Since last fall, the Recovery Audit Contractors have greatly slowed their requests for charts from hospitals nationwide. The program, which has been under fire from the American Hospital Association virtually since it’s inception in 2006, is currently undergoing reform. That being said, for many involved in the previous audits the damage has already been done.
The “patient is always right” model has been the primary driving force behind healthcare for the last several decades. But is this the right approach? Classifying patients as “customers” is a slippery slope. While you might be able to barter with a customer at a shop about the price of a necklace, should doctors ever barter with a patient about their treatment? What about when their patient satisfaction scores are drooping low?
Physician practices may be lagging behind hospitals when it comes to implementing coding software. The hesitation to do so is costing them not only efficiency in coding, but reimbursements withheld due to avoidable errors.
ICD-10 was delayed once again as part of a bill that was meant to fix the physician reimbursement issues with Medicare. The ICD-1o delay was merely a footnote in a jam-packed bill that was going to make many doctors very happy; incidentally, pushing out the date for ICD-10 implementation also pleases many physicians. Some have gone so far as to say, on record, that ICD-10 lacks clinical value.
Summary: CMS has reversed its original proposal to cutback Medicare Advantage plan reimbursement for 2015. The reversal is a result of aggressive lobbying from organizations such as the American Medical Association. What is Medicare Advantage? According to www.medicare.gov, a Medicare Advantage plan is “a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.”
9 million Americans are covered by both Medicare and Medicaid and are part of a unique community of healthcare consumers known as the dual eligible. Dual eligible beneficiaries often have complex health conditions and may be low income, meaning that their access to healthcare would be greatly limited if not for their dual eligibility for coverage.
Yesterday the House of Representatives voted on a bill that included a proposal for delaying the implementation of ICD-10 for another year, bringing the compliance date to October 2015. Hospitals nationwide are in the throes of gearing up for the implementation deadline in October of this year, a mere six months away. While some who are not in healthcare may view the delay as a sign of relief, those who have been spending time and money on the implementations are not sighing so much as groaning at the possibility of pushing the deadline out further.
What is the 2 Midnight Rule? What does it mean for your organization? How does it affect the amount Medicare patient’s pay out of pocket? How does the 2 Midnight Rule affect reimbursement from both inpatient and outpatient perspectives? The 2 Midnight Rule establishes guidelines as to whether or not a physician should admit a patient from outpatient to inpatient. The general rule is if the patient, based upon medical necessity, is expected to require care that will span at least 2 midnights, the patient should be admitted as inpatient, and therefore reimbursable under Medicare Part A. In determining the 2 midnights, all care including outpatient is used in the determination. However, in terms of reimbursement, outpatient is reimbursed via Medicare Part B provisions and inpatient is reimbursed via Medicare Part A provisions.
A patient-centered focus will provide optimal care for the patient which will in turn drive revenue. Do you remember the movie “Field of Dreams”? The basic premise was if you build a stadium they will come. We can adapt this adage to healthcare as well. So many organizations become so focused on the bottom line and don’t realize that if patients aren’t satisfied, they will not return to your facility, they will relay their bad experience to all of their friends, and you will lose revenue.
Under the terms of the Patient Protection and Affordable Care Act (ACA), Medicaid payment rates were to be increased to (at least) match Medicare reimbursement rates for primary care and immunization services provided in 2013 and 2014.