Introduction to CMS and Other Quality Measurement Programs Course

Description

Delve into the historical evolution of coding's connection to payment reform, from its early statistical roots to its current importance in reimbursement determination. Explore the CMS Quality Initiatives, including Inpatient Quality Reporting, Hospital Acquired Conditions, Readmission Reduction, and Value-Based Purchasing, among others, and learn how they impact short-term hospital inpatient settings. Gain insights into the ever-evolving world of quality measurement programs and how accurate and complete coding, aligned with official guidelines, plays a crucial role in compiling vital healthcare statistics.

Included Lessons:

Quality Measurement and CMS Quality Initiatives at a Glance
Quality Measurement and CMS Quality Initiatives at a Glance
What are the CMS Quality Initiatives?
Inpatient Quality Reporting (IQR) (A.K.A., Core Measures)
Hospital Acquired Conditions (HAC) Program
Hospital Readmission Reduction Program (HRRP)
Hospital Value Based Purchasing (HVBP or VBP)
AHRQ PSI-90 Composite
HAC Reduction Program (HACRP)
Summary
Additional Documents

Key Takeaways

CMS Quality Initiatives: Explore the various CMS Quality Initiatives and understand how they affect short-term hospital inpatient settings.
Core Measures and Pay-for-Performance: Comprehend the significance of "Core Measures" and their connection to pay-for-performance programs.
Hospital Readmission Reduction: Learn about the Hospital Readmission Reduction Program (HRRP) and its role in reducing readmission rates for specific diagnoses.
Coding's Impact on Healthcare Statistics: Understand how accurate and complete coding, adhering to Official Guidelines for Coding and Reporting, contributes to the compilation of vital healthcare statistics used for quality measurement and program evaluations.
Importance of Clinical Knowledge: Recognize the importance of clinical knowledge and documentation in coding, as coders may need to support diagnoses with clinical information and query physicians for clarification.
Quality Measurement Models: Gain insights into various quality measurement models, such as Pay for Performance (P4P) and Value-Based Purchasing (VBP), and how they shift reimbursement focus toward patient satisfaction and outcomes.

What are CMS Quality Initiatives, and why are they significant for coders?

CMS Quality Initiatives, such as Inpatient Quality Reporting and Readmission Reduction, are essential as they directly impact coding practices and healthcare reimbursement. This course delves into their details.

How can knowledge gained from this course benefit my career as a medical coder?

This course equips you with a deeper understanding of the evolving healthcare landscape, making you better prepared for coding roles in healthcare institutions that participate in quality measurement programs.

About our Medical Coding Courses

HIAlearn, powered by Health Information Associates (HIA)—a leader in medical coding and auditing for more than three decades—offers a comprehensive online education platform for medical coders. With a catalog of over 200 medical coding courses accepted by the American Health Information Management Association (AHIMA) for Continuing Education Units (CEUs) and a selection approved by the American Academy of Professional Coders (AAPC), HIAlearn caters to both beginners and experienced medical coders seeking to enhance their skills. The platform provides an array of training plans tailored to meet individual learning needs, from mastering challenging coding procedures to understanding broad conceptual frameworks within the coding world. Courses are available across various coding types including CPT, E/M, ICD-10-CM, ICD-10-PCS, and are designed to cater to different coder levels and coding specialties such as inpatient, outpatient, profee, and CDI. Additionally, HIAlearn offers a Coding Updates bundle to ensure coders are up-to-date with the annual changes in ICD-10-CM, ICD-10-PCS, CPT, and IPPS. Beyond individual learning, HIAlearn supports organizations with group discounts, promoting enhanced coding accuracy, efficiency, and compliance across teams.