When it comes to using offshore resources, there are several important compliance requirements HIM professionals need to know. These requirements were created by CMS a decade ago and apply to the use of offshore contractors for all Medicaid, Medicare, and TRICARE patients.
In several recent reports, the Office of Inspector General (OIG) determined that providers are, on average, variant from expected volumes on both short stay inpatient and long stay observation cases. What was not made clear in the OIG report is the reason why it believes such variances exist. The answer to this question likely rests within the details of how hospitals have adjusted (or not adjusted) to the use and application of “new criteria” in their daily and ongoing Medicare billing compliance processes.
HCCs are the basis for risk adjustments for reimbursement models like Medicare Advantage, accountable care organizations (ACO), and other value-based purchasing measures such as Medicare Spending Per Beneficiary. Poor understanding and application of HCCs mean that a hospital’s patients may be much sicker in reality than they appear to be on paper. And that will hit reimbursement hard.
Probably the most onerous duty physicians have is the preparation of the inpatient discharge summary, especially after a long or complicated hospital stay.
Pneumonia discharges impact hospital payments under the Hospital Value-Based Purchasing Program as well as the Hospital Readmissions Reduction Program. The selection of a principal diagnosis, secondary diagnosis, present on admission (POA) status, and discharge status on each claim determines whether a pneumonia discharge will be included in the measure.
The Office for Civil Rights (OCR) released guidance on patient access fees with little fanfare last year but the guidance, intended to clarify existing OCR regulations, became a flashpoint for controversy. The guidance states that organizations may charge a patient either a flat fee of $6.50 or follow a specific methodology for calculating the cost of making a copy of requested patient records. Although some organizations found their fee schedules out of step with OCR’s guidance, the biggest problem came from an unexpected corner: attorneys.
Even though we are set to inaugurate a new president of the United States who vowed to abolish Obamacare, I believe that Donald J. Trump will not touch provisions that address perceived cost inefficiency or quality within our healthcare system. In fact, if you’ve read CMS’ game plan for transforming healthcare published in JAMA in 2014, note that many of these provisions began with George W. Bush and have been embraced by the AMA with the implementation of MACRA.
