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Tag Archives: Program

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.



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 Opinions expressed are that of the author and do not represent HCPro or ACDIS. – Briefings on Coding Compliance Strategies

A Program for Successful PQRS Participation for Radiology Practices – Step 7

At Healthcare Administrative Partners, our mission is to educate practices on CMS Quality Programs and provide a path to optimized performance even in the most challenging markets. This is the final installment of our series of articles, “A Program for Successful PQRS Participation for Radiology Practices,” which was specifically designed to help you maximize reimbursement and reduce compliance issues under the Physician Quality Reporting System (PQRS).  So far we’ve covered…

Medical Billing and Coding Blog

[Announcement] Helping Small Practices Prepare for the Quality Payment Program

The Quality Payment Program is proposed to implement the new, bipartisan law changing how Medicare pays clinicians, known as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). On June 20, HHS announced $ 20 million to fund on-the-ground training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer. These funds will help provide hands-on training tailored to small practices, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas.

As required by MACRA, HHS will continue to award $ 20 million each year over the next five years, providing $ 100 million in total to help small practices successfully participate in the Quality Payment Program. In order to receive funding, organizations must demonstrate their ability to strategically provide customized training to clinicians. And, most importantly, these organizations will provide education and consultation about the Quality Payment Program at no cost to the clinician or their practice. Awardees will be announced by November 2016.

For More Information:


See the full text of this excerpted HHS press release (issued June 20).

The Medical Management Institute – MMI – Medical Coding News & MMI Updates

Which Online Medical Coding and Billing Program is Best?

top medical coding schools

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The ideal online medical coding and billing program depends on many factors. The most important of them is where your personal and professional aspirations lie. Selecting a certificate, diploma, or associate degree program which best aligns with the amount of time you have to spend pursuing a degree as well as your financial situation is the often the best option for you as you gain the knowledge and experience needed to qualify as a medical billing and coding professional.

Generally speaking, an associate degree program allows room for a solid educational foundation in addition to medical coding and billing courses. General education courses are included within medical coding and billing associate degree programs. These general education courses include the arts, sciences, mathematics, techonology, and introductory college writing. In addition to general education courses, medical billing and coding associate degree programs include courses like anatomy, physiology, medical terminology, date information, legal regulatory issues, medical finance and insurance, diseases of the human body, medical reimbursement systems, diagnostic and procedures coding, electronic medical billing, an externship, and medical insurance, billing, and coding. Certificate and dipolma medical billing and coding programs often do not include general education courses but offer a focused set of classes geared directly to medical billing and coding.

Because of this, certificate and diploma medical billing and coding programs are completed in much less time. When comparing the time investment of associate degree programs to certificate and diploma programs, associate degree programs often require two years to complete while certificate and dipolma programs require only one year. When comparing the financial investment between all three programs, diploma and certificate programs are often less expensive than associate degree programs.

That said, when making your choice, be careful and certain to select only accredited medical billing and coding associate degree, dipolma, or certificate programs to ensure the skills and knowledge you acquire are of high quality. Two well known and recognized accrediting bodies for medical coding and billing education and certification are the Commission of Accreditation for Health Informatics and Information Management Education (CAHIIM) and the American Academy of Professional Coders (AAPC). Accreditation ensures that the training you receive is up to date and up to par so that upon completion, you qualify for employment. Ultimately it is employer preference which determines hirability. And it’s entirely individual preference which determines the best educational and professional path to pursue when contemplating medical billing and coding programs. To help you on your search, we did the research to find the best medical coding and billing programs.

So get started on your medical coding and billing program training by browsing the following links:

  • 15 Best Remote Medical Coding Training Programs Online
  • 10 Best Medical Coding Programs
  • Top 10 Medical Billing and Coding Schools
  • Medical Coding Certification and Specialized Certificate Programs
  • Top Medical Coding Schools

    [Home Health] New Program for Evaluating Payment Patterns Electronic Report (PEPPER) Available

    A new Program for Evaluating Payment Patterns Electronic Report (PEPPER) for Home Health Agencies (HHAs) is available through the PEPPER Resources Portal. CMS contracts with TMF to produce and distribute these free reports that summarize HHA claims data statistics for areas that may be at risk for improper Medicare payments. HHAs can use the data to support internal auditing and monitoring activities. Compare your Medicare billing practices with other HHAs in the nation, Medicare Administrative Contractor jurisdiction, and state.

    The report includes:

    • Average case mix
    • Average number of episodes
    • Episodes with 5 or 6 visits
    • Non- Low-Utilization Payment Adjustment (LUPA) payments
    • High therapy utilization episodes
    • Outlier payments

    For More Information:

    •, including a sample HHA PEPPER

    Submit questions to the Help Desk
    The Medical Management Institute – MMI – Medical Coding News & MMI Updates

    Medicare Diabetes Prevention Program Webinar – CMS

    On July 7th, 2016, the Centers for Medicare and Medicaid Services (CMS) announced a proposal to expand the Diabetes Prevention Program to Medicare beneficiaries beginning on January 1, 2018. The Diabetes Prevention Program is a structured lifestyle intervention that includes dietary coaching, lifestyle intervention, and moderate physical activity, all with the goal of preventing the onset of diabetes in individuals who are pre-diabetic.

    The clinical intervention consists of 16 intensive “core” sessions of a curriculum in a group-based, classroom-style setting that provides practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control. After the 16 core sessions, less intensive monthly follow-up meetings help ensure that the participants maintain healthy behaviors. The primary goal of the intervention is at least 5 percent average weight loss among participants.

    Upcoming Webinar

    The Center for Medicare & Medicaid Innovation (CMS Innovation Center) will host a webinar to discuss various aspects of the Medicare Diabetes Prevention Program proposal on Tuesday, August 9, 2016 from 12:00-1:00pm EDTRegistration for this webinar is now open.

    Proposed Rule

    CMS will accept comments on the proposed rule until September 6, 2016, and will respond to comments in a final rule. The proposed rule can be found on the Federal Register.

    The Medical Management Institute – MMI – Medical Coding News & MMI Updates