Medi Care payment rules changed in October, 2008. They will no longer pay the extra costs of treating patients who develop eight serious, preventable conditions after hospitalization. The list includes falls from bed, cathers-associated urinary tract infections and pressure ulcers. News reports indicate large insurance companies are considering similar policies. “Never Events”, hospital attributable medical errors, make up part of the list of the rule changes.
The Center for Medi Care and Medicaid (CMS) notes, “On February 8, 2006 the President signed the Deficit Reduction Act (DRA) of 2005 that required there be an adjustment in Medicare DRG (Diagnosis Related Group) payment for certain hospital-acquired conditions.”
Asking key questions of Health and Human Services regarding the rule changes:
(1) Who pays, and how/why if Medi Care no longer will pay?
The hospital absorbs the cost of treating the hospital-acquired condition, and may not bill the beneficiary for the difference between the two Medicare Severity Diagnosis Related Groups (MS-DRGs).
(2) Is there a limit on their payment, should the infection prove long and difficult in severity and length? Is there the likelihood of long severity of non-covered infection?
In unusual cases in which the costs of treatment greatly exceed the payment rate for the case based on the assigned MS-DRG, Medi Care may pay the hospital an outlier payment. In these cases, after the hospital’s costs of treatment exceed the MS-DRG payment rate by an outlier threshold, Medicare will begin to pay 80 percent of any additional costs. .. [T]he final rule included a tentative outlier threshold for fiscal year 2009 of $20,185. CMS plans to announce the final outlier threshold, after taking into account the MIPPA changes, soon.
(3) Why this change in the rule (budget issue?)?
These changes were mandated by the Deficit Reduction Act of 2005.
(4) Why have they picked these diseases?
These are not all diseases. They are properly called “hospital-acquired conditions,” because they also include things like falls. .. [T]he public was given 60-days to comment, and were selected based on a review of the submitted comments. According to criteria established in the Deficit Reduction Act of 2005, each condition had to be:
(5) What do they expect to be the result of the new policy? An opinion is desired
.
CMS Acting Administrator Kerry Weems says:
“While it may be some time before we can begin to assess the real impact of these steps on patient care, we are hearing from hospitals around the country about efforts they have undertaken in the past year to improve staff training and other measures to reduce the incidence of these preventable conditions.”
Many experts believe that these important changes will drive payment methods and criteria in the near future, and that the adjustments will motivate hospitals to reduce “Never Events.”
–Peter Menkin, San Francisco
Posts Tagged ‘Change’
Medi Care Rule Change by Peter Menkin
Thursday, July 1st, 2010How You Can Change The Atmosphere Of Your Clinic Or Hospital By Having Efficient Medical Billing Software
Saturday, May 1st, 2010 Doctors often get disturbed by managing their several tasks which are related to finance. They are so busy that they are unable to manage their billing systems but no worries when you have medical billing software. This software provides your clinic and hospital a better and advanced atmosphere in which you can resolve your several issues which you are unable to resolve due to your tough timings. Myriad of advantages you can obtain from this software which is a complete package to complete your everyday tasks. This software is especially designed for fulfilling the requirements of doctors so that they can manage their routine properly. I have seen several of my doctor friends who want to manage the record of patients carefully but they are unable to do this because they have no proper system. I have suggested them to use medical billing software which has competent feature of electronic medical records EMR. This core component is beneficial for keeping the records of your patient and you can also easily manage their database according to your own requirement. You can store anything related to patient. You can put any analyzing report about the specific patient and also you can edit the information about him whenever you need to change the previous one. If you have weak memory and you often forget to recall the appointments then you should buy this software as quickly as possible. This software maintains your appointment schedule efficiently and you don’t need to do extra effort to give the appointments to your patients. You can also specify the recall alarms which will tell you about the upcoming appointment of a patient so that you would be able to read his medical history before his arrival. Through this system, you and your employees both will get convenient atmosphere to deal with several important patients. This software is packed with integrated billing module which is good in dealing with your payments into two currencies. Your daily reports and statistics will make the cash flows and management expenses in superb manner. Through this, you will get familiar with your income and expenses on daily basis. If you are unable to understand the language which is installed by default then you will not obtain any problem in translation because integrated language interpreter provides good services to you. You can translate the language in your own and you will not obtain any problem in knowing any feature about this software. Medical billing software is designed in a very special way. You can easily use it in your clinic and also in hospitals to perform multiple of tasks which are difficult to manage manually. Doctors and other staff will be able to manage daily operations because this software is suitable and best fit with the desires of all types of medical care institutions. With this software, you obtain maximum security and full rights to use the required data which is beneficial and important for doctors and medical staff. So purchase this product which is having such magnificent characteristics and qualities.
Doctors often get disturbed by managing their several tasks which are related to finance. They are so busy that they are unable to manage their billing systems but no worries when you have medical billing software. This software provides your clinic and hospital a better and advanced atmosphere in which you can resolve your several issues which you are unable to resolve due to your tough timings. Myriad of advantages you can obtain from this software which is a complete package to complete your everyday tasks. This software is especially designed for fulfilling the requirements of doctors so that they can manage their routine properly.
I have seen several of my doctor friends who want to manage the record of patients carefully but they are unable to do this because they have no proper system. I have suggested them to use medical billing software which has competent feature of electronic medical records EMR. This core component is beneficial for keeping the records of your patient and you can also easily manage their database according to your own requirement. You can store anything related to patient. You can put any analyzing report about the specific patient and also you can edit the information about him whenever you need to change the previous one.
If you have weak memory and you often forget to recall the appointments then you should buy this software as quickly as possible. This software maintains your appointment schedule efficiently and you don’t need to do extra effort to give the appointments to your patients. You can also specify the recall alarms which will tell you about the upcoming appointment of a patient so that you would be able to read his medical history before his arrival. Through this system, you and your employees both will get convenient atmosphere to deal with several important patients.
This software is packed with integrated billing module which is good in dealing with your payments into two currencies. Your daily reports and statistics will make the cash flows and management expenses in superb manner. Through this, you will get familiar with your income and expenses on daily basis. If you are unable to understand the language which is installed by default then you will not obtain any problem in translation because integrated language interpreter provides good services to you. You can translate the language in your own and you will not obtain any problem in knowing any feature about this software.
Medical billing software is designed in a very special way. You can easily use it in your clinic and also in hospitals to perform multiple of tasks which are difficult to manage manually. Doctors and other staff will be able to manage daily operations because this software is suitable and best fit with the desires of all types of medical care institutions. With this software, you obtain maximum security and full rights to use the required data which is beneficial and important for doctors and medical staff. So purchase this product which is having such magnificent characteristics and qualities.
