South Dakota Foundation for Medical Care performs medical review activities in accordance with the CMS Quality Improvement Organizations (QIO) Statements of Work (SOW). The following documents are useful in understanding this activity.
An online resource for hospitals looking to prevent Medicare payment errors and reduce their audit risk. HPMPResources.org provides compliance officers, utilization and health information management professionals and other staff with one-stop shopping for tools and information related to payment error prevention. All of the materials on HPMPResources.org are available to hospitals free of charge as part of the Hospital Payment Monitoring Program (HPMP), the national initiative to measure, monitor and reduce the incidence of improper fee-for-service inpatient payments.
This workbook was designed to give practical guidance and provide helpful tools related to identifying and improving hospital compliance program structures and processes that contribute to payment error outcomes. This workbook was also designed to assist in enhancing the effectiveness of hospitals’ compliance programs. It is important for compliance officers to understand one of the key synergies they can create is with Utilization Management and Quality Improvement within their hospitals to uncover the root causes of improper payments that are due to medically unnecessary services, admission screening criteria compliance, and insufficient medical record documentation.
Chest Pain Triage Tree - This guide is intended to help determine the level of risk for developing cardiac complications in individual patients presenting with chest pain and determine their appropriate disposition from the emergency room.
