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Clinical documentation improvement (CDI), also known as "clinical documentation integrity", is the best practices, processes, technology, people, and joint effort between providers and billers that advocates the completeness, precision, and validity of provider documentation inherent to transaction code sets (e.g. ICD-10-CM, ICD-10-PCS, CPT, HCPCS) sanctioned by the Health Insurance ...
CIA can be used to address quality of care [2] or corporate integrity issues. [1] CIAs create a framework within which the company must operate in order to avoid being barred from participation in federal health care programs. [1] States use CIAs as part of their anti-fraud efforts. [3] [4]: 9 CIAs generally last 5 years.
The National Committee for Quality Assurance (NCQA) is an independent 501(c)(3) nonprofit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. The National Committee for Quality Assurance operates on a formula of measure ...
National Quality Forum (NQF) is a United States–based non-profit membership organization that promotes patient protections and healthcare quality through measurement and public reporting. [ 1 ] [ 2 ] It was established in 1999 based on recommendations by the President's Advisory Commission on Consumer Protection and Quality in the Health Care ...
OEI conducts national evaluations to provide HHS, Congress, and the public with timely and reliable information on significant issues. In FY 2020, OIG produced 44 evaluations. Office of Investigations (OI). OI conducts criminal, civil, and administrative investigations of fraud and misconduct related to HHS programs, operations, and beneficiaries.
The Council of the Inspectors General on Integrity and Efficiency (CIGIE) addresses integrity, economy, and effectiveness issues that transcend individual Government agencies; and increase the professionalism and effectiveness of personnel by developing policies, technical standards, and approaches to aid in the establishment of a well-trained and highly skilled workforce in the Office of ...
Industry-sponsored CMEs can violate federal statutes, according to the U.S. Department of Health and Human Services. "When a pharmaceutical manufacturer rewards high-prescribing physicians by directing a CME provider to pay (or overpay) them as CME faculty, consultants, or members of a speaker's bureau," wrote Morris and Taitsman. [12]
Global Healthcare Accreditation (GHA) [5] Healthcare Facilities Accreditation Program (HFAP) Healthcare Quality Association on Accreditation (HQAA) Institute for Medical Quality (IMQ) Joint Commission (TJC) National Committee for Quality Assurance (NCQA) National Dialysis Accreditation Commission (NDAC) [6] The Compliance Team, "Exemplary ...