All Entries Tagged With: "medicare"
Primary care and healthcare reform: Where do we fit in?
In the healthcare reform discussion, one thing that most people agree on is the need to revamp primary care and primary care reimbursement. One congressional committee has published a Discussion Draft on the House healthcare reform bill.
This bill calls for increasing Medicare reimbursement by 5% (10% if the physician practices in an area defined as a health professional shortage area) for primary care services. These services are defined as evaluation and management services, including new and established patient office visits, and “other physicians services as the Secretary determines are associated with ensuring accessible, continuous, coordinated, and comprehensive care for individuals enrolled under this part.”
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New Medicare enrollment rules = revenue at risk
The recent Medicare enrollment rules went into effect on April 1 and have many practices scrambling. Having originally set the rules to go into effect on January 1, CMS delayed implementation to allow for physician organizations to voice their concerns. However, it appears those concerns fell on deaf ears.
In case you missed this—and apparently many practices did—the new rule shortens the timeframe under which a physician can retroactively bill for services provided following a successful enrollment (or reenrollment) from 27 months to 30 days! Yes, you read that right. This represents a dramatic shift that will put a great deal of pressure on many hospital medicine practices.
Resident work rules: Boom or bust for hospitalists?
Editor’s note: Last month, we posted IOM’s proposed changes on resident sleep hours. Hear what Richard Rohr has to say about what it could mean for hospitalists.
The advent of more restrictive work rules for residents is likely to have significant, and possibly paradoxical, effects on hospital medicine. Residents would be limited to 16 hours of admitting, followed by at least 5 hours of rest, but no more admissions for the remainder of the day. This rule will likely spur further growth of night float systems within residency programs, but it could play out in other ways. [more]
Medicare HAC and POA non-payment changes take effective today
The Centers for Medicare & Medicaid Services (CMS) overhauled its system of MS-DRG hospital reimbursement. Taking effect today, Oct. 1, CMS will cease to pay hospitals for certain “never events,” including hospital-acquired conditions (HAC) with adjustments to present-on-admission (POA) conditions.
For discharges occurring on or after Oct. 1, hospitals will not receive reimbursement for conditions that are “(a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines,” states the CMS Web site. The CMS changes were brought forth by the Deficit Reduction Act (DRA) of 2005, signed by the president on Feb. 8, 2006, in which the secretary of the Department of Health and Human Services named what conditions were reasonably preventable. The changes were published in the CMS Inpatient Prospective Payment System (IPPS) Fiscal Year 2009 Final Rule on July 31.
The 10 categories of HACs under payment provision are the following conditions:
- Foreign object retained after surgery
- Air embolism
- Blood incompatibility
- Stage III and IV pressure ulcers
- Falls and trauma
- Manifestations of poor glycemic control
- Catheter-associated urinary tract infection
- Vascular catheter-associated infection
- Surgical site infection
- Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)
The POA Indicator and HAC payment provision apply only to IPPS hospitals. Some hospitals are exempt, including cancer hospitals, children’s inpatient facilities, and critical access hospitals.
To receive more information on MS-DRGs and to earn CME credits, register for the Webcast called “Clinical Documentation Updates for Hospitalists: Position Your Practice to Maximize Value,” sponsored by HCPro, Inc., in partnership with the Society of Hospital Medicine.
