Health Information Management

Take a high level look CMS’ PSI 90

HIM-HIPAA Insider, April 13, 2015

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Since the implementation of the Hospital Value-Based Purchasing Program (HVBP) 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 team? 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 team members are the subject matter experts on the accurate and complete assignment of diagnoses, and on the provider documentation requirements to support code assignment. The CDI team must understand CMS P4P measures in order to improve data quality.
Continue reading "Take a high level look CMS' PSI 90" on the HCPro website. Subscribers to Briefings on Coding Compliance Strategies have free access to this article in the April issue.

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