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CMS to develop specs for EHR quality measures PDF Print E-mail
Written by : Source from govhealthit.com   
Thursday, 04 November 2010 11:34

The Centers for Medicare and Medicaid Services wants industry help in digitizing clinical quality measures so healthcare providers can send them to CMS directly from their electronic health record systems.

CMS needs to develop technical descriptions for the quality measures in order to guide vendors in how to incorporate the reporting function in their electronic health record (EHRs) products, according to the agency in an announcement Nov. 2 on the Federal Business Opportunities Web site.

Certified EHRs must be capable of calculating results for quality measures from electronic patient information. The work sought by CMS would help streamline the process by which providers could meet pending criteria for meaningful use and other performance-based incentive programs.

To be able to report quality measures from an EHR, CMS said, the specifications should include data elements describing clinical concepts in a standard format so providers can monitor their performance; algorithms to enable providers to calculate quality measure performance; and definitions of measures that can be stored in the EHR so data can be sent or shared electronically in a standard format.

CMS also wants another set of technical descriptions to help it move to a single standard for describing a patient’s health status from an inpatient EHR.

In doing so, CMS plans to offer electronic specifications to guide vendors and providers in how to move to the agency’s preferred Continuity Assessment Record and Evaluation (CARE) standard so it can be included in inpatient EHRs.


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Medical Insurance Specialist PDF Print E-mail
Written by David Andrews   
Thursday, 04 November 2010 15:54
Health InsuranceHealthcare facilities and providers employ "medical insurance specialists" to submit claims, respond to inquiries from medical insurers, and to follow up on overdue payments. The financial stability of the healthcare provider is tied to a steady, dependable flow of payments from medical insurance companies and the government for services provided to subscribers. There are many medical insurers each having their own procedures for receiving, approving, and paying claims.

Medical insurance specialists must know claims processing and billing regulations, and needs to know how to code bills based on the procedures the healthcare provider performed on the patient. The medical insurance specialists must also know how to re-appeal claims which medical insurer partially pay or claims that are rejected by a medical insurance company. Medical insurers usually try to rope in medical expenses and in doing so create extra work for healthcare providers such as requiring preauthorization by the medical insurer before he healthcare provider performs certain procedures on the patient. Post-treatment reports must be submitted to the medical insurer following the procedure. The medical insurance specialist is typically the person responsible for getting the preauthorization and preparing and submitting post-treatment reports.
Last Updated on Monday, 08 November 2010 11:59
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ICD-10 Corner

9 benefits of ICD-10

1. Measuring the quality, safety and efficacy of care
2. Designing payment systems and processing claims for reimbursement
3. Conducting research, epidemiological studies, and clinical trials
4. Setting health policy
5. Operational and strategic planning and designing healthcare delivery systems
6. Monitoring resource utilization
7. Improving clinical, financial, and administrative performance
8. Preventing and detecting healthcare fraud and abuse
9. Tracking public concerns and assessing risks of adverse public health events

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