Corporate Compliance

Note from the Instructor: CMS releases the IPPS Proposed Rule

Medicare Insider, May 1, 2012

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Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

It’s that time of the year again when some things are for certain – trees and flowers are in bloom creating havoc with allergies, the weather can’t make up its mind if its spring or winter and CMS announces its plans for the coming fiscal year regarding IPPS hospital payments.

Last week CMS released the inpatient prospective payment (IPPS) proposed rule for FY 2013, effective for discharges October 1, 2012. Overall, CMS is projecting that payment rates to general acute care hospitals will increase by 2.3 percent - a net update after inflation, improvements in productivity, a statutory adjustment factor and adjustments for hospital documentation and coding changes.

Here is a summary of some of the CMS proposals:

  • Documentation and coding adjustment (DCA): Proposing to complete the remaining -1.9% prospective adjustment while also making a +2.9%to remove the effect of the FY 2012 one-time recoupment adjustment; the adjustment of -0.8 to the standardized amount and a -0.8% adjustment to the hospital-specific rate would result in a total DCA of +0.2% (-1.9 plus +2.9 plus -0.8) to the standardized amount and a -1.3% (-0.5 plus -0.8) adjustment to the hospital-specific rate.

Continue reading Debbie's note at the Medicare Mentor Blog.



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