To track its compliance in core risk areas, such as billing and coding, Cooper University Health Care uses dashboards. “This reflects various elements of coding and billing of new technology that are reviewed and validated,” said Compliance Manager Kerri McCutchin. Contact her at mccutchin-kerri@cooperhealth.edu.
|
New Procedure [name] Dashboard - Potential Items for Inclusion |
Base Year |
Goal |
Month |
Month |
|---|---|---|---|---|
|
Number of procedures Performed |
# |
Not Applicable | ||
|
Number Medicare |
# | |||
|
Number Other Payers |
# | |||
|
Percentage of Performed Procedures Reviewed |
% |
100% |
100% | |
|
Correct Patient Status (inpatient-only procedures) |
% |
100% |
95% | |
|
NCD/LCD [insert #] Requirements Met - Fee-for-Service Medicare |
% |
100% |
75% | |
|
Other Payer Requirements Met |
% |
100% |
100% | |
|
Research - Clinical Trial or Other Registry Form Completed |
% |
100% |
88% | |
|
Joint Decision-Making Tool Completed (if applicable) |
% |
100% |
100% | |
|
Requests for Additional Information (reports not complete at time of review) |
# |
TBD |
5 | |
|
Number of Remediation Activities per Claim (average) |
# |
TBD | ||
|
Coding - HIM | ||||
|
Correct Procedure Code |
% |
100% |
85% | |
|
Correct Diagnosis Codes (except clinical trial diagnosis codes) |
% |
100% |
100% | |
|
Correct Clinical Trial Diagnosis Code (Z00.6) |
% |
100% |
50% | |
|
Correct DRG |
% |
100% |
90% | |
|
Correct Discharge Disposition Code |
% |
100% |
100% | |
|
Number of Remediation Activities per Claim |
# | |||
|
Patient Accounts - Billing | ||||
|
Correct Bill Type (Inpatient Only) |
% |
100% |
95% | |
|
Clinical Trial Condition Code & Value Code (added by billing) |
% |
100% |
68% | |
|
Number of Remediation Activities (Charges, NCT number errors) Total for Month |
# | |||
|
Incorrect DRG (pre-bill review prevention of overpayment) |
$ | |||
|
Incorrect DRG (pre-bill review prevention of underpayment) |
$ |
$10,000 | ||
|
Pre-bill denial-related loss (i.e., patient status; NCD not met) |
$ |
($25,000) | ||
|
Device Implants |
# | |||
