Health Information Management

CDI specialists play vital role in capturing pay for performance measures

HIM-HIPAA Insider, May 11, 2015

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Since the implementation of the Hospital Value-Based Purchasing (HVBP) Program in 2013, CMS has adjusted the MS-DRG payment for each traditional Medicare discharge. The type and amount of the adjustment, which could be a financial penalty and/or an incentive payment, is determined by the hospital's performance for defined quality measures, such as risk-adjusted mortality. Since that time, the number of pay for performance (P4P) programs and quality measures has expanded. By 2017, P4P payment adjustments will impact up to 6% of traditional Medicare revenue.

 
Why is this relevant to the coding and CDI teams? Because many of the P4P measures are claims based, the performance for claims-based measures is derived from diagnosis codes submitted on claims.
 
The CDI specialists are the subject matter experts on accurate and complete assignment of diagnoses, and provider documentation requirements to support code assignment. The CDI team must understand CMS P4P measures in order to improve data quality.
 
The types of diagnoses that can impact these measures are typically chronic conditions, many of which have been off the radar in the inpatient acute care setting, such as restless leg syndrome or loss of weight.
 
Continue reading "CDI specialists play vital role in capturing pay for performance measures" on the HCPro website. Subscribers to Medical Records Briefing have free access to this article in the May issue.



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