Administrative Memos

200503

FROM: Theodore O. Will, Chief Executive Officer
DATE: Mar 25, 2005
SUBJECT: HPMP-Collaborative Learning Series: Upcoming Events
IPRO CONTACTS:

Kathy Terry, Ph.D., Senior Director, Medicare/Federal Health Care Assessment at 516-326-7767, Ext. 226

As you are aware, IPRO in collaboration with the New York State Health Care and Professional Associations, began a new Hospital Payment Monitoring Program (HPMP) interactive, web-based learning series in February 2005. IPRO is pleased to announce the continuation of this collaborative through several upcoming learning sessions.

On April 14, 2005 from 11am to 12:30pm, HANYS has arranged for Eva Gregorek, RHIT, CCS, HIM Analyst at Northeast Health who will present: "Exploring DRGs 14 and 88, Coding Tips and Techniques". This session will include coding tips, direction, discussion and case examples for DRGs 14 (Intra-cranial Hemorrhage or Cerebral Infarction) and 88 (Chronic Obstructive Pulmonary Disease). These DRGs are among the top volume and/or denied DRGs in NY State in addition to being included as Centers for Medicare and Medicaid Services (CMS) target areas for payment error monitoring. The content of this program is directed towards administrators, compliance officers, and HIM/coding professionals.

"Targeted Utilization Issues and Your Data" will be held on May 11, 2005 from 8am to 9:30am. This two-part program is directed towards physicians, administrators, analytic staff, compliance officers, and utilization directors. Part one of the presentation will provide utilization management/admission necessity information to clinicians in regard to DRGs 243 (medical back problems) and 253 (fracture, sprain, strain and dislocation of upper arm, lower leg except foot age > 17 with complication or comorbidity). Case examples and review determinations will be presented. Part two will examine the Program for Evaluating Payment Patterns Electronic Report (PEPPER) as it relates to this CMS target area. Specifically, payment and length of stay data will be discussed. The PEPPER presentation will continue the discussion as to the interpretation and application of PEPPER data, therefore, it is recommended that you have viewed the previously presented and recorded PEPPER training session (also available on JENY under the Payment Error and Case Review Initiatives subsection). Part one of the program will be led by Monty Bodenheimer, MD, Medical Director while the second part will be led by Richard Lee, MS, Sr. Data Analyst, both of IPRO.

The next collaborative session will be held on June 23, 2005 from 11am to 12:30pm. This session entitled "Higher Weighted DRGs (HWDRGs): Data Trends and Coding Tips" will cover statewide data patterns of Higher Weighted DRGs (HWDRGs) including billing patterns and approval/denial rates. (Hospitals submit requests for higher-weighted DRG assignment directly to the fiscal intermediary (FI) for processing and payment. All requests granted by the FI are subsequently selected by CMS for QIO review on a post-payment basis.) We will also discuss coding requirements for the top denied DRGs associated with HWDRG requests. Kathy Terry, PhD, Sr. Director and Renato Estrella, MS, RHIA, Director, both of IPRO, will present on this topic.

As in the past, all of the above collaborative learning sessions will be recorded and available via the virtual library on JENY (http://jeny.ipro.org under Payment Error and Case Review Initiatives). To date we have held two programs: "Welcome to Your Collaborative" which included an overview of program intent, an update on the New York State payment error rate and, a discussion of the top-denied Medicare DRGs for NYS today with related coding tips to mitigate these errors. The second collaborative entitled "Focus on Hospital Issued Notices of Non-Coverage (HINNs)" provided a brief overview of HINNs followed by the presentation of answers, prepared by IPRO, in response to hospital-submitted (written) questions.

Hospitals must register to participate in each Collaborative Learning Session with registration available at https://ifmcevents.webex.com. It is strongly suggested that at least one (1) hospital representative participate in each live session so that your hospital's specific concerns and/or questions may be addressed. Detailed registration instructions for each session are available on Attachment I. Hospital participants will need access to both the Internet and a telephone line for participation in all trainings. While we encourage multiple hosptial participants from each facility, we request your assistance in keeping slots open for all hospitals wishing to participate. Please encourage staff within your facility to share the computer/phone line used for the training event.

Should you have any questions or comments about this memorandum and/or the training please contact Dr. Kathy Terry, Sr. Director, Medicare/Federal Health Care Assessment at 516-326-7767, extension 226.