Advisory panel recommends CMS remove total knees from inpatient-only list
Editor's Note The Advisory Panel on Hospital Outpatient Payment (HOP) on August 22 unanimously recommended that the Centers for Medicare & Medicaid Services (CMS) remove total knees from its inpatient-only list, the Ambulatory Surgery Center Association (ASCA) reports. CMS is requesting information on the feasibility of removing total knees from…
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…
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 issues final PPS rule for 2017
Editor's Note The Centers for Medicare & Medicaid Services on August 2 issued its final rule for the FY 2017 hospital inpatient prospective payment system (PPS), which increases rates by 0.95%. The 0.95% increase reflects the projected hospital market basket update of 2.7% for those hospitals that were meaningful users…
Hospital readmission penalties reach new high
Editor's Note The Centers for Medicare and Medicaid’s (CMS) hospital readmission penalties will hit a new high over the next year as the government agency withholds more than half a million dollars in payments, the August 2 Kaiser Health News reports. CMS will punish more than half of US hospitals…
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…
Free Daily News
- Vertical integration reshaping US healthcare: Impact on cost, access
- ChristianaCare, Atlas Healthcare form joint venture to expand ASC network
- CMS calls for demonstrations of AI technology in healthcare
- Study: Adjuvant nivolumab reduces risk of death, lung cancer recurrence
- Analysis: Hospital safety, quality measures surpass pre-pandemic levels
- FDA: Class 1 infusion system recall expanded
- Anesthesia staffing, communication, patient safety: Q&A with OR Manager Conference speakers
- FDA designates Class 1 recall for infusion system components
- WHO, Joint Commission mark World Patient Safety Day
- Study: COVID-19 boosts risk of postoperative complications, longer hospital stays for emergency surgery patients