Health Information Management

Tips for handling Medicaid HCACs

HIM-HIPAA Insider, June 19, 2012

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Starting in July, hospitals can risk their reimbursement under the Medicaid program for conditions that CMS deems as "reasonably preventable."

CMS, building off its list of Medicare hospital-­acquired conditions (HAC), mandates compliance with its rule, Payment Adjustment for Provider-Preventable ­Conditions ­Including Health Care-Acquired Conditions, by ­July 1. The new Medicaid healthcare-acquired conditions (HCAC) program uses Medicare's preventable conditions in inpatient hospital settings as the base (adjusted­ for the differences in the Medicare and Medicaid ­populations) and provides states the flexibility to identify ­additional preventable conditions and settings for which Medicaid payment will be denied.
In order to be successful in preventing these conditions, providers must include in their policies and procedures evidence-based medicine factors, according to William L. Malm, ND, RN, CMAS, senior data projects manager for Atlanta's Craneware, Inc. Malm suggested providers preparing to comply with the new Medicaid HCAC final rule must:
  • Determine who will report conditions. With the new rule comes a new reporting requirement for ­Medicaid. Is the person doing the Medicare HAC ­reporting also going to do the HCAC reporting? Do you need to hire another FTE? Should you look to your Medicaid ­specialist to handle the new burden?
  • Prepare for multistate cases. Large healthcare systems with facilities in multiple states must be aware of the regulations for each state. "It's very possible some bigger health systems will have to monitor several states," Malm said. Ultimately, CMS said wherever the preventable condition occurred, the hospital must follow that state's reporting requirements.
  • Seek information from your state Medicaid ­program. Each state hospital association should have a specialist intimate with this knowledge, or you could go directly to your state's Medicaid website to see where it's at with its HCAC program.
Note: For more tips, view the June issue of Medical Records Briefing.

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