Inpatient hospitals likely to continue as RAC targets
By the end of 2009, all states will be under the Recovery Audit Contractor (RAC)
audits. The RAC is a newly formed Medicare contractor mandated by Congress to accomplish—among
other things—the recoupment of monies for the Medicare Trust Funds. Hospitals in
particular should note the results of the three-year demonstration program that
ended in March 2008. Inpatient hospitals accounted for $786.3 million or 84 percent
of the overpayments recovered during the demonstration program net of appeals, and
it is likely that inpatient hospitals will continue to be the focus in the permanent
program. Now is the time for hospitals to prepare for RAC audits.
What does it mean to be RAC ready?
Being ready means having systems in place to address Medicare payment rules and
coding guidelines, taking a proactive stance to reduce vulnerabilities before the
RAC auditors point them out. It also means developing a plan of action for medical
record requests and the appeals process should claims be denied.
3M RAC Ready Program provides hospitals with a coordinated solution that addresses
the key RAC target areas while assisting facilities in shoring up processes to operate
under RAC reviews. The offering consists of a combination of a software product
and services that deliver the following outcomes:
- Identifies a hospital’s potential exposure to RACs along with actions needed to
address areas of risk and opportunities
- Provides a proactive approach to coding compliance along with tools to track trends
and create an audit trail
- Identifies case management redesign required to address problematic admissions,
including medically unnecessary short stays
- Delivers a comprehensive RAC management tracking tool that assists with workflow,
communications and trending of issues, denials, monies recovered and areas of risk
- Provides hospitals with a report card of their RAC efforts in case management effectiveness
and coding efforts
For hospitals facing RAC audits, 3M can help reduce the associated risk by identifying
vulnerabilities and offering solutions to operational concerns. As with other 3M
products and services, the 3M RAC Ready Program will be updated as regulations and
coding guidelines change.
Check here
for complimentary webinar on RAC readiness (recorded Sept. 23).
Medicare’s not paying for hospital-acquired conditions (HACs), but 3M customers
are ready
Medicare will soon cease paying for some conditions that arise during a hospital
stay. Customers using the 3M™ Coding and Reimbursement System will have the
information at their fingertips to properly identify and code these hospital-acquired
conditions or HACs.
The country’s largest healthcare payer is putting incentives in place to reduce
HACs. Medicare is positioning to move from “passive payer to active purchaser
of higher value healthcare services.”
Beginning Oct. 1, 2008, Medicare may exclude the following conditions within the
payment calculation if they were not present on admission:
- Foreign object retained after surgery
- Air embolism
- Blood incompatibility
- Pressure ulcer - Stages III and IV
- Falls and trauma in the hospital
- Catheter-associated urinary tract infection
- Vascular catheter-associated infection
- Mediastinitis following coronary artery bypass graft
- Manifestations of poor glycemic control
- Surgical site infection following certain orthopedic procedures
- Surgical site infection following bariatric surgery for obesity
- Deep vein thrombosis and pulmonary embolism following certain orthopedic procedures
Until now, Medicare, insurance companies, and other payers have reimbursed for virtually
all care provided in hospitals—even complications with a root cause in patient
care. Many critics pointed out that there is too little incentive to avoid preventable
complications such as HACs. Under this new rule, hospitals will have to start financing
some complications they do not prevent for their Medicare patients.
For 3M Coding and Reimbursement System and 3M™ Advanced Analyzer customers,
HAC coding and reporting will be easier. Hospital coders will be able to identify
HACs using the Present on Admission indicator as a component of the Medicare Severity-adjusted
DRG algorithm. Customers using the 3M™ Core Grouping Software, the 3M™
Grouper Plus System or the 3M™ Clinical Claims Editor Software will have these
methodologies installed and ready for reporting prior to the Oct. 1, 2008, Medicare
deadline.
Click here
for a recorded webinar about how CMS identifies HACs and how your hospital can address
them.
For more information on how 3M products and services can help you with HAC coding
and reporting, contact your 3M sales representative or call us toll-free at
800-367-2447.
3M supports quality initiative to help Floridians avoid readmission surprises
3M recently played a major role in supporting a quality initiative influencing virtually
all Florida hospitals. This state-wide initiative used the 3M potentially preventable
readmission (PPR) methodology to publish report cards of all acute care
hospitals
in Florida.
The website FloridaHealthFinder.gov
is the first public effort to publish hospital PPR data as a measure for consumers
to consider when choosing a hospital.
PPR rates are based on those patients readmitted to the same facility or another
short-term acute care hospital within 15 days based on the original admission for
the same or related condition. The data is important for patients interested in
quality health care and for hospitals that want to build upon their discharge procedures
and improve the information provided to their patients.
In a press release from June 26, 2008, Holly Benson, secretary, Agency for Health
Care Administration (AHCA), said: “Hospital readmissions are often avoidable
and always costly; by sharing this data, we will help hospitals, providers and especially
patients improve the discharge process and the delivery of health care.”
When a patient unexpectedly returns to the hospital a few days after discharge,
it is a disappointment, setback and loss for everyone. Reducing unplanned readmissions
introduces the potential to reduce misery, improve clinical outcomes and avoid unnecessary
costs.
For more information, contact your 3M sales representative, call us toll-free at
800-367-2447, or visit us online at www.3Mhis.com/ppr.