Can your OR documentation stand up to a RAC audit?
A column on managing the OR revenue cycle. Audits of Medicare payments to hospitals are up dramatically. In all, 89% of hospitals reported activity by recovery audit contractors (RACs) in the third quarter of 2012, according to an American Hospital Association (AHA) survey. Here are tips on how your OR…
Pain and patient experience: A business partnership
Managing patients’ pain is no longer just a clinical goal—it’s a business necessity. The Centers for Medicare and Medicaid Services (CMS) has started incorporating value-based purchasing (VBP) scores, which include customer satisfaction, into hospital reimbursement payments. Of the total VBP score, 30% comes from results from the Hospital Consumer Assessment…
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…
Value-based purchasing rule is final
July 1, 2011, marks the start of hospitals' first performance period under Medicare's new value-based purchasing program. The initial performance period runs through March 31, 2012. The final rule was released April 29, 2011, for the program, which covers hospitals under the inpatient prospective payment system, with some exceptions. Value-based…
HCAHPS: How the OR's scores affect your whole organization
Fiscal year 2013 will be a milestone for hospital reimbursement. That's the year Medicare's proposed new hospital value-based purchasing program starts. Under value-based purchasing, a portion of hospitals' DRG reimbursement will be based on their performance on quality metrics, including patient perceptions of the quality of care (PPQC). (See March…
90-day guarantee: Warranties as a tool for improved patient outcomes
Everything from washers to cars comes with a warranty, so why not health care? Geisinger Health System in Danville, Pennsylvania, introduced health care warranties with an innovative program called ProvenCare. Under the 90-day warranty, one cost covers the surgery and 90 days of follow-up treatment. Geisinger absorbs any additional costs…
More surgical infections on no-pay list
Three more preventable conditions have been added to the list of those Medicare will no longer pay extra for in hospitals in fiscal year 2009, which starts Oct 1, 2008. Medicare also added 13 quality measures for a total of 42 that will need to be reported for a full…
P4P: Building a culture of quality and bringing costs of care down
Pay-for-performance—it's a term you'll hear more about. Medicare officials think pay-for-performance (P4P) could encourage hospitals to improve quality while bringing costs down—a priority given that the hospital trust fund is projected to run out of money in 11 years. Congress has asked Medicare to come up with a plan that…
Aetna to stop covering MAC for GI endoscopy cases
Aetna informed physicians in December that it will no longer pay for monitored anesthesia care (MAC) for routine GI endoscopy as of April 1. Aetna joins others, including WellPoint, Inc, the nation's largest health insurer, that no longer cover anesthesia monitoring for these procedures. MAC can add $300 to $1,500…
Free Daily News
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