Course Provider
Learning Objectives
Understand the importance of collecting metrics.
Identify core reports needed.
Understand the five main areas of metric tracking for compliance, quality improvement, satisfaction, cost, and productivity.
Understand the components which go into payment and clinical documentation.
Define classifications including Medicare Severity-Diagnosis Related Group (MS DRG) and All Patients Refined Diagnosis Related Groups (APR DRG) as well as additional classifications within the DRG system including no comorbidities or complications (non-CC); comorbidity of complication (CC); major comorbidity or complication (MCC); as well as Case Mix Index (CMI) as a measure of complexity and severity.
List the various supports that can assist in providing guidance for effective documentation.
Identify what processes are required for a compliant utilization management process
Describe key components outlined in the CMS State Operating Manual under the Conditions of Participation to participate with Medicaid and Medicare
Describe the role of metrics in optimizing healthcare quality.
Identify the processes required for regulatory compliance and the regulatory underpinnings of compliance.