Categories
- Billing for Preventable Adverse Events: Smart States (12)
- No Pay for No Performance - Health Insurance Reimbursement (5)
- Physician P4P - Pay for Performance (1)
Primary Listings
Hospital-Acquired Conditions Medicare No Longer Pays For (FY 2009)
Starting October 1, 2008, Medicare has expanded its payment implications for hospital-acquired conditions (HACs) such as Stage III and IV pressure ulcers, certain falls, catheter associated UTI and other infections, certain surgical infections, deep vein thrombosis (DVT)/ pulmonary embolism (PE) with hip or knee replacement, and more. List of ten (10) preventable conditions, which if not identified as Present on Admission (POA), will not be reimbursed. Finalized Sept. 2008
PatientFriendlyBilling ® project: Consumerism in Health Care
Report by the Healthcare Financial Management Association, AHA and MGMA, calls for greater attention to pricing transparency, point-of-service payment and simplified charge structures. All are desired by consumers - and can be delivered by the combined efforts of leaders by providers and insurers. Published summer 2006
Other Helpful Listings
Medicare Transition to MS-DRGs for Inpatient Services FY 2008
Historical reference Aug. 2007: CMS rule 1533-FC created 745 new Medicare severity-adjusted DRGs (MS-DRGs) to replace 538 DRGs, to be phased in over 2 years, beginning Oct. 1, 2007. FY 2008 changes also eliminated payment for 8 hospital-acquired conditions such as certain catheter-associated infections, pressure ulcers (decubiti), injuries from falls, mediastinitis after CABG surgery, and 3 [never events]. Pneumonia 30-day mortality will be measured. Full rule (over 2100 pages long) contains substantial changes to reimbursement