Hospital Acquired Infections (HAIs) occur when a patient is exposed to a bacterium, virus or fungi during their hospital stay that leads to an additional condition. These additional conditions can cost hospitals thousands of dollars in lost revenue.
What is CMS doing to reduce healthcare costs? CMS has added observation units which are an additional level of care between inpatient and outpatient. What Are Observation Units? In general, observation units are used to bridge the gap between inpatient and outpatient. They are designed for the patient in which the attending physician cannot determine whether a patient should be classified as outpatient (released within 48 hours) or inpatient (expected to stay at least 2 midnights). The observation units enable the physician to have a bit more time to stabilize the patient and based on medical necessity determine the estimated length of stay. They are billed as outpatient and do not count toward an inpatient admission.
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.
The market is rife with products that claim to be secure enough for a healthcare organization, but this can be difficult to verify. The companies responsible for creating some of the top notch EMRs on the market are also piloting projects around “mobile health” , but physicians and hospital administration remain wary.
The ACA was enacted in 2010 with provisions becoming effective through 2015 and beyond. Many of the provisions have been delayed beyond the dates originally set. For the official information regarding each of the provisions and the current effective dates, please visit www.healthcare.gov. The department given ultimate responsibility for administering the ACA is the Department of Health and Human Services. Additionally, the Center for Medicare and Medicaid Services (CMS) has been given responsibility for carrying out many aspects of the ACA.
Those of us who work in Health Information Management understand the value of good documentation -- and we have especially keen senses when it comes to recognizing excellent documentation when we see it. That being said, we also know when we’re seeing documentation that isn’t so great. And together with medical billers and coders, we’re always looking for ways to improve it.
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.
The Affordable Care Act specifies increased payments for three primary care medical specialties as they relate to Medicaid's Primary Care Rate Increase: Family Medicine, General Internal Medicine and Pediatrics. The Final Rule interprets this language to include some subspecialties with a relation to the original three, but does not list the subspecialties.
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.