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By Denise Johnson, LCSW-C Senior Practice Associate March 2024 In February 2024, a major healthcare cybersecurity attack occurred, affecting many patients and providers including clinical social workers (CSWs). As a result, Change Healthcare became temporarily paralyzed, causing payment disruptions and delays in patient care.
Beginning January 1, 2022, clinical social workers (CSWs) will become eligible to participate in Medicare’s Quality Payment Program (QPP). Medicare has identified 15 measures that CSWs may use to report quality services. Measures for CSWs are generally reported through Medicare Part B claims. December 2021.
In a consumer-driven industry, healthcare organizations must compete to gain new patients and maintain their loyalty. One effective way is to earn high patient satisfaction scores that demonstrate value to customers seeking a trusted healthcare partner. In 2019, $1.9
Attention Clinical Social Workers: CMS Seeking Feedback on Good Faith Estimates. The request for feedback is related to the No Surprise Act (NSA), which protects patients from large, surprise healthcare bills. A list of additional questions is available at [link]. The deadline for submitting feedback to CMS is November 15, 2022.
Revenue cycle management (RCM) is the financial process that makes it possible for most healthcare organizations to fulfill their mission of providing quality care for patients and communities. RCM is the set of functions that comprise the capture, management, and collection of patient service revenue in a healthcare organization.
The Agency for Healthcare Research and Quality calculates that more than 17,000 lawsuits related to pressure injuries are filed each year — second only to wrongful death suits. Understanding the legal implications of gaps in care can help protect all involved: physicians, nurses, other caregivers, and healthcare administrators and leaders.
What’s the good news for healthcare revenue cycle managers? Processing claims is one of the top contributors to wasted healthcare dollars in the U.S., Some Medicare Advantage plans are denying authorization for hospitalization. Claim denials are expected to keep increasing — both in terms of frequency and reasons.
Coding and clinical documentation have never been more important in healthcare. “We You’ll need ongoing training for your staff to improve your clinical documentation and avoid the following coding disasters. Insufficient Clinical Documentation or Underreported codes. Coding is high value — and in high demand.
Coding and clinical documentation have never been more important in healthcare. “We You’ll need ongoing training for your staff to improve your clinical documentation and avoid the following coding disasters. Insufficient Clinical Documentation or Underreported codes. Coding is high value — and in high demand.
In our study, we noted that as few as 28% of women with PPD symptoms reported them to a healthcare provider. I am a nurse with many years of clinical experience and now a vice president and partner in clinical solutions at Relias. Another study found delayed or nonexistent detection, and follow-up was as low as 17.9%
For example, less than 20% of Medicare spending is currently value-based. But momentum will continue, since the Centers for Medicare and Medicaid Services (CMS) announced in 2021 that it plans to transition fully to value-based reimbursement by 2030. Healthcare organizations in the U.S. Why the change to value-based care?
Successful agencies recognize that long-term success depends on meeting required clinical regulations and having staff with the home health specializations to meet shifting client needs. Keeping an eye on your case mix is important with Medicare reimbursement shifting to value-based purchasing. Increasing agency profitability.
Improving patient experience scores is a goal for many healthcare organizations — and for good reason. As they consider new ideas to raise patient satisfaction, healthcare leaders must have an understanding of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scoring system that evaluates these efforts.
When you invest in educating clinicians as wound care specialists, you can put your organization in a stronger business position by: Developing a team with clinical expertise in wound and ostomy care. Increasing reimbursements by effectively treating more clinically complex patients. Develop Clinical Expertise in Wound Care.
According to a 2021 report from the United States Government Accountability Office, Medicare spending on stays for severe wound care declined about 2% from $2.06 According to the Agency for Healthcare Research and Quality , about 2.5 billion in fiscal year 2016 to $2.01 billion in fiscal year 2018. million people in the U.S.
Clinical documentation integrity within this record is essential in both the revenue cycle and patient care processes. Analyzing the data allows providers to identify errors that may be occurring throughout the cycle and lower expenses from denials, incomplete claims, or healthcare fraud investigations.
The speed of change in healthcare requires post-acute care organizations to take a different approach to job preparedness. By arming your care teams with the latest clinical and technical skills and world-class soft skills, you will better prepare them to adapt as needed to meet patients’ future healthcare needs.
An unintended, but positive offshoot of the pandemic is that the crisis highlighted home health’s “very quick and successful adjustments” and “versatility” to serve COVID-19 patients and millions of others served under Medicare, Medicaid, Veterans Administration, and other services. Clinical assessments. Increased Compensation.
maternal mortality continues to increase despite the availability of world-class healthcare resources. Sparkman, who is Relias Vice President and Partner, Clinical Solutions, Patient Safety and Quality, noted that despite advancements, “The U.S. In the U.S., Research has shown that inequities are a critical component of the problem.
Improved care quality and patient safety, reduced readmissions and ER visits, and lower healthcare costs are just some of the positive outcomes of effective care coordination. But care coordination needs to be baked into the productivity standard at an agency,” said Laura Wilson, SimiTree Managing Director of Clinical Operations Consulting.
Tis the season for evaluating training programs and checking everything twice to make sure you’re on the Center for Medicare and Medicaid Services’ and The Joint Commission’s nice lists. One robust, magical platform “Platform” is something we hear quite often in IT, and it’s becoming ever more prevalent in healthcare.
Recent research and reporting indicate that maternal mortality prevention depends on simultaneously addressing three overlapping areas — clinical, social, and behavioral. mothers have access to a very high standard of clinical care, social factors prevent many others from accessing even the minimum level of care they need.
Federal and state agencies’ routine surveys of healthcare organizations can be stressful. With the Biden administration advocating for stricter scrutiny on nursing homes, we know inspection of healthcare facilities may increase even more. Regardless of the healthcare setting, you don’t want to be on this type of list.
New requirements from the Centers for Medicare and Medicaid Services (CMS) announced in November 2021 and a new time-limited enforcement effort by the Occupational Safety and Health Administration (OSHA) announced in March call for focused inspections and put a higher level of scrutiny on nursing home compliance and the quality of care provided.
The Centers for Medicare and Medicaid Services (CMS) issued a final rule in August 2022 to improve maternal health outcomes and advance health equity — two of the Biden-Harris Administration’s key priorities. It is important to focus on clinical protocols and reduction in practice variation. Sadly, U.S. rates are continuing to rise.
During Kennedys confirmation hearing, he struggled to answer questions about Medicare and Medicaid, programs that affect tens of millions of Americans, or provide details about how he would work to drive down health care costs. NASW remains committed to policies that address systemic inequities in healthcare and social services.
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