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Massachusetts General Hospital (MGH) in Boston is working hard to minimize costs and hospitalizations, especially as Baby Boomers age.
In order to do this, MGH has invested heavily in primary care practices to provide hands-on, individualized care for patients suffering from a variety of health problems. In the program, primary care nurses work constantly with patients to arrange medical and nonmedical services, all aimed at keeping seniors healthy enough to stay out of the hospital.
MGH officials hope this program will help make its systems more efficient and contribute to long-term savings.
Source: The Boston Globe
Every hospital should develop and maintain its own internal coding manual. It’s an essential tool to ensure good coding quality and compliance. Although your department must have all the official manuals (i.e., the CPT Manual, the ICD-9-CM Manual, and the HCPCS Manual), an internal coding manual provides much more information, including the following:
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Reference guide for coders
- Backup in case of a compliance audit
- Source for policies and procedures
- External/internal audit information
- Definitions of coding terminology
The following is a checklist you can use as a guide to help develop your own coding manual:
- Coding scope of service and ethical standards
- Coding protocols (use of coding manuals, encoder, and medical record as the source document)
- Coding accuracy
- AHIMA’s standard of ethical coding
- Definitions of coding terms
- Coding classification systems
- Use of outside consultants
- Orientation checklist
- System-wide corporate compliance
- Rebill policy
- Job descriptions
- Other policies
- Tips for the medical staff
- Resources
Editor’s note: This article was adapted from HCPro’s book, The HIM Director’s Handbook, by Jean S. Clark, RHIA. For more information, visit the HCPro Web site.
A recent study by the Agency for Healthcare Research and Quality says that hospitals spent over $30 billion on unnecessary admissions in 2006.
The study used prevention quality indicators to determine whether an admission was unnecessary, and concluded that 4.4 million admissions in 2006 could have been prevented with adequate outpatient care.
Medicare patients accounted for $20.1 billion, or nearly two-thirds of the $30.8 billion total.
CMS has announced a new pilot program—called the Care Transitions Project—aimed at eliminating unnecessary hospital readmissions.
Fourteen communities have been selected to participate in the program. Each of the communities is led by a state Quality Improvement Organization (QIO). QIOs work throughout the country as part of CMS’ quality program to help healthcare providers, consumers, and stakeholder groups to refine care delivery systems to ensure Medicare patients receive high quality and high-value care.
The Colorado Foundation for Medical Care has created a map of the 14 community QIOs selected to participate in the project. CMS will monitor the success of the Care Transitions Project by monitoring the rates at which patients in these communities return to the hospital. The project will run until summer 2011.
Sources: Care Transitions QIOSC
The next CMS Hospital & Hospital Quality Open Door Forum conference call has been postponed until May 6 at 2 p.m. Eastern time. To access the call, dial 800/837-1935 and reference 89323669 as the conference ID.
CMS will also allow access to the "encore" (i.e., recorded) playback of this call beginning two hours after the live conference call has ended. It will expire after three business days. To listen to the encore playback, dial 800/642-1687 and enter 89323669 as the conference ID.
Open Door Forum conference call rescheduled for April 22
The next CMS Hospital & Hospital Quality Open Door Forum conference call, previously scheduled for later this week, has been moved to Wednesday, April 22.
The Iowa Hospital Association (IHA) reports declines in service areas and increases in charity care for Iowa hospitals. Considering all factors, Iowa hospitals’ overall margins have fallen from 5.5% in 2007 to -9.6% at the end of 2008.
Kirk Norris, the President and CEO of the IHA, comments that, unlike other businesses, hospitals must provide their services 24 hours a day every day, despite their customers’ inability to pay.
Another factor contributing to the hospitals’ economic hardships, according to the IHA, are reimbursement rates from Medicare and Medicaid. These programs together make up about 60% of Iowa hospital revenue, and in 2008 Iowa hospitals lost more than $275 million to the two programs.
Hospitals are among the largest employers in the counties where they are located, and Norris calls for the government to take a close look at the burden programs such as Medicare and Medicaid are placing on them.
Source: Iowa Hospital Association
Q: When a physician-owned lithotripsy partnership contracts with a hospital to provide a lithotripter and skilled technician "under arrangements," may the hospital pay for such services using a per-use or percentage-based compensation formula without violating the physician self-referral law?
A: Yes. Under certain circumstances, a hospital may use a per-use or percentage-based formula to compensate a physician-owned lithotripsy partnership that provides a lithotripter and skilled technician to the hospital on an "under arrangements" basis without violating the physician self-referral law.
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