Reference no: EM133638329

Question

Technology to the rescue. Managing the twin burdens of expanding administrative tasks and increased patient payment requires policies and a robust electronic infrastructure. Tracking the Physician Quality Reporting System's (PQRS) mandatory quality measures, for example, demands a system that can automatically pull the necessary information from medical claims or charts. And because failure to comply with CMS programs like PQRS, Meaningful Use and e-Prescribing now means the implementation of penalties, compliance must be a priority. As a result, groups should create compliance departments within the organization and dedicate the necessary human resources to the effort. Processes should be implemented to help make sure that the latest rule-making, directive or regulation - be it from CMS or a commercial payer - is promptly disseminated to the appropriate personnel in the group. Mechanisms should also be established to monitor compliance on a regular, if-not-constant basis. Payment denials also should be tracked to determine the root causes of claims being rejected and appropriate steps should be taken with physicians and/or coders to eliminate non-compliant documentation or coding as quickly as possible.