CMW mentor moment: The FY 2010 IPPS changes impacting case managers
Case Management Weekly, September 2, 2009
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The following article, written by Glenn Krauss, CCS, CCS-P, CPUR, FCS, PCS, C-CDIS, , is adapted from HCPro’s newest resource for hospital case managers—www.CaseManagementMentor.com—a free blog dedicated to connecting hospital case managers to industry pacesetters, peers, and best practices.
CMS released the FY 2010 Inpatient Prospective Payment System (IPPS) Final Rule July 31. Hospital payment rates will increase by an average of 2.1%, instead of the 0.2% proposed earlier in the year. CMS decided against implemeting a 1.9% reduction, referred to as the coding and documentation adjustment. This adjustment accounts for changes in clinical documentation and coding patterns—not real changes in patient acuity.
Implications for case managers
The start of the Medicare Fiscal Year IPPS, which begins October 1 each year, brings a host of new coding, payment, and other regulatory changes including updated relative weights for the 745 MS-DRGs.
Some MS-DRG relative weights increase—others decrease. Relative weights are a proxy for patient acuity. Higher relative weights signify higher acuity, providing for a higher level of reimbursement, while lower relative weights translate into lower acuity with less reimbursement.
In reviewing the Healthcare Financial Management Association’s (HFMA) recent overview of the Final 2010 IPPS Rule, an interesting point was made that certainly impacts hospitals and case managers.
Read the rest of this post, or share your thoughts on this topic.
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