Compliance-- Recent events

Compliance-- Recent events


Well after a some vacation time its back to blogging again on topics I enjoy. I'm going to ramble a bit on the next few posts about the ever changing world of Health Care Compliance and throw in a little HEDIS and NCQA for good measure.  Well since the Supreme Court punted on the Health Care Act and said it was Congress's responsibility it still doesn't really settle the issue. However in the world of compliance, funding may change but regulations and requirements don't... One thing is for certain is that Federal Dollars are going to be tighter and hard to get. In some ways the regulations that HHS have developed are cost saving benefits. If you don't have a 4 or 5 star Medicare rating you aren't going to get the maximum federal payout as the years go by.  As the populations gets older and the strain on the system is going to get heavier and compliance with federal guideline with get more stringent. Plans will need to show improvement with their HEDIS measures covered by STARS. Some measures will get new weight others less but these ranking will never go away.

Congress really doesn't get this deep into regulations and rules and allows this to be the responsibility of the governing federal agency. That's why the funding may change but the rules won't.  Or they might become an unfunded mandate(a nightmare for many entities).   Most of the people serving in congress do not have technical or clinical backgrounds and really have no idea what is being discussed. They rely on staff members to make recommendations with constituent feedback(hopefully). Throw in a whole bunch of lobbyists and you get the current mess we have. That's why congress punts most of the time on regulations and relies on the governing body to put those in place.

Let's take the topic of the ICD-10 conversion. It's scheduled to go live in October of 2013. However they might move to 2014 now. However that's only a proposed change so what do you do? Well you better assume that its going to be next year.  Compliance is about risk avoidance and good practices.  The safe path is to be ready for next year and if it changes you are already prepared and have less work to do.. Besides you'll get better identification and stratification by converting as the level of detail with ICD-10 is greater(unfortunately a bit more complex). I find it surprising that they  want to delay it again(there must be some lobbyist group putting pressure on HHS). At this rate you might as well convert to ICD-11......Imported/Syndicated Blog Original Publish Date : Tue, Jul 17, 2012
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