how cdi programs result in quality coded datacampus.ahima.org/audio/2009/rb021909.pdf · acute or...

© Copyright 2009 American Health Information Management Association. All rights reserved.

How CDI Programs Result in Quality Coded Data

Audio Seminar/Webinar February 19, 2009

Practical Tools for Seminar Learning

Disclaimer

AHIMA 2009 Audio Seminar Series • http://campus.ahima.org/audio American Health Information Management Association • 233 N. Michigan Ave., 21st Floor, Chicago, Illinois

i

The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service. As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments.

Faculty

AHIMA 2009 Audio Seminar Series ii

Amy Gardner, RHIT

Amy Gardner, RHIT, is a cardiovascular services documentation specialist with Deaconess Medical Center in Spokane, WA. Ms. Gardner has over 16 years of experience in the HIM profession, with an emphasis on coding in all areas. She has also written courses for AHIMA.

Contact info: [email protected]

Marilyn Jones, MBA, MN, RN, CCS

Marilyn Jones, MBA, MN, RN, CCS, is a manager with KPMG’s Healthcare Forensic group in Atlanta, GA. Ms. Jones has over 25 years of nursing and healthcare consulting experience, including documentation improvement and compliance in the acute healthcare setting. Prior to consulting she was a nursing director at a university teaching hospital and practiced as a legal nurse consultant at a major law firm.

Contact info: [email protected]

Table of Contents

AHIMA 2009 Audio Seminar Series

Disclaimer ..................................................................................................................... i Faculty ......................................................................................................................... ii Objectives ..................................................................................................................... 1 What is a CDIP? ............................................................................................................. 1 Who Participates? .......................................................................................................... 2 Documentation Specialists .............................................................................................. 2 Necessary Skills for DS (Documentation Specialists) .......................................................... 3 Physician Participation .................................................................................................... 3 Other Participants: ......................................................................................................... 4 Potential “Types” of CDIPs ........................................................................................... 4-5 Is one program type better than another? ........................................................................ 5 Communicating Documentation Needs ............................................................................. 6 Education of Physicians ............................................................................................... 6-7 Changes to DRGs ........................................................................................................... 7 How have MS-DRGs affected documentation? ................................................................... 8 Examples of MCCs .......................................................................................................... 8 ESRD…Implications ........................................................................................................ 9 Quality Measures ........................................................................................................... 9 Vaccination Standards ................................................................................................... 10 RACs and CDIPs ............................................................................................................ 10 POA and HACs .............................................................................................................. 11 HACs ....................................................................................................................... 11 Queries ....................................................................................................................... 12 Expansion Opportunities ................................................................................................ 13 Benefits of CDIP ............................................................................................................ 13 How Current Healthcare Initiatives and Economic Events

Are Impacting Hospitals and the Need for CDI Programs ...................................... 14 The Economic Crisis: Impact on Hospitals................................................................... 14-15 Healthcare Reform ................................................................................................... 15-18 Medicare Reform Initiatives ....................................................................................... 19-23 Medicaid Reform Initiatives ............................................................................................ 24 Value-based Purchasing (VBP) ................................................................................... 25-30 Hospital and Physician Profiling ................................................................................. 30-31 Clinical Documentation Improvement Programs ............................................................... 32 Resource/Reference List ................................................................................................ 33

Audio Seminar Discussion and Audio Seminar Information Online ................................. 33-34 Upcoming Audio Seminars ............................................................................................ 34 Thank You/Evaluation Form and CE Certificate (Web Address) .......................................... 35

Appendix .................................................................................................................. 36 Resource/Reference List ....................................................................................... 37 Resources CE Certificate Instructions


AHIMA 2009 Audio Seminar Series 1

Notes/Comments/Questions

Objectives

Review how clinical documentation improvement programs (CDIP) result in accurate and complete coded dataSummarize how accurate coded data is critical to healthcare delivery, research, public reporting, reimbursement, and policy-makingReview effective CDI methods that ensures complete, clear, and accurate health record documentation for complete and accurate coding

1

What is a CDIP?

Definition of CDIP:• Clinical Documentation Improvement

Program• Importance of a CDIP

2




Who Participates?

Documentation SpecialistsPhysicians, Mid-Levels (ARNPs, PAs)Nursing Staff• Other Ancillary Staff

3

Documentation Specialists

Who are they?• RHITs, RHIAs, CCSs

• Education in coding and HIM skills– Ability to learn clinical knowledge

• RNs• Clinical Knowledge

– Ability to learn coding skills

4




Necessary Skills for DS (Documentation Specialists)

Understanding of Clinical Disease processes• Anatomy and Physiology• Coding Skills• Ability to communicate effectively

• Verbal and Written

• Confidence

5

Physician Participation

Why do we need their support?• Creating Credibility • Improvement in Documentation• Better Profiles• Achieving results in CMS requirements

6




Other Participants:

Nursing staff• Other Ancillary Patient Care Staff

• PT• OT• Dietary

– Assist with BMI documentation

7

Potential “Types” of CDIPs

Case Management Program• Typically RN only focus

• Relies on Case Managers to perform concurrent medical record review

• Incorporates concurrent DRG assignment with daily duties of discharge planning for patients

8




Potential “Types of CDIPs” (Cont.)

HIM Programs• Utilizes RHITs/RHIAs/CCSs with strong

emphasis on coding background• Also utilizes RNs

9

Is one program type better than another?

Choose what works best for your facility…• Both “types” of programs utilize

Inpatient Coders

Decide how to approach your medical staff • Define your mission and goals

10




Communicating DocumentationNeeds

How to communicate with physicians• Creating a level of physician “buy-in”

• Specificity needs

11

Education of Physicians

Best Method of Education• Written• Verbal • Group Presentations

• Show results/outcomes• Encourage participation and question and

answer sessions

12




Education of Physicians (Cont.)

Say it once, say it twice…• Is one conversation enough to help

physician to understand?• Remember to present hard facts

• Coding Clinics• Fliers with information

– Education for documentation specificity requirements

13

Changes to DRGs

October 1, 2008• DRGs to MS-DRGs• Most expansive change since original

inception of DRGs

14




How have MS-DRGs affected documentation?

MCCs• Major Complications/Co-morbidities

• What is the importance?– Why CCs vs. MCCs?

15

Examples of MCCs

Acute or Acute on Chronic CHF• Systolic vs. Diastolic

Renal Failure• Acute Renal Failure• Chronic Kidney Disease

– Stages 1-5

Decubitus Ulcers– Importance of clear documentation of the stages

16




ESRD…Implications

ESRD benefits provided under Medicare RulesImportance of documentation/acknowledgement of this disease

17

Quality Measures

How can DS’s help meet standards?• Heart Failure Measures• Myocardial Infarction Measures• Pneumonia• SCIP

• Concurrent Review to meet standards– Models for concurrent review:

– Who performs this review

18




Vaccination Standards

Meeting Pneumonia and Flu Vaccination Requirements • Who requires this vaccination standard?

• Methods for achieving these standards

19

RACs and CDIPs

How can a CDIP help with RACs?• Considerations

• Players involved

20




POA and HACs

Improving documentation for POAImproving documentation for HACs• Defining the need for specificity to

physicians • Importance of clarity in record for coding

staff

21

HACs

Importance in UTI clarification• Foley vs. UTI

• Pressure Ulcers• Diabetic Ketoacidosis

22




Queries

AHIMA Practice Brief on Queries• Reason for queries• Should the DS( Documentation

Specialist) query for everything• Pick and choose when to query

23

Queries (Cont.)

Written queries• Concurrent vs. Post discharge

• What information to include• To lead or not to lead or just the facts…

24




Expansion Opportunities

Potential for Documentation Specialists:• Growth• Education• Membership in Associations

25

Benefits of CDIP

Specificity in DocumentationBetter ProfilesCMS CORE measure standards metImproved Physician/Mid-Level communicationImproved ability to code/bill more efficiently

26




How Current Healthcare Initiatives and Economic Events Are Impacting Hospitals and the Need for CDI Programs

Economic Crisis Impact on HospitalsHealthcare ReformMedicare Reform InitiativesMedicaid Reform InitiativesValue-based PurchasingHospital and Physician ProfilingClinical Documentation Improvement Programs (CDIP) – The Need Continues

27

The Economic Crisis: Impact on Hospitals

Bad Debt and Charity Care• Rising unemployment• Loss of medical coverage• Slowdown in payment by patients

Access to Credit and Capital Resources• Difficulty in obtaining capital resources• Decreased days cash on hand• Increased cost of borrowing

Negative Investment Income 28




The Economic Crisis: Impact on Hospitals (Cont.)

Housing CrisisDecreased Demand for Hospital and Physician Services• Decline in elective procedures• Decline in admissions

Possible Cuts to Medicaid and Medicare Provider Payments

29

Healthcare Reform

Why is Healthcare Reform Needed?• Healthcare spending in the United States

is 2.3 times higher than in other developed nations1

• Healthcare expenses are projected to increase 83 percent in the next 10 years2

30




Healthcare Reform (Cont.)

• Quality Concerns• Medical Errors

– Approximately 48,000 to 98,000 patient deaths each year3

• Medication Errors– $3.5 billion annually4

• Access Issues • Uninsured Americans5 – 47.0 million • Uninsured for catastrophic healthcare

expenses6 –15.6 million

31


• Medicare Solvency and Beneficiary Impact• Expenditures up from $219 billion in 2000 to

an estimated $486 billion in 2009• Medicare premiums, deductibles, and cost-

sharing are forecasted to consume 28 percent of the average beneficiaries’ Social Security check in 20107

32





What’s New on Capital Hill• President Barack Obama’s selection of

healthcare team• Secretary of Department of Health and Human

Services and Director of a new White House Office on Health Care Reform?

• Jeanne Lambrew, a former aide to President Bill Clinton and a senior fellow at the Center for American Progress – Deputy Director of White House Office of Health Reform

• Director of Centers for Medicare and Medicaid Services (CMS)?

• U.S. Surgeon General?33


Summary of President Obama’s Plan • Estimated cost to implement is significant • Affordable health insurance• Universal coverage is not mandated• Healthcare coverage for all children• Competitive and regulated private system• Establish a National Health Insurance Exchange• Establish a new health insurance plan that would

be available to uninsured as well as small businesses8

34





• Large employer mandate – two options• Contribute to employee health coverage • Contribute to the cost of the public plan

• Expand public payer system• Establish a Small Business Health Tax

Credit • Individual tax credit for premiums• Expand eligibility of Medicaid and the

State Children's Health Insurance Program9

35


Other Healthcare Reform Plans• Senator Edward Kennedy• Senate Finance Chairman Max Baucus • Special Interest Groups are introducing

plans• American Medical Association• American’s Health Insurance Plans• Federation of American Hospitals• American Academy of Family Physicians

36




Medicare Reform Initiatives

Medicare Fee-for-Service Program • Administrative Functional Environment

• Medicare Administrative Contractors (MACs)– Established under the Medicare Prescription Drug

Improvement and Modernization Act of 2003– Focus: customer service, operational excellence, and

financial management– By 2010 to become the central point in CMS’s fee-for-

service program– Replace fiscal intermediaries (FI) and carriers– Nineteen MACs with 15 A/B MACs to process both Part A &

Part B core claims processing operations

37

Medicare Reform Initiatives (Cont.)

MedicareAdministrative

Contractors (MACs)

QualifiedIndependent

Contractors (QICs)

QualityImprovementOrganization

(QIO)

EnterpriseData

Centers (EDCs)

AdministrativeQualified

IndependentContractors(Ad QICs)

Zone ProgramIntegrity Contractors

(ZPICs)

RecoveryAudit

Contractors (RACs)

MedicareSecondary Payer

Recovery Contractor(MSPRC)

Healthcare IntegratedGeneral Ledger

Accounting System(HIGLAS)

BeneficiaryContact

Center (BCC)

38





Functional Contractors• Purpose: To monitor the relationships within the

MAC program• Zone Program Integrity Contractors (ZPICs)

– Find, prevent, and deter waste, fraud, and abuse in Medicare – Seven (7) zones that interacts with a MAC jurisdiction– Perform program integrity functions for Medicare A-D, Durable

Medical Equipment, home health, hospice, and the Medi-Medi program

• Quality Improvement Organization (QIO)– Group of practicing doctors and other health care professionals– Hired to review and improve the care of Medicare beneficiaries– Review complaints regarding quality of health care services

provided to Medicare patients10

39


• Recovery Audit Contractors(RACs)• Demonstration project created by the

Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The Tax Relief and Health Care Act of 2006 made the RAC Program permanent

• Purpose– Find and correct improper Medicare payments paid to

health care providers participating in fee-for-service Medicare

– “Provide information to CMS and Medicare contractors that could help protect the Medicare Trust Funds by preventing future improver payments thereby lowering the Medicare FFS claim payment error rate”11

40





• RACs are paid a contingency fee based on the amount of the overpayments and underpayments that they detect and correct

• California, Florida, and New York were selected as the demonstration states because of there high per capita Medicare consumption

• In 2007, Massachusetts, South Carolina, and Arizona were included in the demonstration project

• RAC demonstration ended March 2008• Goal is to have RACs fully in place by 201012

41


• Four RACs were announced on October 6, 2008 • Diversified Collection Services, Inc. of Livermore,

California, in Region A, initially working in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and New York

• CGI Technologies and Solutions, Inc. of Fairfax, Virginia, in Region B, initially working in Michigan, Indiana, and Minnesota

• Connolly Consulting Associates, Inc. of Wilton, Connecticut, in Region C, initially working in South Carolina, Florida, Colorado, and New Mexico

• HealthDataInsights, Inc. of Las Vegas, Nevada, in Region D, initially working in Montana, Wyoming, North Dakota, South Dakota, Utah, and Arizona

42





• November 4, 2008 Press Release – CMS imposed an automatic stay on the contract work of the four RACs due to a protest filed by two unsuccessful bidders with the Government Accountability Office (GAO). 13

• Protest Resolved • PRG-Schultz, Inc. – subcontractor to HDI,

DCS and CGI in Regions A, B & D• Viant Payment Systems, Inc – subcontractor

to Connolly Consulting in Region C

43


• Results of RAC Demonstration: Cumulative through March 27, 2008• > $1.03 billion of “improper payments” - 96 percent

collected from providers; 4 percent repaid to providers14

44





• Top Overpayment Items for Inpatient Hospitals• Excisional Debridement• Inpatient Rehabilitation Facility (IRF)

services following joint replacement surgery• Heart Failure and Shock• Surgical Procedures in Wrong Setting• Respiratory System Diagnoses with

Ventilator Support• Extensive OR Procedures Unrelated to

Principal Diagnosis15

45


RAC Expansion Schedule

D A

B

Oct. 1,2008

March 1,2009

August 1, 2009 or laterC

16

March 1, 2009

46

*VT, NH, ME, MA, RI, CT (J14) Part A claims (including PartB of A) will not be available for RAC review until August

2009 due to the MAC transition. Part B claims in RI will notbe available for RAC review until August 2009 due to theMAC transition. All other Part B claims are available for

RAC review beginning March 1, 2009.*




Medicaid Reform Initiatives

Medicaid Integrity Program (MIP)• States have the chief responsibility of

controlling fraud in the Medicaid program

• CMS provides oversight, technical assistance, and direction

• Deficit Reduction Act of 2005 established the MIP• Goal: To fight fraud, waste, and abuse in the

Medicaid Program47

Medicaid Reform Initiatives (Cont.)

Medicaid Integrity Group (MIG)• Responsible for implementing and managing the

MIP

• Goals of the MIG• Promote the proper expenditure of MIP funds• Improve program integrity performance nationally• Ensure the operational and administrative excellence of

the MIP• Demonstrate effective use of MIP funds• Foster collaboration with internal and external

stakeholders of the MIP17

48




Value-based Purchasing (VBP)

CMS initiative to align payment policy with the delivery of high quality and efficient care.

49

Value-based Purchasing (Cont.)

Quality Reporting for 2009• To avoid the two percent reduction in the

payment update, hospitals must submit/allow CMS to report quality data

• Thirty quality measures are included in the FY 2009 payment. Topics covered are Acute Myocardial Infarction, Heart Failure, Pneumonia, Surgical Care Improvement Project (SCIP), Mortality & Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

50





Quality Reporting for 2010 • To avoid the two percent reduction in the

payment update, hospitals must submit/allow CMS to report quality data

• Forty-two quality measures are included in the FY 2010 payment

51


New Metrics for 2010• Surgical Care Improvement Project (SCIP)

• SCIP Cardiovascular 2 Surgery – Beta Blocker• Nursing Sensitive Measures – Failure to Rescue• Readmission Measures – Heart Failure Readmission

(Medicare only)• Agency for Healthcare Research and Quality (AHRQ)

Quality Indicators: Inpatient Quality Indicators and Patient Safety Indicators – 9 measures

• Cardiac Surgery Measures – Participation in systematic database for cardiac surgery

• One measure from 2009, PN measure – Oxygenation Assessment, will be retired and not reported by hospitals

52





Quality Reporting for 2011 and Subsequent Years • COPD• Complications of Vascular Surgery – AAA,

Carotid Endarterectomy and Lower Extremity Bypass

• Inpatient Diabetes Care Measures• Healthcare-associated Infections (Central

Line-associated Bloodstream Infections and Surgical Site Infections)

53


• Timeliness of Emergency Care Measures• SCIP Cardiovascular 3 – Beta Blockers• Complications Measures (Medicare

patients) – Healthcare-acquired Conditions (HACs)

• Hospital Inpatient Cancer Care Measures

54





• Serious Reportable Events in Healthcare (“Never Events”)

• Average Length of Stay Coupled with Global Readmission Measure

• Preventable HACs18

55


HACs• Hospital-acquired infections add nearly $5

billion per year to U.S. healthcare costs19

• In 2002, 1.7 million hospital-acquired infections were associated with 99,000 deaths20

• A survey by Leapfrog Group® determined that 85 percent of hospitals did not always follow guidelines to prevent many of the hospital acquired infections21

56





Selection of HACs• High cost• High volume• Results in a higher-paying DRG when existing as

a secondary diagnosis• Condition could reasonably be avoided through

the application of evidence-based guidelines

• Effective October 1, 2008, the higher-weighted DRG is not assigned when a secondary diagnosis listed as a HAC was not present on admission

57


Foreign Object Retained after SurgeryAir EmbolismBlood IncompatibilityCatheter-associated UTIsVascular Catheter-associated InfectionsPressure Ulcers – (Stages III and IV)Falls (complications from)

• Fractures• Dislocations• Intracranial Injury• Crushing Injury• Burns• Electric Shock

Surgical Site Infection, Mediastinitis following CABG

Manifestations of Poor Glycemic Control

• Diabetic Ketoacidosis• Nonketotic Hyperosmolar Coma• Hypoglycemic Coma• Secondary Diabetes with

Ketoacidosis• Secondary Diabetes with

HyperosmolaritySurgical Site Infection following Certain Orthopedic Procedures (Spine, neck, shoulder, elbow)Surgical Site Infection following Bariatric Surgery for Obesity (Laparoscopic gastric bypass, Gastroenterostomy, Laparoscopic gastric-restrictive surgery)Deep-vein Thrombosis and Pulmonary Embolism following Certain Orthopedic Procedures (Total Knee Replacement, Hip Replacement)

HACs Selected – Effective October 1, 2008

58





Candidate HACs• Surgical site infection following device

procedures• Failure to rescue• Death or disability associated with drugs,

devices, or biologics• Dehydration• Malnutrition• Water-borne pathogens• Surgical site infections following procedures –

orthopedic and other• Ventilator-associated pneumonia• Clostridium difficile-associated disease22

59

What is profiling?• Extrapolation of information about hospitals

and/or physicians, based on known dataWhat is being profiled?• Severity of Illness• Expected Risk of Mortality vs. Actual• Quality of Care Measures• Cost Efficiency/Effectiveness• Length of Stay• Readmission Rate• Complication of Medical Care

Hospital and Physician Profiling

60




Hospital and Physician Profiling (Cont.)

Who is Profiling Hospitals and Physicians?• CMS

• VBP Demonstrations and Pilots• VBP Programs• HACs and Present on Admission Indicator

Reporting• Physician Quality Reporting Initiative• Medicare and Medicaid Contractors/Auditors

• State Agencies• The Joint Commission

61

Hospital and Physician Profiling (Cont.)

• Internet profiling sites• HealthGrades®• Leapfrog Group®

• Trade magazines and newspapers• U.S. News & World Report’s Best 100 Hospitals

• Consumers• Employers• Commercial Payers• Managed Care Organizations• Physician Practice Groups• Hospitals

62




Clinical DocumentationImprovement Programs

The need for CDIP continues• Accurate and complete physician documentation

is critical to accurate profiling and appropriate reimbursement in an ever-changing healthcare environment• Implement or revitalize CDIP• Utilize a multidisciplinary approach with your CDIP.

Involve Hospital Administrators, Compliance Directors, Revenue Cycle Managers, Physician Leaders, Health Information Management, Nursing, Case Management and Clinical Documentation Specialists in navigating through healthcare initiatives

63

Clinical Documentation Improvement Programs (Cont.)

• Educate physicians regarding the importance of accurate documentation on public profiling and appropriate reimbursement

• Educate physicians and staff on regulatory reform/initiatives

• Educate coding staff and Clinical Documentation Specialists on new coding guidelines, clinical topics, and medical technology

• Do a risk assessment to determine key areas of vulnerability and determine action steps to correct

• Provide ongoing monitoring, maintenance, and corrective action of your CDIP

64




Resource/Reference List

Kennedy MD, James S., “A Minute for the Medical Staff”, Medical Records Briefing, February 2009: “Define and document acute Kidney injury and chronic kidney disease”Bryant BS, RHIA, RHIT, CCS, Gloryanne, Hirschl BS, CCS, Nancy. “Improve Documentation and coding now, before recovery audit contractors go national in 2010”, Briefings on Coding Compliance Strategies, April 2008Bowman RHIA, CCs, Sue et al., AHIMA, HIM Body of Knowledge, “Managing an Effective Query Process”. Pages 1-9

65

Audio Seminar Discussion

Following today’s live seminarAvailable to AHIMA members at

www.AHIMA.orgClick on Communities of Practice (CoP) – icon on top right

AHIMA Member ID number and password required – for members only

Join the Coding Community from your Personal Page under Community Discussions, choose the Audio Seminar Forum

You will be able to:• Discuss seminar topics • Network with other AHIMA members • Enhance your learning experience




AHIMA Audio Seminars

Visit our Web site http://campus.AHIMA.orgfor information on the 2009 seminar schedule. While online, you can also register for seminars or order CDs, pre-recorded Webcasts, and *MP3s of past seminars.

*Select audio seminars only

Upcoming Seminars/Webinars

Managing the Clinical Documentation Improvement Program (CDIP)March 5, 2009

Coding for HematologyApril 2, 2009

Coding for Multi-System Trauma PatientsApril 9, 2009




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Certificates will be awarded forAHIMA Continuing Education Credit

Appendix


Resource/Reference List ....................................................................................... 37 Resources CE Certificate Instructions

Appendix


Resource/Reference List

http://www.census.gov/prod/2007 pubs/p60-233.pdf

http://www.cms.hhs.gov/HospitalAcqCond/07_EducationalResources.asp#TopOfPage

http://www.reformplans.com/HCR/Comparison-Grid.html

www.cms.hhs.gov/MedicareContractingReform/Downloads/FunctionalEnvironment.pdf - 2008-10-28

http://www.cms.hhs.gov/RAC/01_Overview.asp#TopOfPage

http://www.cms.hhs.gov/RAC/Downloads/AppealUpdatethrough83108ofRACEvalReport.pdf - 2008-12-31

http://http://www.cms.hhs.gov/RAC/Downloads/2007%20RAC%20Status%20Document%20vs1.pdf

http://www.cms.hhs.gov/RAC/Downloads/RAC%20Expansion%20Schedule%20Web.pdf

http://www.cms.hhs.gov/DeficitReductionAct/Downloads/fy08cmip.pdf

http://edocket.access.gpo.gov/2008/pdf/E8-17914.pdf

http://www.cdc.gov/od/oc/media/pressrel/r2k0306b.htm

http://www.leapfroggroup.org/media/file/Leapfrog_hospital_acquired_infections_release.pdf

http://www.cms.hhs.gov/HospitalAcqCond/07_EducationalResources.asp#TopOfPage

Resources

1 OECD health data 2007: Statistics and indicators for 30 countries.” Organization for Economic Co-operation and Development. July 18, 2007

2 Poisal, John A., Christopher Truffer, Sheila Smith, Andrea Sisko, Cathy Cowan, Sean Keehan and Bridget Dickensheets. “Health spending projections through 2016: Modest changes obscure Part D’s impact.” Health Affairs. February 21, 2007

3 Kohm, Linda T., Janet M. Corrigan and Molla S. Donaldson. To Err is Human: Building a Safer Health System. Washington DC: National Academy of Sciences. 2007

Resources

4 Aspden, Philip, Julie A. Wolcott, J. Lyle Bootman and Linda R. Cronenwett. Preventing Medication Errors. Committee on Identifying and Preventing Medication Errors, Board on Health Care Services. Washington, DC: National Academy of Sciences. 2006

5 “Income, poverty, and health insurance coverage in the United States: 2006.” U.S. Census Bureau. August 2007. Available at: http://www.census.gov/prod/2007 pubs/p60-233.pdf

6 Schoen, Cathy, Michelle M. Doty, Sara R. Collins and Alyssa L. Holmgren. “Insured but not protected: How many adults are underinsured?” Health Affairs. June 14, 2005

Resources

7 CMS, CDC, & Prevention Agency for Healthcare Research and Quality. Transcript of “Hospital-Acquired Conditions & Hospital Outpatient Healthcare-Associated Condition Listening Session.” Thursday, December 18, 2008. Available at: http://www.cms.hhs.gov/HospitalAcqCond/07_EducationalResources.asp#TopOfPage

8 World Health Care Congress’ Forum on the Changes Ahead. Available at: http://www.reformplans.com/HCR/Comparison-Grid.html

9 Ibid10 CMS’s publication: Functional Contractors Overview

Available at: www.cms.hhs.gov/MedicareContractingReform/Downloads/FunctionalEnvironment.pdf - 2008-10-28

Resources

11 RAC Permanent Program. Available at: http://www.cms.hhs.gov/RAC/01_Overview.asp#TopOfPage

12 Ibid13 Ibid14 The Medicare Recovery Audit Contractor (RAC)

Program: Update to the Evaluation of the 3-Year Demonstration. January 2009. Available at: http://www.cms.hhs.gov/RAC/Downloads/AppealUpdatethrough83108ofRACEvalReport.pdf - 2008-12-31

15 CMS RAC Status Document FY 2007: Status Report on the Use of Recovery Audit Contractors (RACs) in the Medicare Program. February 2008. Available at: http://http://www.cms.hhs.gov/RAC/Downloads/2007%20RAC%20Status%20Document%20vs1.pdf

Resources

16 RAC Expansion Schedule March 1, 2009. Available at: http://www.cms.hhs.gov/RAC/Downloads/RAC%20Expansion%20Schedule%20Web.pdf

17 Comprehensive Medicaid Integrity Plan of the Medicaid Integrity Program: FYs 2008-2012. June 2008. Available at: http://www.cms.hhs.gov/DeficitReductionAct/Downloads/fy08cmip.pdf

18 2009 Hospital Inpatient Prospective Payment System Final Rule. Available at: http://edocket.access.gpo.gov/2008/pdf/E8-17914.pdf

19 Centers for Disease Control and Prevention: Press Release, March 2000. Available at: http://www.cdc.gov/od/oc/media/pressrel/r2k0306b.htm

20 Klevens et al. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002. Public Health Reports March-April 2007. Volume 122

Resources

21 2007 Leapfrog Group Hospital Survey. The Leapfrog Group 2007. Available at: http://www.leapfroggroup.org/media/file/Leapfrog_hospital_acquired_infections_release.pdf

22 CMS, CDC, & Prevention Agency for Healthcare Research and Quality. Transcript of “Hospital-Acquired Conditions & Hospital Outpatient Healthcare-Associated Condition Listening Session.” Thursday, December 18, 2008.Available at: http://www.cms.hhs.gov/HospitalAcqCond/07_EducationalResources.asp#TopOfPage

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