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Posts Tagged ‘Hospital Reimbursement’

Inpatient Prospective Payment Systems Hospitals Long-Term Care Hospital Fiscal Year 2013 Rates

Friday, October 26th, 2012

IPPS Revisions Released By CMS

Link
We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012.

 We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule.

 In addition, we are implementing changes relating to determining a hospital’s full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers (ASCs) that are participating in Medicare.

We are establishing requirements for the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program.

 DATES: Effective date: This final rule is effective on October 1, 2012.

OIG Work Plan New Hospital Issues Added For 2013

Thursday, October 4th, 2012

 

OIG 2013 Work Plan – Hospital Issues Aded To OIG Work Plan

Hospitals—Inpatient Billing for Medicare Beneficiaries (New)

Hospitals—Diagnosis Related Group Window (New)

Hospitals—Non-Hospital-Owned Physician Practices Using Provider-Based Status (New)

Hospitals—Compliance With Medicare’s Transfer Policy (New)

Hospitals—Payments for Discharges to Swing Beds in Other Hospitals (New)

Hospitals—Payments for Canceled Surgical Procedures (New)

Hospitals—Payments for Mechanical Ventilation (New)

Hospitals—Quality Improvement Organizations’ Work With Hospitals (New)

Hospitals—Acquisitions of Ambulatory Surgical Centers: Impact on Medicare Spending (New)

Critical Access Hospitals—Payments for Swing-Bed Services (New)

Long -Term-Care Hospitals—Payments for Interrupted Stays (New)

 

Issues That Continue To Be On OIG Radar

Hospitals—Same-Day  Readmissions

Hospitals—Acute-Care Inpatient Transfers to Inpatient Hospice Care

Hospitals—Admissions With Conditions Coded Present on Admission

Hospitals—Inpatient and Outpatient Payments to Acute Care Hospitals

Hospitals—Inpatient Outlier Payments: Trends and Hospital Characteristics

Hospitals—Reconciliations of Outlier Payments

Hospitals—Duplicate Graduate Medical Education Payments

Hospitals—Occupational-Mix Data Used To Calculate Inpatient Hospital Wage Indexes

Hospitals—Inpatient and Outpatient Hospital Claims for the Replacement of Medical Devices

Hospitals—Outpatient Dental Claims

Hospitals—Outpatient Observation Services During Outpatient Visits

Critical Access Hospitals— Variations in Size, Services, and Distance From Other Hospitals

Inpatient Rehabilitation Facilities—Transmission of Patient Assessment Instruments

Inpatient Rehabilitation Facilities—Appropriateness of Admissions and Level of Therapy

Hospital Acquired Conditions – 2012 OIG Work Plan

Monday, January 23rd, 2012

OIG To Review Accuracy Of Present-On-Admission Indicators – Hospital Acquired Conditions

 In 2008, CMS began requiring hospitals to submit indicators for present-on-admission (“POA”) with each Medicare diagnoses code.  This enables CMS to identify which diagnoses were present when the patient was admitted and which developed during the term of the stay in the hospital.  Hospitals do not receive any additional compensation relative to conditions that develop during the term of the hospital stay.  In fact, hospitals with high rates of hospital-acquired conditions receive reduced Medicare payments under the Affordable Care Act.

 The 2012 work plan includes a new item relating to hospital-acquired conditions.  The OIG will be using certified coders to review claims for accuracy of POA indicators.  It appears that the OIG will be providing this information to CMS to assist CMS in fulfilling its responsibilities to reduce payment to hospitals with high levels of hospital-acquired conditions.  This action item reflects increased focus on the issue of hospital acquired conditions.

Hospital Inpatient Value-Based Purchasing Program Rules

Saturday, January 22nd, 2011

Hospital Inpatient Value-based Purchasing Program:New Rules Proposed By CMS

CMS has  issued a notice of proposed rule-making to the Federal Register on January 13, 2011 concerning the hospital value-based purchasing program.  The new program has become known as the VBP Program.  CMS was required to develop this program under the Accountable Care Act.

The hospital value-based purchasing program, which would apply beginning in FY 2013 to payments for discharges occurring on or after October 1, 2012, would make value-based incentive payments to acute care hospitals, based either on how well the hospitals perform on certain quality measures or how much the hospitals’ performance improves on certain quality measures from their performance during a baseline period. The higher a hospital’s performance or improvement during the performance period for a fiscal year, the higher the hospital’s value-based incentive payment for the fiscal year would be.

CMS is accepting public comments on the proposed rule through March 8, 2011.

The proposed regulations can be found at this link.

John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
500 First Street, Suite 8000
P.O. Box 8050
Wausau, WI 54402-8050

Tel 715.845.4336
Fax 715.845.2718

Ruder Ware is a member of Meritas Law Firms Worldwide

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