Corporate Compliance

CMS final rule calls for more quality reporting

Compliance Monitor, August 8, 2007

CMS' final Inpatient Prospective Payment System (IPPS) rule released last week requires hospitals to report on more quality measures to receive their full Medicare reimbursement.

Hospitals will need to report on the new measures in 2008 to qualify for the full market basket update in fiscal year 2009. Those that fail to do so will lose 2% of their reimbursement, according to a CMS press release.

CMS will measure 30-day mortality for Medicare patients with pneumonia and plans to adopt two measures relating to surgical care improvement in the 2008 outpatient prospective payment system final rule. The agency will also finalize two additional surgical care improvement measures by program notice after they receive National Quality Forum endorsement.

The rule also implements a provision of the Deficit Reduction Act of 2005 (DRA) that takes the first steps toward preventing Medicare from giving hospitals higher payment for the additional costs of treating a patient who acquires a condition (including an infection) during a hospital stay. The DRA requires hospitals to begin reporting secondary diagnoses that are present on the admission of patients, beginning with discharges on or after October 1, 2007. Beginning in FY 2009, cases with these conditions would not be paid at a higher rate unless they were present on admission.

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