CMS: ICD-10 grace period ends October 1
Editor's Note The Centers for Medicare and Medicaid Services (CMS) on August 18 announced in its FAQ guidelines that the 1-year grace period for claims using the ICD-10 code set will end October 1. Healthcare organizations will be required to use the correct degree of specificity when coding claims. Unspecified…
Impact of race/ethnicity, socioeconomic status on readmission rates after total joints
Editor's Note The addition of race/ethnicity and socioeconomic status to the risk-adjusted algorithm for readmissions after total hips and knees used by the Centers for Medicare & Medicaid Services led to a relative-performance change in readmission rates of <3% of 1,194 hospitals in this study. Policy makers and payers should…
Hospital cost of surgery-related pressure ulcers
Editor's Note This study found that hospital-acquired pressure ulcers add 44% to the cost of major surgical hospital stays, but the amount varies depending on length of stay. Using data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011…
Medicare Advantage pays hospitals 8% less than traditional Medicare
Editor's Note Medicare Advantage plans paid hospitals 8% less for hospital services than fee-for-service Medicare in 2009 and 2012, finds this study. Researchers also found that commercial insurers paid hospitals much higher than Medicare Advantage or fee-for-service Medicare. Some of this difference is because of higher prices commercial plans pay…
Physician-owned surgical hospitals performed better in VBP program
Editor's Note Medicare’s value-based purchasing (VBP) program revealed superior performance associated with physician owned surgical hospitals in this study. Researchers analyzed 3,089 hospitals that included physician-owned surgical, University HealthSystem Consortium, US News & World Report Honor Roll, Kaiser Permanente, and Accountable Care Organization hospitals. Estimated mean total performance scores were…
Help decode ICD-10 for prompt reimbursement
Despite warnings of calamities, implementation of the International Classification of Diseases (ICD)-10 on October 1, 2015, proceeded smoothly, with minimal impact on denied claims. In the fourth quarter of 2015, the percentage of Medicare claims denied was 10%, comparable to the preimplementation figure of 9.9%. But that doesn’t mean OR…
CMS finalizes cut to hospital reimbursement
Editor's Note The Centers for Medicare and Medicaid Services (CMS) on August 2 released its inpatient prospective payment system (PPS) final rule for FY 2017. In the rule, CMS kept a controversial 1.5% cut to hospital reimbursement, which aims to collect $11 billion in overpayments, the August 2 Modern Healthcare…
Many top hospitals fail Medicare’s quality star ratings
Editor's Note The Centers for Medicare & Medicaid (CMS) on July 27 released its Overall Hospital Quality Star Ratings of 3,617 hospitals. Only 102 received the top rating of five stars, and only a few of those are considered among the nation’s best, including Memorial Hermann Hospital System in Houston…
Mortality rates similar for safety-net, other hospitals
Editor's Note In a new study funded by the Agency for Healthcare Research and Quality (AHRQ), safety-net hospitals performed equally as well as other hospitals when evaluated according to medical-surgical mortality rates. Analyzing data from 1,891 hospitals in 31 states, researchers found that despite ongoing financial disadvantages, the quality of…
CMS publishes hospital star ratings
Editor's Note The Centers for Medicare & Medicaid Services (CMS) on July 27 published its Overall Hospital Quality Star Ratings, the July 27 Modern Healthcare reports. The ratings, which are a composite metric of one to five stars, grade the quality of nearly 4,000 hospitals and are posted to the…
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