No doubt you are aware that CMS has posted the proposed FY 2013 Inpatient Prospective Payment Rule for review and comment (comments are due by June 25; Federal Register publication is scheduled for May 11). Perhaps the best news is that this year the scramble to update systems with new ICD-9-CM codes, changes to MCCs and CCs, and revisions to the MS-DRGs won’t happen because CMS imposed a freeze on revisions to the codes to accommodate the implementation of ICD-10 on Oct. 1, 2013. But even... Read more

The benefit of the Recovery Audit Program to the government and its impact on health care providers continues to be evident, based on reports from CMS and the American Hospital Association on activity during the fourth quarter 2011. The CMS Quarterly Newsletter reported overpayment collections of $397.8 million and the return of $24.9 million in underpayments. The American Hospital Association, in its AHA RACTrac Survey, 4th Quarter 2011, reported $444 million in denials since October 2008, an... Read more

Spinal fusion is the latest target area added to the Program for Evaluating Payment Patterns Electronic Reports (PEPPER) for short-term acute care hospitals (and the data were distributed on Feb. 24). But this 30th target area is different from the others: Here the focus is not on coding or whether the patient should have been admitted, but on whether the procedure was medically necessary at all. Medicare requires physicians to document more conservative treatments, such as physical therapy,... Read more

CMS has released its second FY 2012 issue of the Medicare Quarterly Provider Compliance Newsletter (Vol. 2, Issue 2, January 2012). This issue of the newsletter highlights major findings identified by RACs in audits of inpatient hospitals and DME suppliers. It is a good heads-up for providers on hot compliance issues and provides some guidance and resources to help tackle the problem. If you are trying to identify topics for training sessions, this is a good place to start. The current topics... Read more

Hospital readmissions, long recognized as a problem by Medicare and studied by industry analysts, are now becoming a focus of the mainstream media. The catalyst: the looming payment penalties that kick in on Oct. 1, 2012, if a hospital’s Medicare 30-day readmission rate for heart attacks, heart failure and pneumonia exceed a certain threshold, and the scrutiny by Medicare auditors, including the HHS Office of Inspector General. Hospitals are scrambling to find ways to reduce readmissions to... Read more