Tag: Reimbursement

Medicare penalizes 758 hospitals for patient safety issues

Editor's Note The Centers for Medicare & Medicaid Services on December 9 announced that 758 hospitals will have a 1% reduction in Medicare payments for missing targets for hospital-acquired conditions. More than half (54%) of the hospitals were also penalized last year. Penalties are expected to total $364 million. Among…

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By: Judy Mathias
December 15, 2015
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Survey on transition to ICD-10 finds successes, challenges

Editor's Note A survey of 298 attendees at a November 9 KPMG webinar on the transition to ICD-10 gleaned the following responses: 28% said the transition had been smooth 51% found “a few technical issues but overall successful” 11% described the transition as a “failure to operate in an ICD-10…

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By: Judy Mathias
December 7, 2015
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CMS issues notice on ‘two-midnight’ rule payment cut

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on December 1 published a notice with comment period on the basis for cutting inpatient hospital payments by 0.2% in accordance with its “two-midnight” rule. The notice comes in response to an October 6 court ruling that challenged the payment…

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By: Judy Mathias
December 1, 2015
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CMS clarifies ICD-10 implementation issues

Editor's Note The Centers for Medicare and Medicaid Services (CMS) reports that it will reprocess ICD-10 claims with National Coverage Determination and Local Coverage Determination errors automatically and at no cost to providers. CMS is also waiting to reprocess some claims with errors resulting from Local Coverage Determinations until Medicare…

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By: Judy Mathias
November 30, 2015
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OIG announces new initiatives for ASCs

Editor's Note The US Department of Health & Human Services Office of the Inspector General (OIG) released its 2016 Work Plan announcing new initiatives for ambulatory surgery centers (ASCs), the ASCA News Digest reports. The initiatives include: Review the appropriateness of Medicare’s methodology for setting ASC payment rates. Revitalize outdated…

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By: Judy Mathias
November 18, 2015
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Survey: ICD-10 has reduced hospital productivity

Editor's Note In a survey by Himagine Solutions, large hospitals reported a 30% to 45% reduction in productivity for inpatients and a 20% to 40% reduction for outpatients since implementation of the ICD-10 codes, Healthcare Informatics reports. Though loss in productivity can mean a disruption to the revenue cycle, one…

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By: Judy Mathias
November 18, 2015
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Specific care bundles successfully cut surgical site infection rates

Three new studies on reducing surgical site infections (SSIs) were reported at the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) conference in July. Researchers at three different institutions identified several process changes that, once implemented, brought down SSI rates. Each study used different methodology, but all…

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By: Judith M. Mathias, MA, RN
November 18, 2015
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Build a strong anesthesia quality program to boost patient safety and the bottom line

Quality indicators for anesthesia For the past several years, physicians have participated in the Physician Quality Reporting System (PQRS) established by Medicare as a way to assess the quality of patient care and tie that to reimbursement. Beginning in 2015, a negative payment adjustment hit individuals and group practices whose…

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By: OR Manager
November 18, 2015
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CMS finalizes rule for hip and knee bundled payments

Editor's Note The Centers for Medicare and Medicaid Services (CMS) has finalized the rule that will require hospitals in 67 geographic areas to participate in a test of bundled payments for hip and knee replacements, Modern Healthcare reports. Medicare's average bundled payment ranges from $16,500 to $33,000 for surgery, hospitalization,…

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By: Judy Mathias
November 17, 2015
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Study: Readmission common after emergency general surgery

Editor's Note Readmission after emergency general surgery procedures is common and varies widely according to patient factors and diagnosis, this study finds. Of more than 177,000 patients analyzed, nearly 6% were readmitted within 30 days. The most common reasons were surgical site infections (16.9%), gastrointestinal complications (11.3%), and pulmonary complications…

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By: Judy Mathias
November 16, 2015
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