Sow's Ear to Silk Purse: Transforming Hospital-Acquired Conditions (HACs) Into Organizational Learning

摘要

Background. In 2008, the Centers for Medicare and Medicaid Services (CMS) announced 12 HACs for which modification of the hospital bill is required, so that CMS will not pay hospital charges connected with the HAC. In New York State, the Department of Health followed suit and added additional HACs. Other payers also identified subsets of the CMS HACs that require bill modification. Intervention detail. NYU Langone Medical Center put in place a process to identify cases where a HAC occurred, review the case, identify the charges associated with the HAC, and modify the bill. A HAC electronic coding flag prompts intensive coding review, referral for RN/MD case review for coding accuracy and identification of care elements related to the HAC, detailed review of the itemized hospital bill to identify those elements relating to the HAC, and bill modification.