IHA Daily Briefing: Oct. 8

OIG Issues Report Examining IRF Medicare Payments
CMS Increases Accrediting Organization Oversight
AHRQ Releases State Healthcare Quality Snapshots
Register Today for HCPro Medicare Boot Camp®
Briefly Noted

OIG Issues Report Examining IRF Medicare Payments
The Department of Health & Human Services (HHS) Office of the Inspector General (OIG) issued a report last week showing that approximately $5.7 billion in Medicare payments to inpatient rehabilitation facilities (IRF) in 2013 (the most recent year for which data was available) were unreasonable and unnecessary. The OIG began conducting this review when the Centers for Medicare & Medicaid Services’ (CMS’) Comprehensive Error Rate Testing program detected an increase in the percentage of error in Medicare inpatient rehabilitation payments from 9 percent in 2012 to 62 percent in 2016.

According to the OIG, for 175 of 220 IRF stay claims reviewed, medical documentation did not support that the IRF care was reasonable and necessary, in accordance with Medicare requirements. The OIG thus recommended that CMS:

  • Better educate IRF clinical and billing staff on Medicare rules for coverage and documentation;

  • Increase oversight of IRFs, including post-payment medical review;

  • Ensure better representation of IRFs at hearings conducted at the Administrative Law Judge level of appeal; and

  • Re-evaluate the entire Medicare IRF payment system.

CMS concurred with all the OIG’s recommendations.


CMS Increases Accrediting Organization Oversight
The Centers for Medicare & Medicaid Services (CMS) announced on Thursday that it is taking action to improve quality and safety in healthcare facilities by empowering patients with more information to help them make decisions about where to receive care. CMS is strengthening its oversight of accrediting organizations and increasing the transparency of hospital performance data for patients in these three ways:

  • Publicly posting accrediting organizations’ performance data;
  • Redesigning the accrediting organizations’ validation surveys; and
  • Releasing its most recent annual report to Congress.    

Read more here.


AHRQ Releases State Healthcare Quality Snapshots
The Agency for Healthcare Research and Quality (AHRQ) recently updated its National Healthcare Quality and Disparities Report with state-by-state snapshots. Each state is compared to a national benchmark on 124 measures, which are derived from the top-performing states. Each measure is then categorized on whether it is "far away," "close to" or "achieved or better" than the national benchmark.

Across the measures, Illinois:

  • Achieved or better than the benchmark for 38 measures;
  • Close to the benchmark for 43 measures; and
  • Far away from the bench mark for 32 measures.

Compared to all states, for the most recent data year, the performance for all Illinois measures is in the average range. For the baseline year, performance is in the average range.


Register Today for HCPro Medicare Boot Camp®
Learn how to comply with the latest Medicare rules and regulations, prevent missed revenue opportunities, minimize denials and prepare for program integrity audits by attending HCPro Medicare Boot Camp® – Hospital Version at IHA's Naperville office on Oct. 22-26.

This intensive, weeklong program combines lectures, class discussions and hands-on exercises to give participants expert insight into Medicare benefit and payment rules and their applications.

The program is designed for hospital revenue cycle, finance and reimbursement, and compliance staff, including:

  • Government billing specialists;
  • Patient Financial Services supervisors and managers;
  • Auditors and analysts;
  • Chargemaster coordinators;
  • Compliance officers;
  • Recovery Audit Contracting liaisons;
  • Case managers;
  • Coders; and
  • Legal Department personnel.

New to this course are implementation insights for 2018 changes to the inpatient-only list. Participants will also discuss how Local and National Coverage Determinations affect coverage of cases that meet the Two-Midnight Benchmark. Based on feedback from past participants, course exercises will be presented as illustrative case studies and incorporated into the instructor's presentation.

The program will be held from 8 a.m.-4:30 p.m. each day. Tuition includes all program materials, including an extensive program notebook, and continental breakfast, lunch and refreshments each day. To enhance learning and interaction, the program is presented in a small classroom setting. Space is limited so register today.


Briefly Noted
A new database supported by the National Institutes of Health and the Department of Defense aims to establish the number of people in the United States living with limb loss and to provide insight on their challenges and needs. The Limb Loss and Preservation Registry, expected to be operational in 2020 will be the first national registry of people who have lost limbs and promises to collect data that will improve prevention, treatment and rehabilitation efforts for this population. Read more here.