Health Information Management

FY 2012 IPPS final rule includes some surprises

HIM-HIPAA Insider, September 20, 2011

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It's that time of year again. The FY 2012 IPPS final rule is out, and hospitals that are bracing for changes effective October 1 may be pleasantly surprised with what's in store for them this time around.  

DCA less than anticipated
 
CMS finalized a documentation and coding adjustment (DCA) of -2% instead of the proposed -3.15%. Hospitals should be grateful for this change, but remember that subsequent DCAs are inevitable, says James S. Kennedy, MD, CCS, managing director at FTI Consulting in Atlanta.
 
Clinical documentation and coding integrity efforts will continue to take center stage, Kennedy says.
 
DRG changes
 
CMS significantly increased the relative weight for several DRGs-with and without CCs or MCCs. For example, the relative weights for MS-DRGs 665 (prostatectomy with MCC) and 855 (infectious and parasitic diseases with operating room procedure without CC or MCC) rose 17.9% and 16%, respectively.
 
CMS significantly decreased the relative weight for other MS-DRGs. For example, MS-DRGs 782 (other antepartum diagnoses without medical complications) and 769 (postpartum and post-abortion diagnoses with operating room procedure) decreased 33.1% and 26%, respectively. Access a complete list of FY 2012 DRGs and their relative weights in Table 5 at http://tinyurl.com/2012IPPStables.
 
Coders must remember that with respect to the recalibration of relative weights, accurate capture of CCs is crucial for correct DRG calculation, says Kennedy.
 
Editor’s note: Click here to read the entire article in the September issue of Briefings on Coding Compliance Strategies.



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