Understanding Initiatives for Quality Reporting and Reimbursements

CHICAGO, September 3, 2009—The continued focus on the delivery and measurement of quality patient care has led to initiatives that link reimbursement to patient care quality, according to a Practice Brief in the September issue of the Journal of AHIMA. These initiatives, commonly referred to as value-based purchasing, include present-on-admission indicators, hospital-acquired conditions and serious reportable events. This article defines each of these terms and explains how organizations should report and track them for quality reporting and reimbursement.

These terms should not be used interchangeably even though they do overlap and can be interrelated; each has a distinct definition and purpose. This brief discusses the role health information management (HIM) professionals play adhering to ethical coding guidelines and their responsibilities in these initiatives:

• Understanding and explaining the regulatory environment
• Providing subject matter expertise in the application of the requirements
• Leveraging knowledge of reimbursement methodologies
• Supporting the data analyses associated with improving the healthcare delivery system.

The September Practice Brief also includes a glossary of terms and acronyms, and a list of questions that HIM professionals can review to assist their discussions with external payers.

Also in this issue

This month’s Journal of AHIMA includes the Legal e-Speaking article “Managing Audit Trails” that examines the definition and usage of audit trail management and the challenges that IT departments encounter when storing a vast quantity of data.

Read these articles, our cover story and more in the September issue of the Journal of AHIMA or online at journal.ahima.org.

About AHIMA

Representing more than 53,000 specially educated Health Information Management professionals in the United States and around the world, the American Health Information Management Association is committed to promoting and advocating for high quality research, best practices and effective standards in health information and to actively contributing to the development and advancement of health information professionals worldwide. AHIMA’s enduring goal is quality healthcare through quality information. www.ahima.org