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- Draft NPDB Guidebook open for public comment
The National Practitioner Data Bank (NPDB) is revising the NPDB Guidebook to incorporate legislative and regulatory changes adopted since its last edition, including the merger of the NPDB with the Healthcare Integrity and Protection Data Bank. The revised Guidebook will offer more and clearer examples of when and how to report and query, more useful tables explaining Data Bank policies, and live links to statutes, regulations, and the NPDB website.
- CMS finalizes two-midnight inpatient presumption as part of 2014 IPPS final rule
CMS finalized a major change to its inpatient admission guidelines as part of the 2014 IPPS final rule, released August 1.
As part of the rule, CMS finalized the two-midnight presumption for inpatient admissions. If a patient the physician expects a patient’s treatment, testing, or surgery to require an inpatient stay covering two midnights, and admits the patient based on that belief, CMS will presume that the stay is be medically necessary.
CMS emphasized that the physician must formally order an inpatient admission, but added that the physician can consider the time the patient has already spent in the ED or observation when deciding whether to admit the patient.
CMS made the change in part to reduce long outpatient or observation stays.
CMS also finalized the timely filing requirement for Part A to Part B rebilling. In March, CMS released a ruling and a proposed rule allowing hospitals to rebill Part A inpatient services as Part B outpatient services if the inpatient stay was not medically necessary and the services would have been covered in the outpatient setting. The ruling, which went into effect in March, did not including a filing timeframe. Under the final rule, hospitals will have one year from the date of service to rebill claims.
CMS finalized the criteria to rank hospitals with a high rate of hospital-acquired conditions (HAC). Hospitals in the lowest quartile for HACs will see a payment reduction of 1%.Look for more analysis of the rule from HCPro next week.
- CMS proposes sweeping changes to E/M visits, increased packaging, and new comprehensive APCs
CMS released a number of proposed changes to the OPPS payment system July 8. The 2014 OPPS Proposed Rule is shorter than normal at 718 pages, but the proposed changes are significant and probably the most sweeping changes since the inception of OPPS, says Jugna Shah, MPH, president and founder of Nimitt Consulting.
- Healthcare attorney: 'Secure the human' to keep patient data safe
For healthcare providers looking to ensure the security of electronic patient information, it's just as important to solidify employee knowledge as it is to encrypt data and implement improved IT solutions, says Lee Kim, an attorney with Pittsburgh-based firm Tucker Arensberg who also serves as chair of the mHIMSS Legal/Policy Taskforce. Lee also says that providers frequently should conduct gap analyses to see where deficiencies may lie in security efforts.
- ACDIS/AHIMA Query Escalation Policies Released
In the April edition of the CDI Journal, ACDIS published the joint ACDIS/AHIMA practice brief on “Guidelines for Achieving a Compliant Query Practice.” The intent of this practice brief is to maintain the integrity of the coded healthcare data. The purpose of the query process outlined is to ensure appropriate documentation appears in the health record. Additional policies may need to be implemented when questions arise regarding the clinical validity in practitioner documentation.
- June, so soon?
As we break for a long weekend and the unofficial start of summer, I want to tell you about a couple of items on the Credentialing Resource Center roster.
The complete resource for up-to-date HIPAA privacy and security training and compliance, including whitepapers, books, online learning, Briefings on HIPAA newsletter and CD-Roms.
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