In January, CMS sent the Stage 3 Notice of Proposed Rulemaking to the Office of Management and Budget, which is the final stop for proposed rules that must be federally reviewed prior to their release. CMS representatives...Read More »
Quality. It’s been CMS’ mantra over the past few years.
Traditionally, the inpatient prospective payment system (IPPS) final rule’s release marked changes in MS-DRG assignment, creation of new ICD codes, and payment and regulatory measures.
Such items essentially vanished of late...Read More »
Three university hospitals saw a doubling of Recovery Auditor (RAC) audit activity from 2010–2011 to 2012–2013, and a nearly three-fold increase in overpayment determinations, according to a new study in the Journal of Hospital Medicine.Read More »
For calendar years (CYs) 2010 and 2011, Medicare paid hospitals $711 million for claims that included a diagnosis code for Kwashiorkor, a form of severe protein malnutrition typically found in third-world countries that is extremely rare in the United States.Read More »
Medicare’s Value-Based Purchasing ties reimbursement to quality measures, assessing criteria such as mortality, patient satisfaction, and other items.Read More »
Department of Health and Human Services Secretary Sylvia Burwell announced last week plans to ramp up Medicare payment reforms featuring alternative payment models and value-based payments.Read More »
The CDI specialist’s role is changing. It’s no longer enough to query for diagnoses and report corresponding codes. The diagnosis must be backed up by clinical indicators and thorough documentation—or it risks being overturned by an auditing agency. Read More »
Query revision for ICD-10-CM/ PCS compliance is underway for at least 51% of those responding to a recent ACDIS poll. Of the 657 responses, 46% indicated that their facility has not embarked on a query update project, with 3% waiting until after the implementation date and 14% indicating they...Read More »
