CMW mentor moment: ACE demonstration project could change how CMS pays hospitals and physicians
Case Management Weekly, January 13, 2010
Want to receive articles like this one in your inbox? Subscribe to Case Management Weekly!
The following article is an excerpt from HCPro’s resource for hospital case managers—CaseManagementMentor.com—a free blog dedicated to connecting hospital case managers to industry pacesetters, peers, and best practices.
Before CMS institutes a new national regulation, it often tests it on a smaller group. These demonstration projects identify weaknesses in the new rules and allow CMS to make necessary tweaks and changes. Demonstration projects also allow other facilities that are not involved in the project to learn from their peers. A recent example of this is the Recovery Audit Contractors (RAC) demonstration period.
One of the current demonstration projects that could have a large effect on case management and coordination of care is the Medicare Acute Care Episode (ACE) Demonstration project.
Essentially ACE changes how Medicare pays for healthcare services. Instead of paying the hospital and physicians separately, CMS bundles both payments into a lump sum. The payment system operates much like the DRG system where the one payment will cover the patient’s entire stay, rather than each individual service.
Extending the DRG concept to pay for physician services would encourage physicians to work with hospitals to control costs and improve quality, stated the June 2008 Medicare Payment Advisory Commission’s Report to Congress: Reforming the Delivery System.
Click here to read the rest of this post, or share your thoughts on this topic.
Browse more blog posts at www.CaseManagementMentor.com.
Want to receive articles like this one in your inbox? Subscribe to Case Management Weekly!
Related Products
Most Popular
- Articles
-
- HIPAA Q&A: Level of encryption needed for email
- Q&A: Acute respiratory failure diagnosis does not require intubation
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- HIPAA Q&A: TPO disclosures to a business associate
- Capturing all necessary codes for IUD insertion and removal can be challenging
- What does case-mix index mean to you?
- Topic: CMS, OESS post new security compliance review information, checklist
- Identify potential Medicaid RAC target areas
- Q/A: Coding infusions to correct low potassium levels
- OB services: Coding inside and outside of the package
- E-mailed
-
- HIPAA Q&A: Level of encryption needed for email
- Q&A: Acute respiratory failure diagnosis does not require intubation
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Q/A: Coding infusions to correct low potassium levels
- CMS has reformulated payments for some bilateral procedures
- Oxygen Cylinder Storage Requirements
- Q&A: Follow CMS' coding guidelines when using modifier -25
- Hospitals are not bound by InterQual criteria for determining patient status
- Q/A: New code for image-guided minimally invasive lumbar decompression
- Understand the spine to code back procedures correctly
- Searched