Corporate Compliance

Hospital Readmissions Reduction Program for Quality, Case Management, and CDI webcast

Medicare Insider, September 8, 2015

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Pay for performance programs such as the Hospital Readmissions Reduction Program (HRRP) link the payment hospitals receive to performance for defined quality measures. The HRRP reduces payments by up to 3% for hospitals with “excess readmissions.”


CMS determines each hospital’s excess readmission ratio using claims-based data; assigned ICD-9-CM (soon to be ICD-10) codes have a direct impact on this calculation. If the hospital’s predicted readmission rate exceeds the expected readmission rate, the hospital will receive a financial penalty. The quality of claims data is therefore extremely important, influencing not only what discharges are included in the program but the excess readmission ratio. Examples of claims data that impact program measure performance include the principal diagnosis, secondary diagnoses, and discharge disposition.


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