Tag Archives: Medicare

Transitional care interventions: Evidence supports more intense interventions

Responding to value-based-purchasing, provider groups across the US are implementing or tweaking programs to reduce unnecessary hospital readmission or emergency department visits. Much of this is stimulated by Medicare’s plans to move the bulk of their payment into new models and the current incentives around readmission reduction for beneficiaries with certain conditions. Continue reading

MedPAC financing recommendations for rural hospitals should be extended to all

In the MedPAC October meeting, the commission returned to the seemingly intractable problem of equalizing access to health care for rural communities. Medicare payment offers three sources of support within the inpatient prospective payment system (IPPS) for rural hospitals—through designation as a Medicare-dependent hospital, a sole-community hospital or qualification for a low-volume adjustment. A fourth avenue of support is exempting a hospital from IPPS and allowing it operate as a Critical Access Hospital (CAH). Continue reading

HCCs: Don’t Underestimate Their Importance

So there are PPCs and HACs, PPRs and PPAs, PSIs and VBP just to name a few. But please don’t forget or underestimate the importance of HCCs. Why should you care about HCCs? HCCs are Hierarchical Condition Categories (there’s a mouthful). In simpler terms, HCCs are diagnoses/conditions that are present in the patient that complicate their care and management and require more resources to treat. Sounds easy enough right? Continue reading

The Results Are In: Pioneer ACO Model

Last week, The Journal of the American Medical Association (JAMA) published the results of a study that showed that the Pioneer Accountable Care Organization (ACO) Model achieved almost $400 million less spending for patient care than fee-for-service (FFS) Medicare patients over two years. These cost savings were attained without deterioration in the quality of care. Continue reading

SGR and ICD-10: Time for Spring Cleaning

It’s that time of year again. For people not working in the healthcare industry, it’s time for flowers to start blooming, windows to be opened to fresh air, swimsuit shopping and, even though we had a short-lived blizzard in Colorado yesterday, I’m ready for spring! Let the spring cleaning begin. However, there is the painful memory of last year, when ICD-10 was delayed “at least until October 1, 2015” via the SGR repeal bill, also known as the doc fix bill. I remember exactly where I was when I heard the news. Continue reading

Data Value: Important Mammogram Coding Change

A policy and data specialist colleague of mine was working with the 2015 NCCI data and noted that CMS had, for the first time, added screening and diagnostic mammogram codes to the edit.

Specifically, CPT 77055 and 77056 and HCPCS G0204 and G0206 (diagnostic mammography) and CPT 77057 (screening mammography) and 77063 (screening digital breast tomosynthesis, bilateral) cannot be billed on the same claim on the same date of service (DOS). Continue reading

“The Times They Are a-Changin’”

Sing along with me! We are entering a time of unprecedented change in healthcare. I had the pleasure of attending and speaking at the Healthcare Finance Management Association (HFMA) Region 11 Symposium in San Diego recently. This was one of the most dynamic conferences I have ever attended and I came away, by far, with more knowledge than I was imparting. There were certainly some clear surprises which I would like to share with you. The biggest reward for me was listening to finance leaders express their compassion and determination to care for their populations. Not only were they committed to ensuring all had access to healthcare and the means to pay for it, they were extremely focused on making it affordable and were open to an overhaul to pricing and pricing structures. It is moments like this that make me proud to be a member of the healthcare community.

What other lessons did I learn? Continue reading

Dumb Ways to Die: The 8 Not Dumbest ICD-10 Codes

Yes, there are ICD-10 codes for exceedingly rare ways to die, and yes, they are easy to parody. This does not matter at all, since not many people are admitted to the hospital for a prolonged stay in a weightless environment.

What does matter is that preventable errors in hospital care are the third leading cause of death, after cancer and heart disease. Updated estimates in a 2013 study in the Journal of Patient Safety say that between 210,000 and 440,000 people die in US hospitals every year because some preventable harm was done to them. Continue reading

Alert Fatigue: The Implications for Reducing Preventable Hospital-Acquired Conditions

Blog post by Krysten Brooks, RN, BSN, MBA

Hospitals across the country have launched a wide-range of initiatives to reduce hospital-acquired conditions (HACs), but despite their efforts, a quarter of the nation’s hospitals face reimbursement penalties according to a preliminary analysis released in June by CMS that scored hospitals based on rates of acquired conditions and patient complications. While Medicare’s HAC Reduction Program plans to release final scores later this year, the healthcare organizations facing penalties can expect to lose approximately one percent of each Medicare payment from October 1, 2014 through September 30, 2015, translating into billions of dollars in lost reimbursement.

The Medicare penalties will undoubtedly hit some organizations hard, and these hospitals are moving quickly to analyze avoidable complications and intervene to improve quality. Facilities are also auditing clinical documentation for completeness and accuracy and examining documentation workflow to analyze process breakdowns and problems. Continue reading

Alphabet Soup: Acronyms and E&M Coding

As healthcare professionals, we have a lot of acronyms to keep straight, don’t we? Feels like alphabet soup in my head some days. I’m reminded of a scene in the movie, Good Morning Vietnam, where Robin Williams’ character has an entire conversation using acronyms, making fun of the military jargon. We could do the same in healthcare, especially in E&M coding.

Today, let’s think a bit about HPI, not to be confused with PHI. If you have a translator in your head the way I do, these two don’t even sound the same, but for those outside the realm of coding, these acronyms can get confusing. PHI is Protected Health Information. HPI, or History of Present Illness, is the portion of the E&M (Evaluation and Management) visit during which the patient describes why they are seeing the physician. Continue reading