...Medicare Audits Affecting Healthcare Ecosystem Medicare is the most prominent health insurance program in the world; accounting for two percent of gross domestic production, seventeen percent of the U.S. health expenditures, and one-eighth of the government’s national budget. The major impact that this government payer program has in the healthcare ecosystem is the massive coverage it provides to the elderly and disabled. Costing about $260 billion annually, Medicare inaugurated the Recovery Audit Contractor (RAC) program to make claims more cost effective with the detection of over and under payments. The recovery audit was first drafted through Section 306 of the Medicare Modernization Act (MMA) of 2003 which directed the Department of Health and Human Services (DHHS) to constitute a demonstration of the program. The required program began in 2005 and utilized RACs to isolate and correct inappropriate payments in the Medicare Fee-For-Service (FFS) program. According to the Centers for Medicare and Medicaid Services (CMS) (2014), the demonstration ended in 2008 resulting over $900 million in overpayments and nearly $38 million in underpayments. The success of the audit trial gave CMS a “valuable new tool for preventing future inappropriate payments” (American Health Information Management Association (AHIMA), 2009). This succession brought the recovery audit into legislation under Section 302 of the Tax Relief and Healthcare Act of 2006 which mandated a permanent...
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...Chapter 16 – Software Quality Assurance Overview This chapter provides an introduction to software quality assurance. Software quality assurance (SQA) is the concern of every software engineer to reduce costs and improve product time-to-market. A Software Quality Assurance Plan is not merely another name for a test plan, though test plans are included in an SQA plan. SQA activities are performed on every software project. Use of metrics is an important part of developing a strategy to improve the quality of both software processes and work products. Software Quality Assurance • Umbrella activity applied throughout the software process • Planned and systematic pattern of actions required to ensure high quality in software • Responsibility of many stakeholders (software engineers, project managers, customers, salespeople, SQA group) SQA Questions • Does the software adequately meet its quality factors? • Has software development been conducted according to pre-established standards? • Have technical disciplines performed their SQA roles properly? Quality Assurance Elements • Standards – ensure that standards are adopted and follwed • Reviews and audits – audits are reviews performed by SQA personnel to ensure hat quality guidelines are followed for all software engineering work • Testing – ensure that testing id properly planned and conducted • Error/defect collection and analysis – collects and analyses error and defect data to better...
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...However, to make this decision, management must know what the reengineering will cost. This contribution describes an eight step tool supported process for calculating the time and the costs required to reengineer an existing system. The process is derived from the author’s 20 year experience in estimating reengineering projects and has been validated by several real life field experiments in which it has been refined and calibrated. Keywords: Reengineering, cost estimation, risk analysis, software measurement, gap analysis. It has been 15 years since the first studies on the economics of software reengineering projects appeared and since then a great deal of research has been done and a wide range of practical experience gathered.[1] At that time, reengineering projects were being calculated on the basis of the size alone, without consideration of complexity and quality. In the meantime, we have learned a lot more about how the complexity and quality of the software effect reengineering costs. The topic of estimating the costs of a reengineering project has also become more important to decision makers in industry since they have other alternatives to choose from. Reengineering is an alternative to redevelopment, to purchasing a standard package or to doing nothing at all. Therefore, management wants to know, what the return on investment is for each alternative. Without having a cost estimation it is not...
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...Volume 1, Issue 2, December 2010 19 Analysis of Software Quality Models for Organizations Dr. Deepshikha Jamwal University of Jammu Department Of Computer Science & IT jamwal.shivani@gmail.com Abstract Software Quality model is a vital to obtained data so that actions can be taken to improve the performance. Such improvement can be measured quality, increased customer satisfaction and decreased cost of quality. Software metrics and quality models play a pivotal role in measurement of software quality. A number of well known qualities models are used to build quality software. Different researchers have proposed different software quality models to help measure the quality of software products. In our research, we are discussing the different software quality models and compare the software quality models with each other. Also a framework containing steps is proposed by authors. Some recommendations are also framed hereby in the following research paper. Keywords Software Quality Models, McCall model, Dromey‟s model, FURPS model, ISO 9126 model. Objectives To begin with there are some common objectives: To analysis various software quality models w.r.t various attributes. The presence, or absence, of these attributes can be measured objectively. The degree to which each of these attributes is present reflects the overall quality of the software product. These attributes facilitate continuous improvement, allowing cause and effect analysis which maps to these...
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...Evaluation of Software Quality Krzysztof Sacha Warsaw University of Technology, Nowowiejska 15/19 00-665 Warszawa, Poland k.sacha@ia.pw.edu.pl Abstract. The paper describes a method, which we used to evaluate the expected quality of software that was developed for a huge governmental system. The evaluation lasted nearly two years and was performed along with the software development process. The output that was expected by our customer consisted of a quality assessment accompanied by a set of recommendations on what to do in order to enhance the quality of the product. 1 Introduction The ultimate goal of software engineering is to find methods for developing high quality software products at reasonable cost. As computers are being used in more and more critical areas of the industry, the quality of software becomes a key factor of business success and human safety. Two approaches can be followed to ensure software quality. One is focused on a direct specification and evaluation of the quality of software product, while the other is focused on assuring high quality of the process by which the product is developed. The software industry is currently entering a period of maturity, in which particular informal approaches are specified more precisely and are supported by the appropriate standards. Quality characteristics of software products are defined in ISO/IEC 9126 [1]. For each characteristic, a set of attributes which can be measured is determined. Such a definition...
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...Title:The Relationship between Software Metrics and their respective Quality Factors Introduction The major goal of Software Engineering is to produce ‘Quality’ Software that meets the user’s needs. Software quality is defined as “an effective software process applied in a manner that creates a useful product that provides measurable value for those who produce it and those who use it”. (Pressman 2010: 400) For quality software to be designed, the problem must be understood, requirements gathered in order to produce a high-quality software solution, which must contain all the functional features that are required by the end user. McCall (1977) developed a Software Quality model which is vital to obtain data to improve the performance of a piece of software. The McCall quality model defines and identifies the quality of a software product by addressing the three perspectives, product operation; the ability of the product to be easily understood and operated to produce the required results of the user, product revision; the ability of the software product to undergo changes which include error correction, flexibility, system adaptation, product transition; the ability of the software to adapt to new environments and adapt to rapidly changing hardware (Jamwal 2010). The model gives a relationship between Software Quality Factors and Metrics used to quantify the quality of software. Software Quality factors represent attributes or characteristics of software that a user would use to...
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.../m'cCall, Gene F./Waiters Software Quality for an Vk~~ '4 Paul K./RichA'rds -General Electric Company .,..... . 4- Approved for public release; distribution unlimited. ROME AIR DEVELOPMENT CENTER Air Force Systems Command Griffiss Air Force Base, New York 13441 This report has been reviewed by the PADC Information Office (01) and is releasable to the National Technical Information Service (NTIS). At NTIS it will be releasable to the general public, including foreign nations. RADC-TR-77-369, Vo] III (of three) has been reviewed and approved for publication. APPROVED: JOSEPH P. CAVANO Project Engineer APPROVED: (2 &4~L ( ALAN R. BARNUM, Assistant Chief information Sciences Division FOR THE COMMANDER: JOH" F . HUSS Acting Clief, Plans Office If your address has changed or if you wish to be removed from the RADC mailing list, or if the addressee is no longer employed by your organization, please notify RADC (ISIS) Griffiss AFB NY 13441. This will assist us in maintaining a current mailing list. Do not return this copy. Retain or destroy. SECURITY CLASSIFICATION OF THIS PAGE (IW.i, Vt e En eed)RE REPORT DOCUMENJATIO4 PAGE I. REPORT NU bER . D I S UC ON BFRE COMPTING ORM ... ' j2. GOVT ACCESSION NO. 3. ft9CIPIkNTIS CATALOG NUMBER RADC-TR-77-369, 4. TITLE (and Subtlfe) Vol III (of three) COVERED S. TYPE OF REPORT A P91111O0 Final Technical Report FACTORS IN SOFTWARE QUALITY Aug 76 - Jul 77 ...
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...Introduction The use of software solutions to support business-critical processes has a decisive influence on the commercial success of the banks. At present, they are faced with the challenge of selecting optimal solutions to fit their particular needs, and implementing them. Information technology is indisputably crucial to the activities of financial service providers. A considerable proportion of funds should be spent on core banking systems, which provide indispensable support for bank-specific business processes. For some years now, banking software has been the source of lively debate. The advanced age of many business-critical systems, as well as their rigidity and complexity, have proven to be a burden to banks. Concern exists that they might no longer be able to meet the demands of today’s market. The triggers of this concern have been software systems that have been in use for a number of years and have been further developed over the course of time; in many instances they have been linked up – as effectively as possible – to bolt-on applications. Many core banking systems have grown up over the years that are lacking in the necessary flexibility, which has been compensated by workarounds. The technical problems that affected RBS Group has caused the banks to rethink their IT strategy. The transformation of the software environment is not merely giving banks the flexibility and agility they need. The use of appropriate applications also constitutes an effective...
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...The major goal of Software Engineering is to produce ‘Quality’ Software that meets the user’s needs. Software quality is defined as “an effective software process applied in a manner that creates a useful product that provides measurable value for those who produce it and those who use it”. (Pressman 2010: 400) For quality software to be designed, the problem must be understood, requirements gathered in order to produce a high-quality software solution, which must contain all the functional features that are required by the end user. McCall (1977) developed a Software Quality model which is vital to obtain data to improve the performance of a piece of software. The McCall quality model defines and identifies the quality of a software product by addressing the three perspectives, product operation; the ability of the product to be easily understood and operated to produce the required results of the user, product revision; the ability of the software product to undergo changes which include error correction, flexibility, system adaptation, product transition; the ability of the software to adapt to new environments and adapt to rapidly changing hardware (Jamwal 2010). The model gives a relationship between Software Quality Factors and Metrics used to quantify the quality of software. Software Quality factors represent attributes or characteristics of software that a user would use to relate or determine the overall quality of a piece of software. While Software metrics provide...
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...A Software Quality Assurance and Management System Er.Ashish Kumar Tripathi, Er. Sachin Kumar Dhar Dwivedi, Mr. Saurabh Upadhyay Abstract- Software quality objectives covers a variety of techniques and measurements, including gathering code metrics, enforcing coding rules, and proving the absence of run-time errors. The guide also takes into account the origin of the code, its stage in the software life cycle, and the safety aspects of the application. The guide explains how to gradually adapt the code verification process to achieve targeted quality objectives Index Terms- Application and System S/W, System efficiency, testing and good designing tools. -------------------------------------------------------- 1-Introduction Quality assurance for automotive systems can require different types of verification activities throughout the development process. Early verification focuses on evaluating intermediate software builds and removing defects at coding time. This represents an emerging trend because performing verification early in the process can improve overall quality and reduce development time. Post-production verification focuses on evaluating final build quality or finding defect root causes after the product is complete. This is the most common approach to automotive system verification. 3-About Software ProductsSoftware products may be • Custom - developed for a particular customer, according to its specifications Generic (“package”) - developed for...
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...Why Are There So Many Deaths Caused By Medical Errors and What Solutions Can Decrease Them? Health Service Systems – HSM541 June 20 2015 Background Medical errors kill at least 44,000 people and perhaps as many as 98,000 people per year. Or do they kill over 180,000 per year? Maybe even 440,000 people killed by medical errors? Allen (2013) In 1999 the Institute of Medicine (IOM) published a report titled “To Err Is Human: Building A Safer Health System” that leveled the healthcare community. They reported that according to two studies “perhaps as many as 98,000 people die in hospitals each year as a result of medical errors that could have been prevented”. IOM (1999) Then the Office of Inspector General for Health and Human Services followed up with a report in 2010 that stated “bad hospital care contributed to the deaths of 180,000 patients in Medicare alone in a given year”. Allen (2013) And finally in 2013, the numbers were once again raised. Per a report from the Journal of Patient Safety that approximately “440,000 PAEs (preventable/potential adverse events) that contribute to the death of patients each year from care in hospitals. This is roughly one-sixth of all deaths that occur in the United States each year”. They are now the U.S.’s third leading cause of death, behind only heart disease and cancer. All of the numbers mentioned in the first paragraph are medical errors that were “preventable”. Mistakes by the people you put your trust in killed you...
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...In the 1999 research studies began to review the problem of medical errors and how they occurred. Studies and reports, such as the Institute of Medicine IOM report in 1999, strongly suggest that most medical errors are related to systems and processes and not individual negligence or misconduct. The IOM report recommended that the key to addressing medical errors is to focus on improving the processes used to deliver healthcare and not placing blame on the individuals involved. Approximately 1.3 million people are injured annually in the United States following "medication errors". The FDA defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or harm to a patient”. The U.S. Food and Drug Administration (FDA) currently review medication error reports that come from drug manufacturers and through Med Watch, the agency's safety information and adverse event reporting program. The agency also receives reports about medication errors from the Institute for Safe Medication Practices (ISMP) and the U.S. Pharmacopeia. Some things the FDA has put into place to prevent medication errors: * Drug Name Review: To minimize drug name confusion, FDA reviews about 400 drug names a year that companies submit as proposed brand names. The agency rejects about one-third of the names that drug companies propose. * Drug Labels: FDA regulations require all over-the-counter (OTC) drug products (more than 100,000) to have a standardized...
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...Bar Code Safety and Efficacy http://www.psqh.com/sepoct05/barcodingrfid1.html Errors that occur earlier in the medication process are more readily detected (~50% are prevented during the ordering stage) while very few (< 2%) are caught at the administration stage (bates et al., 1995). further, it has been noted that more than one third of medication errors occur at the latter stage (leape et al., 1995). because of the relatively high proportion of errors and the lack of success preventing them, error reduction strategies targeted at the administration stage High rates of preventable medication errors have been repeatedly reported in studies in the medical literature (Bates et al., 1995; Leape et al., 1995; Flynn et al., 2002; Kanjanarat et al., 2003). It is difficult, however, to cite a single number to define the extent of the medication error problem due to differences in institutions, study methodologies, error definitions, and other variables. On the high end of estimates, one study that compiled data from 36 institutions reported 19% (~1 in 5) of the medication doses studied over a 4-day period involved medication errors (Barker et al., 2002). These errors included wrong time (43%), omission (30%), wrong dose (17%), and unauthorized drug (4%). The number of these errors deemed potentially harmful adverse drug events (ADEs) was 7%. A comprehensive review of medication error studies cited in the Institute of Medicine (IOM) 2000 report on errors in the U.S. healthcare system...
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...Quality Improvement Project: Address barriers and leveraging strengths to achieve improvement in your organization. The numbers of medical error that occur in hospital settings are usually under estimated. Improving these events has come a long way since 2005. The Patient Safety and Quality Improvement Act has contributed to the healthcare industry by allowing employees to report without fear of liability to agencies who then identify, analyze, and reduce risks and hazards that often occur when administering care to a patient (Youngberg, 2011). This is a great tool in advancing the training process of the health care team and increasing patient safety. In addition to employees having what I would call free speech to the Patient Safety Organizations, provider’s organizations can have the same privilege so long as they establish a relationship with the PSO who has participated in the peer review process. Any healthcare organization that wants to improve the quality of care their patient receives would encourage their employees to participate. Having a manager with strong leadership skills within the organization can also be a driving force for positive change. Strong leaders are creative, experienced and can motivate employees. They will be able to detect where and how a problem was initiated and can create a plan focused on preventing the problem. They can be an advantage to achieve quality improvements by analyzing data, composing a safety plan for all clients in and out...
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...“Nursing’s Role in Promoting Quality and Patient Safety Assignment” Nurses inherently are concerned with patient safety. They are best positioned to prevent medical errors at the bedside. There is a moral and legal imperative to implement safe practices at all times. Nurses and the profession are negatively impacted when medical errors occur. Until recently the Centers for Medicare & Medicaid Services (CMS) mandated that all patient medications be administered 30 minutes before or after a scheduled time (Department of Health & Human Services [DHHS] & Centers for Medicare & Medicaid Services [CMS], 2011, December 22). Given the expanding role of nurses, the CMS mandate is now unrealistic and counter-productive. The Institute for Safe Medication Practices (ISMP) addressed this issue by creating an Acute Care Guideline for the timely administration of schedule medications. Institute for Safe Medical Practice The ISMP is dedicated to preventing medical errors by promoting safe medication administration procedures (ISMP, 2013a). The ISMP reviews all facets of safe medication administration. Medication errors frequently result in debilitating injuries or death. The ISMP posits that the most frequent medical error is medication administration. Medication error affects over 1.5 million people annually (ISMP, 2007b, p. 1). The ISMP has committed staff and resources to reduce medication errors. It has developed training and educational programs for health care staff and consumers...
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