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CMS struggles with implementation of no-pay conditions

Quality Improvement Monitor, October 24, 2008

The Centers for Medicare and Medicaid Services (CMS) has faced early challenges as it rolls out its “no-pay conditions,” ModernHealthcare.com reports.

Coding and defining what conditions are reasonably preventable by providers have proven to be difficult, said Thomas Valuck, medical officer and senior advisor in the CMS’ Center for Medicare Management. Valuck was speaking during a panel discussion about payment models during the recent National Quality Forum policy conference in Washington.

The policy, which went into effect October 1, will reimburse hospitals for certain conditions patients acquire after admission. CMS tracks whether a patient has a hospital-acquired condition through the use of its present-on-admission code that hospitals must use for all Medicare claims. But Valuck said coding limitations don’t always catch when a claim is moved into a higher payment group.

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