keyword
https://read.qxmd.com/read/38546122/association-of-national-accreditation-program-for-rectal-cancer-accreditation-with-outcomes-after-rectal-cancer-surgery
#1
JOURNAL ARTICLE
Calista M Harbaugh, Nicholas J Kunnath, Pasithorn A Suwanabol, Justin B Dimick, Samantha K Hendren, Andrew M Ibrahim
BACKGROUND: The National Accreditation Program for Rectal Cancer (NAPRC) defined a set of standards in 2017 centered on multidisciplinary program structure, evidence-based care processes, and internal audit to address widely variable rectal cancer practices and outcomes across U.S. hospitals. There have been no studies to-date testing the association between NAPRC accreditation and rectal cancer outcomes. STUDY DESIGN: This was a retrospective, observational study of Medicare beneficiaries aged 65-99 years with rectal cancer who underwent proctectomy from 2017-2020...
March 28, 2024: Journal of the American College of Surgeons
https://read.qxmd.com/read/38344670/medicare-meets-the-cloud-the-development-of-a-secure-platform-for-the-storage-and-analysis-of-claims-data
#2
Roy L Simpson, Joseph A Lee, Yin Li, Yu Jin Kang, Circe Tsui, Jeannie P Cimiotti
INTRODUCTION: Cloud-based solutions are a modern-day necessity for data intense computing. This case report describes in detail the development and implementation of Amazon Web Services (AWS) at Emory-a secure, reliable, and scalable platform to store and analyze identifiable research data from the Centers for Medicare and Medicaid Services (CMS). MATERIALS AND METHODS: Interdisciplinary teams from CMS, MBL Technologies, and Emory University collaborated to ensure compliance with CMS policy that consolidates laws, regulations, and other drivers of information security and privacy...
April 2024: JAMIA Open
https://read.qxmd.com/read/38165452/upcoding-in-medicare-where-does-it-matter-most
#3
EDITORIAL
Keith A Joiner, Jianjing Lin, Juan Pantano
Upcoding in Medicare has been a topic of interest to economists and policy makers for nearly 40 years. While upcoding is generally understood as "billing for services at higher level of complexity than the service actually pro- vided or documented," it has a wide range of definitions within the literature. This is largely because the financial incentives across programs and aspects under the coding control of billing specialists and providers are different, and have evolved substantially over time, as has the published literature...
January 2, 2024: Health Economics Review
https://read.qxmd.com/read/38097448/enabling-the-context-for-aboriginal-and-torres-strait-islander-community-controlled-birthing-on-country-services-participatory-action-research
#4
JOURNAL ARTICLE
Yvette Roe, Jyai Allen, Penny Haora, Sophie Hickey, Melanie Briggs, Liz Wilkes, Carmel Nelson, Kristie Watego, Rebecca Coddington, Sarah Ireland, Sue Kruske, Yu Gao, Sue Kildea
PROBLEM: Establishment of Birthing on Country services owned and governed by Aboriginal and Torres Strait Islander Community Controlled Health Services has been slow. BACKGROUND: Birthing on Country services have demonstrated health and cost benefits and require redesign of maternity care. During the Building On Our Strengths feasibility study, use of endorsed midwives and licensing of birth centres has proven difficult. QUESTION: What prevents Community Controlled Health Services from implementing Birthing on Country services in Queensland and New South Wales? METHODS: Participatory action research identified implementation barriers...
December 13, 2023: Women and Birth
https://read.qxmd.com/read/37954901/institutional-structures-and-processes-to-support-sepsis-care-a-multihospital-study
#5
JOURNAL ARTICLE
Meghan K Lóser, Jennifer K Horowitz, Peter England, Rania Esteitie, Scott Kaatz, Elizabeth McLaughlin, Elizabeth Munroe, Megan Heath, Pat Posa, Scott A Flanders, Hallie C Prescott
OBJECTIVES: To identify opportunities for improving hospital-based sepsis care and to inform an ongoing statewide quality improvement initiative in Michigan. DESIGN: Surveys on hospital sepsis processes, including a self-assessment of practices using a 3-point Likert scale, were administered to 51 hospitals participating in the Michigan Hospital Medicine Safety Consortium, a Collaborative Quality Initiative sponsored by Blue Cross Blue Shield of Michigan, at two time points (2020, 2022)...
November 2023: Critical care explorations
https://read.qxmd.com/read/37922135/a-supportive-heart-failure-care-program-to-reduce-hospital-readmissions
#6
JOURNAL ARTICLE
Claudine Hagan, Heide Cygan, Laurie Rockwell, Karen Naccarato, Tina Bowers, Barbara Katz
In the United States, heart failure (HF) is the leading reason for hospital readmissions, with 27% of Medicare recipients with HF being readmitted within 30 days The purpose of this quality improvement project was to decrease HF readmissions during their first 30 days of care with our home health agency. The Supportive Heart Failure Care education program was based on the results of a population assessment and included establishment of agency-wide best practices, nursing education sessions, and implementation of best practices focused on evidence-based self-management...
November 2023: Home Healthcare Now
https://read.qxmd.com/read/37857442/medicare-advantage-growth-amidst-mounting-scrutiny
#7
JOURNAL ARTICLE
Eli Y Adashi, Daniel P O'Mahony, I Glenn Cohen
The Medicare Advantage Program, home to nearly half of the eligible Medicare population, has recently come under increased scrutiny. The Government Accountability Office called on the Centers for Medicare & Medicaid Services to monitor "disenrollment of MA beneficiaries in the last year of life, validate MA-provided encounter data, and strengthen audits used to identify and recover improper payments to MA plans." The House Subcommittee on Oversight and Investigations of the Committee on Energy & Commerce, dedicated a hearing to "Protecting America's Seniors: Oversight of Private Sector Medicare Advantage Plans...
October 19, 2023: Journal of the American Board of Family Medicine: JABFM
https://read.qxmd.com/read/37817310/emergency-medical-treatment-and-labor-act-impact-on-health-care-nursing-quality-and-safety
#8
JOURNAL ARTICLE
Theresa Ryan Schultz, Jacqueline Forbes, Ashley Hafen Packard
Nurse knowledge and expertise in Emergency Medical Treatment and Labor Act (EMTALA) laws are a prerequisite to meet emergency department practice laws and regulatory standards. The EMTALA is a federal law that requires anyone coming to an emergency department for care to be stabilized and treated, regardless of their insurance status or ability to pay. Regulatory standard infractions resulting from an EMTALA violation complaint may include (1) penalties and/or fines, (2) future unannounced Centers for Medicare & Medicaid Services surveys, (3) documented Centers for Medicare & Medicaid Services deficiencies that require timely response, action plan, and audit for expected outcomes, (4) Medicare/Medicaid nonpayment for services, and (5) termination of a hospital's Medicare agreement...
September 29, 2023: Quality Management in Health Care
https://read.qxmd.com/read/37783147/immunohistochemistry-and-immunofluorescence-utilization-audit-by-subspecialty-in-an-academic-setting-a-step-toward-stewardship
#9
JOURNAL ARTICLE
Mahmoud A Khalifa, Brooke Gagner, Liam Chen, Paari Murugan, Molly E Klein, Emilian Racila, Khalid Amin, Daniel Miller, Jimmie Stewart, Yanli Ding, Mariya Farooqui, Sandhyarani Dasaraju, Oyedele A Adeyi
There are immunohistochemistry (IHC) and immunofluorescence (IF) panels described in the literature and established by personal and institutional experiences that are in common use by pathologists in their daily practice. Stewardship is a difficult discussion because IHC utilization is influenced by many factors including the pathologist's experience, background, practice setting, personal bias, and medicolegal culture. We developed the methodology to audit the IHC/IF utilization in our academic subspecialty practice...
September 28, 2023: Annals of Diagnostic Pathology
https://read.qxmd.com/read/37756235/imaging-incidence-and-type-in-primary-care-patients-with-low-back-pain-a-cross-sectional-study-on-new-referrals-to-an-australian-specialist-spinal-surgical-centre
#10
JOURNAL ARTICLE
Isaac J Tennant, Yun-Hom Yau, Derek Yull, Peter Murphy, Ian R Whittle
Introduction Low back pain (LBP) is common and a significant cause of morbidity. Many patients receive inappropriate imaging for LBP in primary care. Aim To explore the incidence and type of spinal imaging conducted for LBP patients referred from general practice for specialist surgical opinion, and evaluate whether imaging conformed to clinical guidelines. Methods Audit of a sequential cohort (n  = 100) of new LBP patients referred from primary care for specialist opinion at a suburban Australian capital city independent Spinal Centre...
September 2023: Journal of Primary Health Care
https://read.qxmd.com/read/37548141/audit-of-surgeon-billing-in-workers-compensation-insured-elective-spinal-surgery-in-new-south-wales-australia-from-2010-to-2018
#11
JOURNAL ARTICLE
Adriane M Lewin, Justine M Naylor, Mark Sheridan, Ian A Harris
BACKGROUND: Medical billing practices have received increasing scrutiny in Australia and worldwide. In 2015, the Australian Government initiated a comprehensive review of the Medicare Benefits Schedule (MBS), including spinal surgery. This study provides a snapshot of five spinal surgeon billing patterns and associated costs in the workers compensation system in New South Wales prior to these changes. METHODS: This retrospective cohort study used workers compensation billing data from the State Insurance Regulatory Authority to capture elective spinal surgeries in New South Wales from 2010 to 2018...
August 7, 2023: ANZ Journal of Surgery
https://read.qxmd.com/read/37197811/evaluating-an-audit-and-feedback-intervention-for-reducing-overuse-of-pathology-test-requesting-by-australian-general-practitioners-protocol-for-a-factorial-cluster-randomised-controlled-trial
#12
JOURNAL ARTICLE
Denise A O'Connor, Paul Glasziou, Dina Schram, Alexandra Gorelik, Amelia Elwick, Kirsten McCaffery, Rae Thomas, Rachelle Buchbinder
INTRODUCTION: Consistent evidence shows pathology services are overused worldwide and that about one-third of testing is unnecessary. Audit and feedback (AF) is effective for improving care but few trials evaluating AF to reduce pathology test requesting in primary care have been conducted. The aim of this trial is to estimate the effectiveness of AF for reducing requests for commonly overused pathology test combinations by high-requesting Australian general practitioners (GPs) compared with no intervention control...
May 17, 2023: BMJ Open
https://read.qxmd.com/read/36763368/association-of-commercial-to-medicare-relative-prices-with-health-system-financial-performance
#13
JOURNAL ARTICLE
Fredric Blavin, Nancy Kane, Robert Berenson, Bonnie Blanchfield, Stephen Zuckerman
IMPORTANCE: Various studies have documented the rise in commercial insurance prices during the past 2 decades; however, estimates on the association of rising costs with health systems' financial health are lacking. This study calculated 2 measures from standardized Audited Financial Statements (AFSs)-operating margins and days of unrestricted cash on hand-to explore the associations. OBJECTIVE: To estimate the association between health systems' financial condition and the ratio of commercial to Medicare relative prices...
February 3, 2023: JAMA health forum
https://read.qxmd.com/read/36755372/medicare-s-hospital-readmissions-reduction-program-and-the-rise-in-observation-stays
#14
JOURNAL ARTICLE
Brad Wright, Canada Parrish, Anirban Basu, Karen E Joynt Maddox, Joshua M Liao, Amber K Sabbatini
OBJECTIVE: To evaluate whether Medicare's Hospital Readmissions Reduction Program (HRRP) is associated with increased observation stay use. DATA SOURCES AND STUDY SETTING: A nationally representative sample of fee-for-service Medicare claims, January 2009 - September 2016. STUDY DESIGN: Using a difference-in-difference (DID) design, we modeled changes in observation stays as a proportion of total hospitalizations, separately comparing the initial (acute myocardial infarction, pneumonia, heart failure) and subsequent (chronic obstructive pulmonary disease) target conditions with a control group of nontarget conditions...
February 8, 2023: Health Services Research
https://read.qxmd.com/read/36526252/medicare-hospice-policy-changes-and-beneficiaries-rate-of-live-discharge-and-length-of-stay
#15
JOURNAL ARTICLE
Kan Z Gianattasio, Melinda C Power, Dale Lupu, Christina Prather, Ali Moghtaderi
CONTEXT: The 2014 Improving Medicare Post-Acute Care Transformation (IMPACT) Act systemized audits of long hospice stays, and the 2016 two-tier payment system decreased daily reimbursement rates after 60 days of enrollment. Both aimed to reduce long stays. OBJECTIVE: Examine how live discharge rates and length-of-stay changed in relation to the policies. METHODS: We computed monthly hospice-level percent live discharges and length-of-stay using 2008-2019 Medicare hospice claims...
December 13, 2022: Journal of Pain and Symptom Management
https://read.qxmd.com/read/36464082/2021-annual-report-of-dataderm%C3%A2-the-database-of-the-american-academy-of-dermatology-aad-corrigendum
#16
JOURNAL ARTICLE
Marta Van Beek, TRobert A Swerlick, Barbara Mathes, Margo J Reeder, Toni Kaye, Arik Aninos, Mason Totaro, Alyssa Burns, Matthew Fitzgerald, Caryn D Etkin, Jeffrey P Jacobs
The American Academy of Dermatology (AAD) launched DataDerm™ in 2016 as the clinical data registry platform of AAD. The 2021 annual report of DataDerm was published in the Journal of the American Academy of Dermatology (JAAD) in May 2022. Routine audit of DataDerm identified incorrect data in one sentence in the manuscript as well as in Supplemental Tables 3, 4, and 5 of this annual report. This corrigendum is therefore published to provide corrected data. The following sentence in the original publication contains incorrect data; the correct data is provided in the text below: Of the 81...
December 1, 2022: Journal of the American Academy of Dermatology
https://read.qxmd.com/read/36322482/interventions-to-reduce-waste-and-improve-billing-compliance-with-medications-in-single-dose-vials
#17
JOURNAL ARTICLE
Anthony Trovato, Linda S Tyler, Nancy A Nickman, Russell Findlay
DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: The purpose of this process improvement project was to implement features in the electronic health record to help reduce inappropriate drug waste and Medicare billing noncompliance for injectable drugs in single-dose vials in outpatient settings...
November 2, 2022: American Journal of Health-system Pharmacy: AJHP
https://read.qxmd.com/read/36318943/trends-in-icd-10-cm-coded-administrative-datasets-for-injury-surveillance-and-research
#18
JOURNAL ARTICLE
Julia F Costich, Dana B Quesinberry, Lara K Daniels, Ashley Bush
OBJECTIVES: Accurate injury surveillance depends on data quality in administrative datasets created for billing and reimbursement. Significant effort has been devoted to testing the ability of candidate injury case definitions to identify injury cases accurately in these datasets. We used interviews with experienced coders, informed by a review of the current literature, to identify three clinical coding trends that may affect the consistency of surveillance data: "clinical documentation improvement or clinical documentation integrity" (CDI), coding by treating clinicians, and certain electronic health record features...
November 2022: Southern Medical Journal
https://read.qxmd.com/read/36246865/multicriteria-decision-frontiers-for-prescription-anomaly-detection-over-time
#19
JOURNAL ARTICLE
Babak Zafari, Tahir Ekin, Fabrizio Ruggeri
Health care prescription fraud and abuse result in major financial losses and adverse health effects. The growing budget deficits of health insurance programs and recent opioid drug abuse crisis in the United States have accelerated the use of analytical methods. Unsupervised methods such as clustering and anomaly detection could help the health care auditors to evaluate the billing patterns when embedded into rule-based frameworks. These decision models can aid policymakers in detecting potential suspicious activities...
2022: Journal of Applied Statistics
https://read.qxmd.com/read/36219633/audit-proof-your-mohs-note
#20
JOURNAL ARTICLE
Howard W Rogers
Medicare has updated its guidance for documentation of Mohs micrographic surgery (MMS). Recent insurer audits have focused on and issued denials and recoupments based on these criteria. Understanding and implementing the latest documentation requirements is critical to proper reimbursement for MMS.
August 2022: Cutis; Cutaneous Medicine for the Practitioner
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