HPMP INSIGHT June 2007
IN THIS ISSUE- Present-on-Admission
- Are You Preparing for Severity-Adjusted DRGs?
- New York State Fiscal Year 2005 Payment Error Cause Analysis (PECA)
- Notification of Hospital Discharge Appeal Rights - Update on CMS-4105-F
Present-on-Admission
Effective October 1, 2007, Medicare will begin to accept a Present-on-Admission Indicator (POA) for every diagnosis on inpatient acute care hospital claims. However, providers must submit the POA on hospital claims beginning with discharges on or after January 1, 2008. Critical access hospitals, Maryland waiver hospitals, long-term care hospitals, cancer hospitals and children's inpatient facilities are all exempt from this requirement. For more details, please visit the web site at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5499.pdf
Return to topAre You Preparing for Severity-Adjusted DRGs?
On April 25, 2006, the Centers for Medicare & Medicaid Services (CMS) issued the FY 2008 hospital inpatient prospective payment system (IPPS) proposed rule (CMS-1533-P). To view details on FY 2008 IPPS proposed rule, please go to CMS website.
The proposed rule would create 745 new severity-adjusted DRGs (Medicare Severity DRGs, or MS-DRGs) to replace the current 538 DRGs. The CMS' plan to adopt severity-adjusted DRGs is the most significant change to the Medicare hospital inpatient prospective payment system since the Prospective Payment System (PPS) was created in 1984. These changes are important in improving the accuracy of Medicare's payment for inpatient stays to better account for the severity of the patient's condition.
CMS contracted with the RAND Corporation to evaluate the classification and weighting methodologies of five different systems to support the implementation of severity-adjusted DRGs. An interim RAND Corporation report has been issued and is publicly available at: http://www.cms.hhs.gov/Reports/downloads/Wynn0307.pdf A final report is expected from RAND by September 1, 2007.
With the proposed rule on severity-adjusted payment methodology, hospitals must begin considering how they will prepare for this transition. Coders must familiarize themselves on what to expect from this change and what would be the impact in terms of their coding knowledge and skills. It is critical for Coders to improve their coding skills, know ICD-9-CM codes in depth; and understand disease etiologies, manifestations and symptoms. To prepare for a successful implementation of a severity-adjusted coding and DRG methodology, a joint effort between the healthcare provider and the coder may be essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures.
Return to topNew York State Fiscal Year 2005 Payment Error Cause Analysis (PECA)
The Centers for Medicare & Medicaid Services (CMS) pulls a random sample of claims from short-term, acute care, NYS hospitals each month to assess the Medicare fee-for-service payment error rate. The random sample is reviewed for admission necessity, DRG/coding accuracy and, billing errors. Records that are not submitted for review are issued technical denials, resulting in full fiscal recoupment by CMS for a failure to provide the medical record. Each year, CMS provides aggregated national and NYS data, which details the causes of the payment errors.
The NYS PECA data has been posted to your hospitals QualityNet Users inbox as of Friday, June 15, 2007. If you have questions about the data please contact Dr. Kathy Terry at 516-209-5364. For difficulties with downloading the data, you may contact Karen Sharpe at 516-209-5562.
Return to topNotification of Hospital Discharge Appeal Rights - Update on CMS-4105-F
CMS has posted a webpage on cms.hhs.gov where information and updates on the revised notification process will be posted including notices and instructions as they are finalized.
HPMP Compliance Workbook: http://providers.ipro.org/index/hpmp-compliance-workbook
DRG Coding Corner: http://www.ipro.org/drg
JENY: http://jeny.ipro.org/forumdisplay.php?f=34
Top 10 denied DRGs: http://providers.ipro.org/index/hpmp-topten-denied-drgs07
Top 7 DRGs: http://providers.ipro.org/index/hpmp-top-seven-drgs
Hospital Payment Monitoring Program: http://www.ipro.org/hpmp
Coding for Quality: Documentation and Coding Tips for Gastrointestinal Disorders: http://www.ipro.org/gi
Please pass this E-mail on to anyone who might be interested in the information. If you have not subscribed to HPMP Insight, visit http://lists.ipro.us/read/all_forums/subscribe?name=hpmp-announce to subscribe to this newsletter.
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 8SOW-NY-TSK3B-07-06
To access previous HPMP Insight updates, visit
http://lists.ipro.us/read/?forum=hpmp-announce Return to top
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