Corporate Compliance

Note from the instructor: Implementation of FY 2013 Value-Based Purchasing Program (VBPP) and Hospital Readmission Reduction Program (HRRP) adjustments to IPPS hospital operating payments has begun

Medicare Insider, October 2, 2012

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Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

On the road to pay-for-performance

At the risk of being redundant, I would like to spend just a few more minutes focusing on CMS’ latest efforts on the road to pay-for-performance with respect to inpatient hospital services, particularly those reimbursed under the Inpatient Prospective Payment System (IPPS) methodology. This is all part of CMS’ overall Hospital Quality Improvement Program, that began with reporting certain inpatient quality indicators. Eventually, those hospitals who failed to do so, with reasonable reliability during the prior fiscal year (FY), received 2% less than the full update to their standardized operating payments in the following FY.

CMS then moved on to identify certain hospital-acquired conditions (HACs) that, in its estimation, would not occur after the patient had been admitted if the hospital was providing a reasonable quality of care. The HACs all rose to the level of conditions and comorbidities (CCs) or major conditions and comorbidities (MCCs), the presence of at least one of which is likely to result in higher-paying MS-DRG assignment. If the HACs were not documented as being present on admission, they were ignored for purposes of MS-DRG assignment.

Continue reading Judith’s note at the Medicare Mentor Blog.

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