

Newell is the director of CDI quality initiatives for Enjoin. She has extensive operational and consulting expertise in coding and clinical documentation improvement, performance improvement, case management, and health information management. You can reach Newell at (704) 931-8537 or [email protected]. Opinions expressed are that of the author and do not represent HCPro or ACDIS.

HCPro.com – Briefings on Coding Compliance Strategies

Preliminary MIPS Performance Data Available

Clinicians who participated in the Merit-based Incentive Payment System (MIPS) last year can now access preliminary performance feedback data. The final MIPS scores and feedback data for 2017 will be available in July. Clinicians can access their performance feedback and scores with their Enterprise Identity Data Management (EIDM) credentials on the Quality Payment Program website. Between […]
AAPC Knowledge Center

Measure Your HEDIS Performance in 2018

Providers educated on new measures ensure accurate and updated patient health status. Written by: Meera Mohanakrishnan, MS, CPC, COC, CPC-P, CRC, CPC-I, CCS More than 90 percent of health plans use Healthcare Effectiveness Data and Information Set (HEDIS) to measure healthcare and service performance from overuse and appropriateness to chronic condition management. For 2018, the […]
AAPC Knowledge Center

Plan for Quality Performance in 2018

The first performance year of the Merit-based Incentive Payment System (MIPS) has come to a close — the last day to submit data to the Centers for Medicare & Medicaid Services (CMS) was March 31. Unlike last year, eligible clinicians need to report a full year of quality data for 2018. There’s no time to […]
AAPC Knowledge Center

Indicator For Medical Operations – Assessing the Performance

An indicator for medical operations is a system that is especially designed to deal with the management structure in medical organizations. This assists clinics as well as the doctors so that they can assess well the performance in relation to the procedures. Most organizations including the health care industry implement a particular form of administration system which is usually about the inventory, accounting and sales systems. There may be other aspects included here but the most important thing is that there is consistency in every process to accomplish most favorable care excellence.

Typically the medical KPIs are incorporated into the system so that they can be some sort of software application. Generally, medical service focuses on four different areas which involve emergency services, monetary aspects, patient approval and facilities. There are a number of key indicators that can be used here depending on the factor that is considered as the central point. You can include the indicator for the cutback in the number of deaths brought about by medical abandon, elimination of demise after surgery and decrease in number of patients that are readmitted as a result of lacking care quality.

Even though these areas are considered as minute by many people, you can hypothesize that by taking them one by one, a company will be able to achieve its purposes. When it comes to patient satisfaction indicator for medical operation, the focal point here is given to the clinic’s relationship with the customers. To ensure that the company will reach its goal of becoming the prime choice of customers, it is imperative that the personnel and everyone behind the organization should work hard to build up the credibility.

When it comes to the emergency services, this pertains to the ability of the clinic or the medical institution to respond to different kinds of emergencies. This way, the people will continuously support the efforts of the organization because it is apparent that they are concerned about the importance of their clients. Actually, there is a great need for organizations to prioritize their patients and their needs since this is what medical firms are all about. They are created to cater to the demands of the public by providing quality service especially when it is called for.

Monetary aspects are also important since the clinic will not be able to survive without money. However, it is important for institutions to ensure that every activity that they perform is organized and well planned. With this, they can save from the expensive issues that they have to deal with. Lastly, the facilities that they are offering should be first rate and usable. A hospital should bear in mind that they are helping people live and thus, they have to consider the amenities that they provide.

The performance of the medical companies should prove to be very effective so that the care that they provide will be deemed as quality service. The indicator for medical operations is believed to be a great help in the mission of the organization to be a good service provider.

If you are interested in Indicator for Medical, check this web-site to learn more about medical KPIs.

It’s Not Too Early to Prepare for a MIPS Performance Data Audit

Beginning in 2019 the level of reimbursement from Medicare to many physicians will be determined in part by their performance in the Merit-based Incentive Payment System (MIPS).  Medicare will award a higher level of payment to those eligible clinicians and groups who report that they have successfully met certain criteria for Quality, Advancing Care Information, and clinical practice Improvement Activities.  MIPS is the successor program to the Physician Quality Reporting System (PQRS) and Meaningful Use of Electronic Health Records (MU-EHR) incentive programs, and CMS (the Centers for Medicare and Medicaid Services) has indicated that it will continue its practice of auditing the data submitted by practices just as they did under the earlier programs.  As this article in Healthcare IT News illustrates, the result of failing an audit will be non-payment of expected incentives (in the case of a pre-payment audit) or returning of funds already paid and possibly even federal sanctions depending on the severity of the infraction. 


Radiology Billing and Coding Blog

It’s Not Too Early to Prepare for a MIPS Performance Data Audit

Beginning in 2019 the level of reimbursement from Medicare to many physicians will be determined in part by their performance in the Merit-based Incentive Payment System (MIPS).  Medicare will award a higher level of payment to those eligible clinicians and groups who report that they have successfully met certain criteria for Quality, Advancing Care Information, and clinical practice Improvement Activities.  MIPS is the successor program to the Physician Quality Reporting System (PQRS) and Meaningful Use of Electronic Health Records (MU-EHR) incentive programs, and CMS (the Centers for Medicare and Medicaid Services) has indicated that it will continue its practice of auditing the data submitted by practices just as they did under the earlier programs.  As this article in Healthcare IT News illustrates, the result of failing an audit will be non-payment of expected incentives (in the case of a pre-payment audit) or returning of funds already paid and possibly even federal sanctions depending on the severity of the infraction. 


Radiology Billing and Coding Blog