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Claims denials often occurred because the patient's disposition didn't match up with what the Centers for Medicare & Medicaid Services (CMS) required to authorize a procedure, reports Maura Corvino, MSOL, RN, CEN, assistant vice president for emergency services and patient access at Valley Health System in Ridgewood, NJ.
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If a patient gives untruthful information to registrars to avoid paying for services, this fraud can result in dangerous clinical outcomes as well as lost revenue.
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Some states have highly developed quality improvement organizations (QIOs) that have for years worked with healthcare organizations to improve quality, share information, and tackle problems.
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Mention the U.S. Department of Veterans Affairs (VA) hospital system to QI professionals and you'll likely hear about any of the dozens of projects and programs developed at the VA that have percolated throughout the country and beyond with great positive impact on patients.
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Failure and near-misses offer a significant opportunity to change the way you do something in a way that will benefit patients. But is there a best method of doing a root-cause analysis (RCA)? According to St. Joseph's Hospital in St. Paul, yes.
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For some organizations, finding out where you fit in compared to other organizations is something they do regularly and well.
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It was nice to win a national award for case management last winter, says Pat Metzger, RN, MSA, system executive for care management at Memorial Hermann in Houston. But that wasn't the aim when the program started a decade before the Franklin Award landed on her desk.
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Healthy Kids, Healthy Weight is a clinical research program at University Hospitals Rainbow Babies & Children's Hospital in Cleveland, OH. The program is open to children ages 4-18 with a body mass index (BMI) above the 85th percentile in children of the same age and sex.
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A house owned by the Catawba Valley Medical Center (CVMC) in Hickory, NC, which is a part of its campus, is the site of a prevention and treatment program to address childhood obesity. The program is called Healthy House.
