CMS, AMA announce efforts to help with transition to ICD-10
Editor's Note In less than 3 months, healthcare providers will switch from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures. To help providers get ready for the October 1 deadline, the Centers for Medicare & Medicaid Services is releasing additional guidance that will allow for flexibility in…
New ACS Interactive Web Tool Helps Surgeons Avoid Medicare Penalties
Editor's Note The American College of Surgeons has launched a new web tool to help surgeons navigate and succeed in Medicare’s mandatory quality programs: Physician Quality Reporting System, Electronic Health Record-Meaningful Use, and Value-Based Modifier. Surgeons who do not successfully participate in these programs in 2015 could face up to…
CMS Issues Proposed Rule for Hospital Outpatient and ASC Payments
Editor's Note The Centers for Medicare & Medicaid Services on July 1 issued a proposed rule for CY 2016 for the hospital outpatient prospective payment (OPPS) and ambulatory surgical center (ASC) payment systems. CMS proposes an OPPS decrease of .01%. The change is based on a projected hospital market basket increase…
CMS Proposes Changes to the 'Two-Midnight' Rule
Editor's Note On July 1, the Centers for Medicare & Medicaid Services released proposed updates to the “Two-Midnight” rule regarding when inpatient admissions are appropriate for payment under Medicare Part A. The proposed update allows physicians to use their judgment to admit patients for short hospital stays on a case-by-case…
Editorial
Reports that emerged in late 2014 reflect both progress and problems in healthcare delivery. And while regulatory and financial hurdles continue to loom large in 2015, some of these obstacles are being cleared. The Agency for Healthcare Research and Quality cited an impressive 1.3 million decline in the number of…
Professional standards and patient empathy ease burden of payment collection
Delivering quality healthcare doesn’t end when a patient leaves the postanesthesia care unit. It continues until the final installment of the bill is paid. It continues even when the payment is overdue, missing, or refused. To stay in business, an ambulatory surgery center (ASC) must collect the fees it has…
Editorial
More than 2,600 hospitals in fiscal year 2015 are facing Medicare readmission penalties, to the tune of an estimated $428 million, a recent Kaiser Health News report indicates. Among these, 39 hospitals—including some specialty surgical hospitals, small community hospitals, and a major teaching facility—will lose the maximum 3% of their…
Potential rewards justify efforts to create bundled payment programs
Physician alignment is a key element of current hospital strategy. Last month, we looked at how hospital ORs can use co-management agreements to build strong collaboration with surgeons. Payment reform has created an even more sophisticated option—participation in a bundled payment program. Bundled payment initiatives are more complex than most…
Prepare now for more stringent joint replacement documentation requirements
Medicare administrative contractors (MACs) in several states recently ratcheted up their documentation requirements for joint replacement surgery and other orthopedic procedures. For hospital ORs, these changes represent the tip of an iceberg that calls for careful navigation. Enhanced medical necessity documentation requirements were launched in Florida in 2011. The state’s…
Medicare reimbursement, allowable procedures at forefront of ASC challenges
Leaders of ambulatory surgery centers (ASCs) can expect to continue facing challenges related to reimbursement even as they try to increase the kinds of procedures that can be performed in their facilities, say experts with the Ambulatory Surgery Center Association (ASCA). Other key factors that will determine their future success…
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