Please find below definitions for common terms in our industry.
Clinical Documentation Improvement (CDI) - According to the American Health Information Management Association, "[c]linical documentation in the health record is critical to the patient, the physician, and the healthcare organization. Acute care hospitals, in particular, have become more dependent on physician (provider) documentation in order to comply with the Centers for Medicare and Medicaid Services (CMS) regulations regarding quality and reimbursement. Clinical documentation improvement (CDI) programs began in the 1990s to assist physicians in their documentation efforts."
Recovery Audit Contractors (RAC) - According to the American Hospital Association, "The Tax Relief and Health Care Act of 2006 made permanent the Medicare Recovery Audit Contractor (RAC) program to identify improper Medicare payments - both overpayments and underpayments-in all 50 states. RACs are paid on a contingency fee basis, receiving a percentage of the improper overpayments and underpayments they collect from providers.
RACs may review the last three years of provider claims for the following types of services: hospital inpatient and outpatient, skilled nursing facility, physician, ambulance and laboratory, as well as durable medical equipment. The RACs use proprietary software programs to identify potential payment errors in such areas as duplicate payments, fiscal intermediaries' mistakes, medical necessity and coding. RACs also conduct medical record reviews.
From March 2005-March 2008 the RAC program operated as a demonstration program and in July 2008, the Centers for Medicare & Medicaid Services (CMS) reported that the RACs had succeeded in correcting more than $1.03 billion in Medicare improper payments. Approximately 96 percent ($992.7 million) of the improper payments were overpayments collected from providers, while the remaining 4 percent ($37.8 million) were underpayments repaid to providers.
As required by The Tax Relief and Health Care Act of 2006, the permanent RAC program is now implemented in all 50 states."
International Classification of Diseases - 10 (ICD-10) - According to the World Health Organization, "ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as from 1994. The classification is the latest in a series which has its origins in the 1850s. The first edition, known as the International List of Causes of Death, was adopted by the International Statistical Institute in 1893. WHO took over the responsibility for the ICD at its creation in 1948 when the Sixth Revision, which included causes of morbidity for the first time, was published. The World Health Assembly adopted in 1967 the WHO Nomenclature Regulations that stipulate use of ICD in its most current revision for mortality and morbidity statistics by all Member States.
The ICD is the international standard diagnostic classification for all general epidemiological, many health management purposes and clinical use. These include the analysis of the general health situation of population groups and monitoring of the incidence and prevalence of diseases and other health problems in relation to other variables such as the characteristics and circumstances of the individuals affected, reimbursement, resource allocation, quality and guidelines."
