NORTH DAKOTA HEALTH CARE
REVIEW, INC.
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2007
Calendar of Events
2006 Calendar
of
Events
MEDICARE
Health Care Quality Improvement Program (HCQIP)
NDHCRI
holds a contract with the Centers for Medicare & Medicaid Services
(CMS) to
serve as the Quality Improvement Organization (QIO) for
Follow this link to access NDHCRI publications
for all Projects, such as newsletters and Quality Quest.
For quick access to the Tools offered by
NDHCRI, follow this link.
Please follow this link to learn more
about the 2006
Quality Forum.
Nursing
Home
Quality Initiative (NHQI)
Home Health
Quality
Initiative (HHQI)
Hospital Quality Improvement Projects
Surgical Care
Improvement Project
Pneumonia
Hospital
Reporting
QUEST
Q&As
Hospital
Reporting and Data Collection Resource - CMS Specifications Manual
5
Million Lives Campaign
Physician Office Quality Improvement Projects
Adult
Immunization
Breast
Cancer
Diabetes
Doctors'
Office Quality - Information Technology (DOQ-IT)
Welcome to
Medicare exam *updated 5/19/06*
Fistula
First *new 06/01/06*
Physician
Voluntary Reporting Program (PVRP) shifting to Physician Quality
Reporting Initiative (PQRI) *new 01/18/07*
Chronic
Kidney Disease Educational Series *NEW posting
10/03/06*
CMS
QualityNet Quest Questions and Answers
There is a wealth of information available through this website, in particular, please look to the Frequently Asked Question feature, also known as QNet Quest located midway down the right hand portion of the main home page.
If you follow this link, you are taken to a “Search” page. You may use the drop down box to access questions and answers related to a particular topic. You may select any of the topics and then click the “search” button and you will have access to Q&As from the past or submit your own question. Or you can enter a keyword and search for Q&As with that word contained in them.
You can change how the results are sorted by clicking on any column header. To arrange the results by date, click on the “Published” column header. This will arrange the sort in chronological order. Clicking on the same column header will toggle between ascending and descending order for that column.
To View the full Q&A,
click on the magnifying glass on the right hand side of the Q&A.
Medicare
Beneficiary Protection Program
NDHCRI is
committed to improving the lives of people with
Medicare, not only by ensuring good medical care, but also by serving
as an
advocate and information resource. Select one
of the
following topics to see how NDHCRI can provide information and
education:
Benefits
Improvement and Protection Act (BIPA)
Please follow this link for updates
effective 07/28/05. Update
Beginning
July 1, 2005, Home Health Agencies, Skilled Nursing Facilities,
Comprehensive Outpatient Rehabilitation Facilities, Swing Beds and
Hospices with
beneficiaries in Original Medicare will be required to notify
beneficiaries of their right to a new expedited review process when
these providers anticipate that Medicare coverage of their services
will end. For more information follow this link BNI information.
Questions regarding the new expedited review process may be e-mailed to
bipaexpeditedreviews@cms.hhs.gov.
Please follow this link to fill out your facility's contact information. Benefits Improvement and Protection Act (BIPA) Contact Information.
Notification of
Hospital Discharge Appeal Rights - Update on CMS-4105-F
CMS has created a webpage on cms.hhs.gov where information and updates on the revised notification process have been posted including notices and instructions. The link is http://www.cms.hhs.gov/BNI/12_HospitalDischargeAppealNotices.asp#TopOfPage.
CMS continually updates the Q&As on this
website. Providers should check the
website often for
updates.
Federal Register - Final Rule for Notification of Hospital Discharge Appeal Rights
Guidance from CMS on Notification of
Hospital Discharge Appeal Rights
Follow this link to a
powerpoint presentation created by CMS about Hospital Discharge
Appeal Rights
Hospital Discharge Notice Provider Training
An educational session is being provided by the Beneficiary Protection
Program
Quality Improvement Organization Support Center, TMF Health Quality
Institute
entitled "Notification of Hospital Discharge Appeal Rights: Provider
and
QIO Responsibilities". To access this recorded webex follow this
link, go the upper right corner and click on "View Event Recordings"
then once on this page, scroll down to "TX - HINN Provider
Training". Educational
Session
NDHCRI letter templates for Hospital Discharge Reviews
Please follow this link to access the Letter
Templates that NDHCRI will be using for notifications related to
the
Hospital Discharge Appeals.
Beneficiary Notice of Liability *temporary form as of 07/25/07*
This template is an interim form for HINN 12 that may be used until CMS releases their final version.
Contact Form
It is very important for each
facility to fill out this form
and return it to NDHCRI as soon as possible.
We need to be able to locate the contact person or department
when an
appeal has been requested by a beneficiary or their representative. The inability to reach a contact person at
your facility could incur further liability for your facility.
Please fill out this Contact Form and fax to NDHCRI.
For your convenience here are the contact numbers for NDHCRI:
Medicare Beneficiary Hotline
1-800-472-2902 (In State)
1-888-472-2902 (Out of State)
NDHCRI Fax 1-800-838-6009
List of documents to be submitted to NDHCRI to complete the appeal/review.
Hospital Discharge Notice Review Process
Who is authorized by law to make health care decisions?
Authorized Representative North Dakota's Century
Code
Follow this link to the North
Dakota Century Code statement which can be found on pages 17 and 18
of this
document.
Special Project: Admissions
with three day or less length of stay
HPMP
Resources
HPMP
Compliance workbook
HPMP QIO Support Contractor
Resources
HPMP FOCUS_PDSA
Beneficiary
Complaint Response Program
Program
for Evaluating Payment Patterns
Electronic Report (PEPPER)
Please
follow this link for information about PEPPER.
This link will lead you to more resources. PEPPER resources
Look to the Calendar of Events for future training sessions.
Case
Review
MEDICAID
NDHCRI
provides
review of Medicaid utilization, as well as pre-authorization review.
Occasionally, NDHCRI will engage in focused reviews at special request.
Preauthorization Areas
Specialty
Unit Criteria: CDU and Psychiatric
