Surgery is front and center in new Medicare value-based purchasing
This year, the quality movement takes a big step with the start of Medicare’s value-based purchasing (VBP) program. Beginning October 1, 2012, part of your hospital’s Medicare payments will be based on your hospital’s performance on a set of quality measures, usually referred to as the core measures and HCAHPS…
Hospitals losing on physician preference items
An analysis by Premier of data from 323 of its member hospitals shows they are losing $1.82 billion annually for 12 orthopedic and cardiac case categories because of Medicare reimbursement shortfalls. Lack of evidence-based outcomes data and the rising cost of physician preference items (PPIs) are also cited as reasons…
SCIP measures to weigh in Medicare pay starting in 2013
The dawn of hospital pay for quality has arrived. Hospitals have been reporting Surgical Care Improvement Project (SCIP) measures and other quality measures to Medicare for public display. Now starting in fiscal year 2013, how well they perform on 7 of the SCIP measures and 18 other measures will determine…
Medicare to collect infection data
For the first time, all hospitals will have to report data on infections to receive their full payment update from Medicare in future years. Data will be collected on 2 types of infection: central line-associated bloodstream infections (CLABSI) starting January 1, 2011, for a full payment update in 2013 surgical…
Payments and penalties for outcomes
Under the health care reform law, starting in 3 years, hospitals will stand to be paid more for meeting quality and outcome measures. They will also be penalized for hospital-acquired conditions and readmissions. Pilot projects will be launched to test new ways to deliver and pay for care to Medicare…
Advice on keeping up with C-codes
C-codes, HCPCS, APCs, OPPS, IPPS—OR business managers need to master an intricate and sometimes mysterious set of Medicare regulations in charging for surgical services. In this column, Keith Siddel, MBA, an expert on health care business operations, responds to questions posed by members of OR Manager's OR Business Management Listserv.…
Self-administered drugs (SAD): Who pays?
There are certain drugs Medicare will not reimburse your facility for— even if they are given to a patient during surgery. These medications fall in the confusing category of self-administered drugs, or SAD. It's wise to know your organization's policy on SAD. If the policy is to bill patients for…
Avoiding inpatient-only claims pitfalls
Understanding how Medicare pays for inpatient and outpatient surgery is critical to your hospital's revenue. Medicare stipulates that certain procedures will be paid only if performed on an inpatient basis. How can you avoid pitfalls of billing for these inpatient-only procedures? OR Manager asked Keith Siddel, MBA, an expert on…
Six hospitals settle with feds over Medicare claims for kyphoplasty
Six hospitals in Indiana and Alabama agreed to pay the government more than $8 million to settle allegations that they submitted false claims to Medicare, the US Department of Justice announced September 29, 2009. The settlements resolve allegations that from 2002 to 2008, the hospitals overbilled Medicare for kyphoplasty, a…
Never events': Sorting out confusion
There's a lot of discussion about Medicare no longer paying for "never events." Surprisingly, so far, the policy has had little financial impact. Until recently, Medicare hadn't given instructions about how claims for these events should be handled. There is also confusion about how Medicare defines a "never event" for…
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