On My Mind: QualityCounts Inpatient Report Compares Cost and Quality at Alliance Network Hospitals
By: Cheryl DeMars
, President & CEO
In the next few weeks we will release our yearly update of our QualityCounts® Inpatient Hospital Report. As with previous reports, it provides cost and quality information on the hospitals that participate with The Alliance. We continue to see variation in cost and quality. Here are a few headlines...
Join us March 27 and Learn What it Takes to Steer Workers Toward Higher Value Providers
Join us March 27 for our next Alliance Learning Circle Taking the Wheel: Steering Employees to Higher Value Care.
This event will dig into the topic of "steerage", or helping health care consumers make better choices by...
Webinar Recording and Executive Summary Available from Wellness Event
If you weren't able to join us in January for our Alliance Learning Circle The Future is Now: The Next Generation of Worksite Wellness, you can still take advantage of the information shared...
Help Your Employees Know their BP
Do you know your blood pressure? Do your employees know theirs or if it falls into the healthy range? Offering on-site blood pressure screening is a quick and easy way...
Do You Know What PPACA Provisions You Must Follow This Year?
When the Patient Protection and Affordable Care Act (PPACA) was signed into law in 2010, it seemed that implementation of most things was a far way off. Now nearly two years later, many of its provisions are beginning to take effect...
Please join us in welcoming Austin-Westran, Hartung Brothers Incorporated, and Milwaukee Drivers Health & Welfare Trust Fund (Teamsters Local 344) to The Alliance cooperative on March 1, 2012.
Please join us in welcoming Kevin Engelien, research & development manager, to The Alliance. Kevin brings more than 15 years experience in research, product development and marketing...
Employees Reveal Their Perspectives on Health, Wellness and CDHPs
Each month The Alliance highlights health care and benefit management news for employers in News You Can Use, with a link to take you to the original story or report.
This month we look at a new study by Aon Hewitt, The Futures Company and the National Business Group on Health.
Getting Ready for Baby? Don't Forget to Choose a Quality Hospital
The Alliance encourages employers to distribute the monthly QualityCounts® for Employees informational piece to their employees. This new newsletter encourages moms-to-be to think about quality when choosing a hospital...
Support Wisconsin's Locally Owned Farms and Help Employees Eat Healthy
Community supported agriculture (CSA) is an arrangement between local farms and households. Households pay a fee to the farm, which entitles them to a "share" of the farm's harvest. Each week...
What Did You Miss on The Alliance Member Forum on LinkedIn?
A recap of the news shared recently on The Alliance Member Forum on LinkedIn:
- Does your organization see health and wellness as a financial investment related to the bottom line? Or is it more of a cultural investment? Take our poll
- More articles...
The Alliance encourages employers to distribute the monthly Provider Update listing
(.pdf) to their employees.See which providers we've added in northern Illinois.
Just a reminder: Always check the online provider directory
for the most current provider information!
Correcting a Claim that Fails a CCI Edit
Since 2009, The Alliance has reviewed claims during repricing to identify coding combinations that are not permitted according to the National Correct Coding Initiative (CCI) edits. In applying the CCI edits, The Alliance uses the same set of edits that are available free of charge from CMS for use in the Medicare program. Applying CCI edits brings consistency to the claims repricing function, reduces incorrect payments and helps to minimize the need to issue refunds.
Because The Alliance is following these public edits, medical necessity and/or appropriateness of care are not the decisions that are being made. Line items that reprice to $0.00 do so because they have failed the edit based solely on the way they were submitted.
While the number of claims that are impacted is quite small, we often get questions from providers who are uncertain what to do next. Here are some things that you can do to determine whether the claim should be resubmitted:
- Review the coding of your claim and whether global surgery package modifiers were used. Global surgery modifiers include -25, -59 and other modifiers that identify distinct services, including RT and LT.
- If a modifier should have been applied, you may resubmit a corrected claim to The Alliance. Medical records are not required; although you will want to make sure that your documentation supports the use of any global surgery modifiers on your claim.
- If no changes to the claim are appropriate, the adjustment should be taken and the rebundled charge written off. Neither the patient nor the benefit plan is liable for unbundled charges.
If you need to review the CCI edits, you will find them on the Coding Edits page on the CMS website.
Questions about specific claims can be directed to provider relations at 608.276.6620.