What are the primary data sources for Medicaid statistical data?
Mar 23, 2022 · CMS has posted the 2022 Quality Rating System Measure Technical Specifications (PDF), which includes the measure specifications and guidelines for data collection for the 2022 QRS measure set. The documents for 2021 include: CMS has posted the Quality Rating System and Qualified Health Plan Enrollee Experience Survey: Technical Guidance for ...
How do hospitals collect patient data?
Dec 01, 2021 · Medicaid Data Sources - General Information. The primary data sources for Medicaid statistical data are the Medicaid Statistical Information System (MSIS), the Medicaid Analytic eXtract (MAX) files, and the CMS-64 reports. The following is a general explanation of these reports and the types of program and financial data collected from the states. MSIS is …
Where can I find information about the Medicaid program and expenditures?
HHCAHPS scores are designed to reflect the care received by Medicare and Medicaid patients. The basic sampling procedure is to draw a random sample of eligible patients on a monthly basis. Smaller home health agencies should survey all HHCAHPS-eligible patients. Data are collected from patients throughout each month of the 12-month reporting period.
What are the different types of healthcare data collection?
According to the data collected by the Center for Medicare and Medicaid Services, health spending in the United States as a percentage of GDP has risen from 5% in 1960 to 18% in 2015. Which of the following are the forces that are responsible for this upward trend in health spending? There may be multiple answers. Check all that apply.
What data does CMS collect?
What is included in Medicare claims data?
What is the CMS database?
What is the CMS-64 report?
How is Medicare data collected?
What are claims data?
Where does CMS get its data?
What is the CMS Medicare tracking system?
What is a CMS report?
What is CMS's role in the HHS?
CMS is the lead agency for a number of actions in the HHS Disparities Action Plan, including efforts to increase access to dental care for children in Medicaid and CHIP, and improve language access in Medicaid and CHIP.
What is CMS in healthcare?
As part of the overarching Centers for Medicare & Medicaid Services (CMS) initiative to support health care quality improvement to underserved Medicare and Medicaid enrollees, CMS is engaged in a multi-partner health disparities collaboration. This unique collaboration includes:
What is the HHS Action Plan?
HHS Action Plan to Reduce Racial and Ethnic Disparities. HHS unveiled its Action Plan to Reduce Racial and Ethnic Health Disparities ("HHS Disparities Action Plan") in April 2011, which outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities.
What is the data collection system in healthcare?
Health care involves a diverse set of public and private data collection systems, including health surveys, administrative enrollment and billing records, and medical records, used by various entities, including hospitals, CHCs, physicians, and health plans. Data on race, ethnicity, and language are collected, to some extent, by all these entities, suggesting the potential of each to contribute information on patients or enrollees. The flow of data illustrated in Figure 5-1 does not even fully reflect the complexity of the relationships involved or the disparate data requests within the health care system. Currently, fragmentation of data flow occurs because of silos of data collection ( NRC, 2009 ).
Why do hospitals collect demographic data?
Because hospitals tend to have information systems for data collection and reporting, staff who are used to collecting registration and admissions data, and an organizational culture that is familiar with the tools of quality improvement, they are relatively well positioned to collect patients' demographic data. In addition, hospitals have a history of collecting race data. With the passage of the Civil Rights Act of 1964 3 and Medicare legislation in 1965, 4 there was a legislative mandate for equal access to and desegregation of hospitals ( Reynolds, 1997 ). Therefore it is not surprising that more than 89 percent of hospitals report collecting race and ethnicity data, and 79 percent report collecting data on primary language ( AHA, 2008 ).
How can a hospital system change?
Systems changes can involve training a large number (possibly hundreds) of hospital registration/admission staff (many of whom may be off site) and modifying practice management and EHR systems to ensure that proper and consistent data fields are in place across multiple departments and units that serve as patient entry points. Ideally, these systems would be made interoperable through the development of interfaces that would make it possible to relay the data across different systems.
What is the purpose of the 2006 National Public Health and Hospitals Institute survey?
A 2006 National Public Health and Hospitals Institute (NPHHI) survey asked hospitals that collected race and ethnicity data whether they used the data to assess and compare quality of care, utilization of health services, health outcomes, or patient satisfaction across their different patient populations.
How can we address health disparities?
Addressing health and health care disparities requires the full involvement of organizations that have an existing infrastructure for quality measurement and improvement. Although hospitals, community health centers (CHCs), physician practices, health plans, and local, state, and federal agencies can all play key roles by incorporating race, ethnicity, and language data into existing data collection and quality reporting efforts, each faces opportunities and challenges in attempting to achieve this objective.
When did Aetna start collecting data?
Aetna was the first national, commercial plan to start collecting race and ethnicity data for all of its members. In 2002, Aetna began directly collecting these data using electronic and paper enrollment forms. Multiple mechanisms are now used to capture race, ethnicity, and language data.
Why is data capture important in health care?
The above discussion of challenges faced by various health and health care entities highlights how important it is for data capture and quality to overcome Health IT constraints and minimize respondent and organizational resistance . Integration of data systems has the potential to streamline collection processes so that data can be reported easily, and an individual will not need to self-identify race, ethnicity, and language need during every health encounter. Until such integration is achieved, enhancing legacy Health IT systems, implementing staff training, and educating patients and communities about the reasons for and importance of collecting these data can help improve data collection processes.
What is the Medical Record Committee?
The Medical Record Committee is assessing various strategies to improve documentation in the health record. Concerns have been raised that current documentation practices may be insufficient to support diagnoses or reflect the progress and clinical findings in patient care.
What does Carolyn do in Medicare?
a) Review claims for errors prior to releasing information to the Medicare program. Carolyn works as a coder in a hospital inpatient department. She sees a lab report in a patient's health record that is positive for staph infection; however, there is no mention of staph in the physician's documentation.
What is the responsibility of the Health Information Director?
The Health Information Director is given responsibility to manage the information and access to the deficiency module, clinical coding module, and release of information module with the electronic health record. This is an example of what data strategy method?
Do HIM professionals have the skills to manage the EHR?
c) HIM professionals do not have the skills to manage the EHR.
Is the paper record still used?
a) It is still known as the paper record since it was originally paper.
What chapter is Healthcare Data Sets and Standards?
Start studying Chapter 4: Healthcare Data Sets and Standards. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
What is NCQA in healthcare?
A widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA)
What is the purpose of data store?
Stores the data items name, description, and other details about each data item.
What is descriptive list?
A descriptive list of the names, definitions, and attributes of data elements to be collected in an information system or database whose purpose is to standardize definitions and ensure consistent use.
How are Medicare and Medicaid payments reported?
Gross charges for these services are then translated into costs. This is done by multiplying each hospital’s gross charges by each hospital’s overall cost-to-charge ratio, which is the ratio of a hospital’s costs (total expenses exclusive of bad debt) to its charges (gross patient and other operating revenue).
How much is the Medicare shortfall?
This includes a shortfall of $56.8 billion for Medicare and $19.0 billion for Medicaid. For Medicare, hospitals received payment of only 87 cents for every dollar spent by hospitals caring for Medicare patients in 2019. For Medicaid, hospitals received payment of only 90 cents for every dollar spent by hospitals caring for Medicaid patients in 2019.
What is underpayment in healthcare?
Underpayment occurs when the payment received is less than the costs of providing care, i.e., the amount paid by hospitals for the personnel, technology and other goods and services required to provide hospital care is more than the amount paid to them by Medicare or Medicaid for providing that care.
Do hospitals have to be on Medicare?
Hospital participation in Medicare and Medicaid is voluntary. However, as a condition for receiving federal tax exemption for providing health care to the community, not-for-profit hospitals are required to care for Medicare and Medicaid beneficiaries. Also, Medicare and Medicaid account for more than 60 percent of all care provided by hospitals. Consequently, very few hospitals can elect not to participate in Medicare and Medicaid.
Is Medicare underpayment voluntary?
Hospital participation in Medicare and Medicaid is voluntary. However, as a condition for receiving federal tax ...
Is Medicare and Medicaid bridging the gaps?
Bridging the gaps created by government underpayments from Medicare and Medicaid is only one of the benefits that hospitals provide to their communities. In a separate fact sheet, AHA has calculated the cost of uncompensated hospital care (financial assistance and bad debt), which also are benefits to the community.
Center For Medicaid and Chip Services Objectives
Health Disparities Data Collection in Medicaid and Chip
- The Affordable Care Act of 2010 (Section 4302) requires the secretary of the Department of Health ad Human Services (HHS) to establish data collection standardsfor race, ethnicity, sex, primary language, and disability status, and calls for these categories to be consistently collected and reported in all national population health surveys that rel...
HHS Action Plan to Reduce Racial and Ethnic Disparities
- HHS unveiled its Action Plan to Reduce Racial and Ethnic Health Disparities("HHS Disparities Action Plan") in April 2011, which outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities. CMS is the lead agency for a number of actions in the HHS Disparities Action Plan, including efforts to increase access to dental care for children i…
National Stakeholder Strategy For Achieving Health Equity
- The HHS Action Plan to Reduce Racial and Ethnic Health Disparities complements the National Stakeholder Strategyfor achieving health equity ("NPA Stakeholder Strategy"), which proposes a comprehensive, community-driven approach to reduce health disparities in the U.S. and achieve health equity through collaboration. Together, the HHS Disparities Action Plan and the NPA Stak…
Hospitals
Community Health Centers
- CHCs are front-line providers of care for underserved and disadvantaged groups (Taylor, 2004) and therefore are good settings for implementing quality improvement strategies aimed at reducing racial and ethnic disparities in care. Yet while CHCs serve diverse patient populations and, as organizations, understand the importance of demographic data for improving the qualit…
Physician and Group Practices
- The structure and capabilities of primary and specialty care entities vary tremendously, ranging from large groups or health centers with highly structured staff and advanced information systems to solo physician practices with correspondingly small staff. The ability and motivation of these entities to collect and effectively use race, ethnicity, and language data consequently al…
Health Plans
- Health plans, including Medicaid managed care and Medicare Advantage plans, have the capabilities necessary to systematically compile and manage race, ethnicity, and language data, and thus have roles to play in quality improvement (Rosenthal et al., 2009). Plans, though, may have limited opportunities for direct contact during which the data can b...
Surveys
- Federal and state health agencies administer surveys that are primary sources for estimating the health of a population and current and future needs for health care services (Ezzati-Rice and Curtin, 2001; Mays et al., 2004). For example, a number of studies reviewed in Chapter 2 employed surveys such as the National Health Interview Survey (NHIS), the National Latino and Asian Ame…