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…
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 Revitalize outdated…
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…
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…
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…
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,…
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…
Editor's Note The Nationwide Inpatient Sample (NIS) database underreports data on patients’ weight, body mass, alcohol use, and tobacco use, finds a study from the Johns Hopkins University School of Medicine, Baltimore. Medicare uses NIS data to set reimbursement rates based on a hospital’s risk for readmissions and surgical complications. The…
Editor's Note A coalition of 111 medical societies on November 4 sent letters asking Senate and House leaders to take legislative action to pause Stage 3 of the electronic health records meaningful use program and revise Stage 2 so that it enables provider success, HealthData Management reports. Stage 3 requirements…
Editor's Note On October 30, the Centers for Medicare & Medicaid Services (CMS) released the final 2016 payment rule for ambulatory surgery centers (ASCs). ASC payment rates will increase by 0.3%, which is based on a projected inflation rate of 0.8% minus a 0.5% productivity adjustment required by the Affordable…