Finance
Provides the latest news and updates on federal and state hospital and health system reimbursement policies and procedures.
Look to issues pages on Medicare (CMS), Medicaid (ODJFS), Bureau of Workers' Compensation (BWC) and other payers, community benefit reporting, the Hospital Care Assurance Program (HCAP), and hospital billing & collection. Look also for educational programming announcements, financial tools and OHA data products, and links to federal and state third-party payers and related organizations.
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Medicare 2011 IHPPS Final Rule Out; 2.9% Coding Cut Still In
August 9, 2010:
CMS' final rule on its FFY 2011 Medicare inpatient hospital prospective payment system (IHPPS) was publised in the Federal Register Aug. 16, including a 2.9 percent cut to recover what CMS alleges was a past increase in operating and capital payments related to better ICD.9.CM coding, rather than the cost of the care (2.5 percent to long-term care hospitals). A brief CMS fact sheet is available as is a detailed review by Lawrence Goldberg (Grant Thornton). The 2011 IHPPS final rule is expected to be published in the Federal Register on Aug. 16 and go into effect Oct. 1.
CMS' 2.9 percent "coding creep" cut was by far the most controversial and contested part of the 2011 final rule and is expected to be the subject of intense Congressional lobbying this summer and fall. According to American Hospital Association (AHA) estimates, it will reduce Medicare payment to hospitals nationwide by $3.7 billion in 2011 ($125 million estimated in Ohio), with another cut of the same size scheduled for FFY 2012. Overall, and due specifically to the coding cut, AHA states the average acute care hospital will be paid .4 percent less in 2011 than it was in 2010.
Other aspects of the final rule include:
- Sets of additional quality reporting measures for FFY 2011, 2012 & 2013, totaling 60 measures once all are effective.
- Three updates to payment policy for Critical Access Hospitals, including what many think is the
first step off a slippery slope of tying the allowance of state hospital tax payments to "related" returns.
- Further tinkering with the three-day, "DRG Window" inpatient admission bundling rules, with CMS now saying all outpatient non-diagnostic care in the three days before an inpatient admission will be considered related -- a complete reversal of policy re-stated a year ago -- unless the hospital specifically documents that it is not, using a yet-to-be released format.
- Lower thresholds for IHPPS outlier payments for acute care hospitals.
- Better payments to "low-volume" and Medicare-dependent hospitals
Other Announcements