Impacto da inconformidade dos registros de enfermagem no contexto das glosas hospitalares / Impact of the nonconformity of nursing notes in the context of hospital glosses

Objective: to describe the impact of nonconformity of nursing notes in the context of hospital glosses. Method:retrospective, documental and descriptive study, carried out by analyzing financial statements of patients' records of the hospital's sector of private health insurance. The data were collected between April and May 2017, which were later analyzed using descriptive statistics. Results:a total of 194 financial statements of the medical records were analyzed and, among the found glosses, the nursing notes stand out,being responsible for the hospital glosses, mainly: the absence of nursing notes and evolutions; absence of medication check; and absence of evidence of accomplishment or exchange of dressings. Although the financial impact has been almost inexpressive, the impact on the quality of care can be immeasurable. Conclusion: it is concluded that it is important to use strategies such as applicability of concurrent auditing to reduce hospital glosses, to provide improvements in health outcomes and ensure qualityin nursing care

Objetivo: descrever o impacto da inconformidade dos registros de enfermagem no contexto das glosas hospitalares. Método: estudo retrospectivo, documental e descritivo, realizado por meio de análise de demonstrativos financeiros de prontuários de pacientes de um Hospital de Convênio privado de saúde. A coleta dos dados ocorreu entre os meses de abril e maio de 2017, os quais, posteriormente, foram analisados por meio de estatística descritiva.Resultados: 194 demonstrativos financeiros dos prontuários foram analisados e, dentre as glosas encontradas, destacam-se os registros de enfermagem, sendo responsáveis pelas glosas hospitalares, preponderantemente: a ausência de anotações e evoluções de enfermagem; ausência de checagem de medicações; e ausência de evidências de troca ou realização de curativo. Embora o impacto financeiro tenha sido quase inexpressivo, o impacto na qualidade da assistência pode ser imensurável. Conclusão: conclui-se que é importante o uso de estratégias como aplicabilidade da auditoria concorrente para reduzir as glosas hospitalares, proporcionar melhorias nos resultados de saúde e, em especial, assegurar qualidade nos cuidados de enfermagem.

ZPICs Use An Arsenal Of Weapons To Fight Fraud.

CMS recently made changes to Chapter 4 of the Medicare Program Integrity Manual, which include governance for ZPICs.

Government audits in practice: how to mitigate RAC risk.

This article discusses the current movement by Recovery Audit Contractors to target physician practices and recommends a variety of steps providers should take to mitigate the expense and staff inconvenience of audits.

Independent evaluation: insights from public accounting.

BACKGROUND: Maintaining the independence of contract government program evaluation presents significant contracting challenges. The ideal outcome for an agency is often both the impression of an independent evaluation and a glowing report. In this, independent evaluation is like financial statement audits: firm management wants both a public accounting firm to attest to the fairness of its financial accounts and to be allowed to account for transactions as it sees fit. In both cases, the evaluation or audit is being conducted on behalf of outsiders--the public or shareholders--but is overseen by a party with significant interests at stake in the outcome-the agency being evaluated or executive management of the firm. METHOD: We review the contracting strategies developed to maintain independence in auditing. We examine evidence on the effectiveness of professionalism, reputation, liability and owner oversight in constraining behavior in auditing. We then establish parallels with contracting for evaluations and apply these insights to changes that might maintain and improve evaluator independence. CONCLUSIONS AND RECOMMENDATIONS: By analogy with the Sarbanes Oxley Act of 2002 reforms in auditing, we recommend exploring using a reformulated Technical Working Group to encourage more prompt release of more evaluation results and to help insulate evaluators from inappropriate pressure to change their results or analysis approach.

Políticas públicas de fomento ao controle social: estudo da relação entre participação social e falhas na gestão pública em prefeituras municipais na região Nordeste / Public policies that promote social control: a study of the relationship between social participation and failures in governance at municipal governments in the Northeast

Este estudo visa a contribuir com o debate acerca da participação social nas atividades de fiscalização e controle da implementação de políticas públicas. A partir de ideias encontradas no arcabouço teórico que discute esse tema, buscou-se verificar em que medida as falhas constatadas pela Controladoria-Geral da União (CGU) nas fiscalizações e auditorias que se realizam no âmbito dos municípios brasileiros se correlacionam ao perfil participativo da sociedade civil em cidades da região Nordeste. Os resultados desta pesquisa sinalizam que entre participação social e falhas na gestão pública não se observam apenas relações diretas e positivas, mas diversas combinações entre essas duas variáveis.

What your practice should know about Medicare RAC audits.

The Recovery Audit Contractor (RAC) Program has become permanent by statute, and RACs have expanded their focus and efforts to identify improper Medicare payments in all 50 states. Physicians and practice groups that bill Medicare Parts A and B may be subject to a RAC Audit. There are two types of RAC reviews and audits, and there are five levels of appeals available to providers when Medicare claims are denied or a RAC audit identifies a previous Medicare overpayment. Physicians and practice groups should take steps to ensure compliance with Medicare regulations and to be prepared prior to receiving a letter from a RAC.

Preparing for a RAC audit Yale-New Haven Hospital.

To prepare for a RAC audit, Yale-New Haven Hospital has: Developed a RAC readiness team with a multilevel team structure and clearly delineated roles. Created an efficient workflow design. Implemented a software solution that's capable of providing both real-time and retrospective RAC tracking and tools to manage cases from initial denial through final appeal.