Quality measures, such as the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program, form the basis of the 2015 IPPS final rule, released August 4.
There's bad news for case managers that were hoping that the 2-midnight rule would go away. It's not?at least not in fiscal year (FY) 2015. In the 2015 Inpatient Prospective Payment System (IPPS) final rule published August 22, CMS said while it may be willing to look into adjusting the payment methodology for the 2-midnight rule, the rule itself will stand.
CMS' fiscal year 2015 IPPS final rule focuses on quality initiatives mandated by the Affordable Care Act, including updates to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program. This quality focus creates a need for increased interdisciplinary collaboration across quality, HIM, risk management, revenue cycle, compliance, and technology.
Changes may be afoot for the 2-midnight rule. CMS' 2015 inpatient prospective payment system (IPPS) proposed rule seeks opinions about an alternate payment for short hospital stays.
The release of CMS' 2014 inpatient prospective payment system (IPPS) final rule was a major game changer for hospitals. While you may be caught up in understanding and applying the 2-midnight rule for inpatient admissions, it's important to remember that the final rule also brings about significant changes to quality of care. We discussed these issues and their impact on the hospital landscape during HCPro's September 10 audio conference "2014 IPPS Final Rule Explained."
Editor's note: This is the first in a two-part series that analyzes the 2014 inpatient prospective payment system (IPPS) final rule. This month we discuss the final rule's impact on inpatient status criteria. We will address quality-of-care changes in the next issue of MRB.
CMS finalized a documentation and coding adjustment (DCA) of -2% for fiscal year (FY) 2012, according to the inpatient prospective payment system (IPPS) final rule. CMS originally proposed a year-over-year reduction of 0.5% in payments to acute care hospitals, including a DCA of -3.15%. However, CMS finalized a cut of 2%, a decrease from 2.9% in FY 2011, which translates to $1.13 billion more in hospital payments in FY 2012 than hospitals received the previous year.
