Hospital Case Management – May 1, 2014
May 1, 2014
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Don’t ignore the two-midnight rule. It’s still in effect
A bill signed into law on April 1 directs the Centers for Medicare & Medicaid Services (CMS) to postpone post-payment audits of the two-midnight rule until after March 31, 2015. In the meantime, CMS has implemented pre-payment probe and educate reviews to determine if hospitals are in compliance. -
Are you ready for ICD-10 implementation?
Implementation of ICD-10 has been postponed until Oct. 1, 2015, and all claims submitted after that point must use the new coding system. -
‘Probe and Educate’ MAC reviews in effect
When the Medicare Administrative Contractors (MACs) conduct probe and educate prepayment audits of compliance with the two-midnight rule, inadequate documentation and lack of one or more of the components of certification are major reasons for the denials, according to Ralph Wuebker, MD, MBA, chief medical officer for Executive Health Resources, a Newtown Square, PA, healthcare consulting firm. -
CMS calls a temporary halt to the RA program
The Centers for Medicare & Medicaid Services (CMS) has announced a pause in the Recovery Auditor program while it develops new contracts with the auditors, and so the auditors can complete all claims reviews before the current contracts expire. -
Program cuts 30-day readmit rate to 10.6%
After St. Rose Hospital in Hayward, CA, started its readmission reduction program, the community hospitals 30-day readmission rate for all diagnoses dropped by 37% and the 90-day readmission rate declined by 43%. -
Providers collaborate to reduce readmissions
A readmission reduction collaborative of San Francisco Bay-area hospitals and their post-acute partners has reduced hospital readmissions by 20% among participating hospitals, preventing more than 4,000 readmissions. -
Hospital cuts denials by 63%
Patient access areas are seeing more procedures requiring authorization, a surge in the number of insured patients, and more clinical requirements from payers. All of these factors make an increase in claims denials and much lost reimbursement very likely. -
Patient Transitions — It’s Not Just Discharge Planning Anymore
Prior to the advent of the inpatient prospective payment system (IPPS), the discharge planning process was simpler and slower. Patients generally stayed in the hospital until they were well and then went home.