Case Management

News: CMS issues IPPS proposed rule for FY 2013

Case Management Weekly, May 9, 2012

Inpatient acute care hospitals could see a 2.3% increase in payment rates under the fiscal year (FY) 2013 Inpatient Prospective Payment System (IPPS) proposed rule, released April 24. The 2.3% is a net update after inflation, improvements in productivity, a statutory adjustment factor, and adjustments for hospital documentation and coding changes.

The IPPS proposed rule also includes provisions to strengthen the Hospital Inpatient Quality Reporting Program and it proposes new policies and measures for the Hospital Value-Based Purchasing Program.

“It's good that they're lowering the burden on hospitals from tracking so many quality issues, but they're coming up with a couple other things, like [hospital-acquired conditions (HAC)],” says Robert S. Gold, MD, CEO of DCBA, Inc., in Atlanta.

“If the goal is to reward excellence, hospitals have to ensure that their coders are up to speed with appropriate identification of complications and with [present on admission] POA indicators as well as the over-documentation issues that could lead to financial penalties,” says Gold. CMS also proposes a methodology to calculate the readmissions adjustment factor for inpatient hospitals that could result in a 0.3% decrease in overall payments to hospitals.

CMS did not propose any major changes to the ICD-9-CM code set, which stands true to the original plan of a minimal update to ICD-9-CM for 2012, says Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding at HCPro, Inc, in Danvers, Mass. “Since we are proposing to use ICD-9-CM until October 1, 2014, it potentially adds another year of limited updates.”

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