News: FY 2019 IPPS final rule released, reduces quality reporting requirements

An overhaul of the newly coined Promoting Interoperability Programs (PIP, formerly known as the Electronic Health Record Incentive Programs), significant reductions to reporting requirements for quality initiatives, updates to payment rates, and changes CC/MCC designations for some conditions, represent new initiatives in CMS’ fiscal year (FY) 2019 Inpatient Prospective Payment System (IPPS) final rule, Revenue Cycle Advisor reported. The changes take effect October 1, 2018.

The top 10 CC/MCC changes CDI professionals should be aware of, according to Allen Frady, RN, BSN, CCDS, CCS, CRC, CDI education specialist for ACDIS and HCPro based in Middleton, Massachusetts, include:

1. Acute respiratory distress syndrome (ARDS) is now an MCC
2. Sepsis following an obstetrics procedure can be coded and is an MCC
3. Congenital Zika virus is an MCC
4. Appendicitis has new codes for patients with peritonitis who may or may not have a rupture and may or may not have an abscess
5. HIV disease is no longer an MCC; it’s been downgraded to a CC
6. Encephalopathy unspecified or other are no longer MCCs; they’ve been downgraded to CCs
7. Cholangitis is no longer guaranteed a CC
8. New codes were added for insertion of pacemakers
9. New codes were added for adult and child labor/sexual exploitation and are designated as CCs
10. Sepsis following a procedure initial encounter as a secondary diagnosis now provides a CC

In its ongoing mission to reduce administrative burden, CMS removed a number of quality reporting and pay-for-performance program measures.

According to CMS, 18 previously adopted measures that are topped out, do not result in better patient outcomes, or have associated costs that outweigh the benefit of its continued use in the program will be removed. For example, the “safe surgery checklist use” measure was removed because it did not result in better outcomes. Similarly, the “stroke education” measure was removed because the costs outweigh the benefits of its continued use.  

CMS is also de-duplicating 21 measures, meaning that while the measure may fall off the list in one program it may remain on the list in one of the other four (the Hospital Inpatient Quality Reporting Program, the Hospital Value-Based Purchasing, the Hospital Readmissions Reduction, or the Hospital-Acquired Condition Reduction Programs) to simplify and streamline measures across programs, Revenue Cycle Advisor reported. For example, the catheter-assisted urinary tract infection and the central line-associated bloodstream infection outcome measures were removed from all programs besides the Hospital-Acquired Condition Reduction Program.

Six healthcare-associated infection patient-safety measures that are being de-duplicated will be removed for calendar year 2020, one year later than originally proposed in April.

The IPPS also removes the requirement that a written inpatient admission order be present in the medical record as a specific condition of Medicare Part A payment, as a means, according to CMS to reduce the number of denied claims for clerical errors, the final rule says.

One of the key provisions of PIP includes finalizing a new performance-based scoring methodology consisting of a smaller set of objectives, according to Revenue Cycle Advisor. This, CMS says, will provide a more flexible, less-burdensome structure, allowing eligible hospitals to place their focus back on patients.

Another large change included in this year’s IPPS final rule, is a requirement for hospitals to establish and make public a list of standard charges, and to update this information annually, or more often, as appropriate, in order to encourage price transparency by improving public accessibility of charge information.

Stay tuned over the coming weeks for more updates on what CDI professionals need to know about the final rule changes.

Editor’s note: This article originally appeared in Revenue Cycle Advisor. To read more about the final rule, see the CMS fact sheet. To read about what CDI professionals need to know about the proposals and in the final rule, click here.