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Briefings on Coding Compliance Strategies (Single Article)

Quality measures affect more than just IPPS reimbursements
December 2006

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IPPS hospitals must report 21 quality measures in 2007, but be aware of significant case mix index (CMI)/coding implications for two of these measures: Acute myocardial infarction (AMI) Congestive heart failure (CHF) The reason? Borderline AMI and CHF patients who qualify for these diagnoses under official coding guidelines don't always need the clinical care as required by the quality measures, according to Nancy Hirschl, BS, CCS, president of Hirschl and Associates in Laguna Niguel, CA. For example, a "probable" AMI patient may not need quality measure #6, "Thrombolytic agent re-ceived within 30 minutes of hospital arrival."

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