Medical Records: Compliance with CMS Hospital CoPs and Proposed Changes 2018

Medical Records: Compliance with CMS Hospital CoPs and Proposed Changes 2018 is an event dedicated to CMS regulations and interpretive guidelines for medical records.

Topics

• Introduction to the CMS hospital CoPs
• CMS survey memos
• How to obtain a copy
• Changes to verbal orders, standing orders and H&P update
• Interpretive guidelines issued
• Five requirements for discharge instructions
• Proposed changes to CMS discharge planning standards and what forms would need to be changed
• How to keep posted of new changes
• Changes to transfer form, admission assessment form and discharge planning form
• Proposed changes to federal drug and alcohol drug
• Confidentiality and privacy memo
• TJC changes to comply with CoPs
• OCR new information on HIPAA
• AHIMA practice guidelines
• Autopsies
• Final changes to privacy, security, HITECH
• HITECH and Breach Notification law
• History and physicals
• Verbal orders and changes
• Incident reports
• Grievances
• Medical record education and personnel
• Medical record service requirements
• Content of records
• Author identification
• Legibility and authentication requirements
• Standing orders and protocols
• List of procedures for consent requirements
• Informed consent
• Completed medical records
• Discharge summaries
• Restraint and seclusion
• Other sections of CoPs that are important for documentation in the medical record
• Pre-anesthesia assessment
• Medication documentation
• Visitation with changes to advance directives, consent and plan of care
• Post anesthesia assessment
• Organ donation documentation
• Notification of OPO in deaths
• Anesthesia standards

Who should Attend

• Health Information Management Directors
• Chief Nursing Officers (CNO)
• Health Information Management Staff
• Radiology Directors
• Compliance Officers
• Hospital Legal Counsel
• Lab Directors
• Chief Operating Officers (COO)
• Chief Executive Officers (CEO)
• Joint Commission Coordinators
• Chief Medical Officers (CMO)
• Risk Managers
• Quality Improvement Coordinators
• Patient Safety Officers
• Nurse Educators
• Nurse Managers/Supervisors
• Emergency Department Managers
• Clinic Managers
• Staff Nurses
• Surgery Department Nurse Managers
• Medical Department Nurse Managers
• ICU Nurse Directors
• OR Nurse Directors
• Outpatient Directors
• CCU Nurse Directors
• Policy and Procedure Committee
• IS Directors
• Anyone involved in the implementation of the CMS or Joint Commission medical record and documentation standards