CMS released the results for year five of the Hospital Readmissions Reduction Program. Here is what you need to know: What was covered? CMS examined hospitals’ 30-day readmission rates for seven conditions: Heart attacks Heart failure Pneumonia Chronic lung disease Hip and knee replacements Coronary artery bypass graft surgery What...
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Clinical Documentation Improvement in 2016
Clinical Documentation Improvement in 2016 – The New Normal Over the past several years, Clinical Documentation Improvement (CDI) Programs have proliferated. In fact, 81% of hospitals have reported having a CDI Program according to a 2015 study by the Advisory Board. The emphasis on documentation has been driven by internal...
2017 IPPS Rule Released
The Centers for Medicare & Medicaid Services (CMS) released the FY 2017 IPPS Rule this week (accessible at https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-18476.pdf). Key things to be aware of in the 2,434 pages: Two-midnight rule inpatient pay cuts were not adopted Financial benefits and penalties related to the reporting of quality data and meaningful...
The Cardiac Bundle – What You Need to Know
Just as many hospitals are adjusting to the Comprehensive Care for Joint Replacement (CJR) bundled payment model, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on the next bundled payment model – the cardiac bundle (bypass surgeries and heart attacks). Many in the industry are not...
Stay compliant: High cost DRGs you need to pay attention to
It’s been eight months since the implementation of ICD-10. It appears the sky has not fallen. Coder productivity as expected has slowed, but is showing signs of improvement. In a recent AHIMA survey conducted in early May approximately 68% of the 156 coding professionals who responded reported that there was...
Limit Denials through Proactive, Pre-Bill Auditing
The Department of Health and Human Services (“HHS”) issued a proposed rule, published in the Federal Register on July 5th, to change Medicare appeals procedures in an attempt to make the process more streamlined and efficient. Currently, the HHS Office of Medicare Hearings and Appeals (“OMHA”) has a backlog of...
OIG Issues Spring 2016 Semi-Annual Report
Recently the Health and Human Services (“HHS”) Office of Inspector General (“OIG”) issued its Spring 2016 Semi-Annual Report (“Report”) to Congress for the six-month period ending March 31, 2016. The OIG is mandated to report on a semiannual basis to Congress on the administration of HHS’ programs. The Report summarizes...
Slowing the Revolving Claims Door with Pre-Bill Revenue Integrity Reviews
For the majority of healthcare organizations across the country, the transition to ICD-10 was smooth – cases are being timely coded and dropped and revenue cycle A/R goals are being met. Don’t get too comfortable. Every leader in the revenue cycle should be asking the following questions: How have our...
Reporting Structures of a Compliance Program
While implementing an effective compliance program is not a guarantee of fraud, waste and abuse prevention, it does help mitigate the risk of improper conduct. One key element of an effective and successful compliance program is oversight and defined reporting. Below are tips to consider when implementing or evaluating the...
Coding Clinic Updates: Significant Changes to CHF and Diabetes Coding
Coding Clinic 1st Quarter 2016 Updates The release of Coding Clinic 1st Quarter 2016 (effective with discharges which started on March 18, 2016) brought about two significant changes. Heart Failure The first change is the acceptance of the more contemporary heart failure classification terms that refer to ejection fraction and...