Proposed CMS Rules are Based on Reporting Outcome Data

On May 11, CMS announced proposed changes to inpatient Medicare payments by releasing the annual Inpatient Prospective Payment System (IPPS). The CMS changes include a proposed increase of 3% in hospital payment rates, the creation of a new DRG and price transparency. In Under this CMS update, hospitals that report quality data and are “meaningful users” of their EHR system will be rewarded with increased reimbursement. Maintaining revenue and getting paid for services provided continues to be tantamount. Prioritize comprehensive, correct documentation and coding to avoid extra work and denials.

All of the CMS changes are premised on hospitals providing more detailed outcome data to CMS on Medicare cost reports. For instance, hospitals will be required to list their negotiated rates median payer-specific negotiated rates for inpatient services by Medicare Severity-Diagnosis Related Group (MS-DRG). The newly created DRG is an increase in CAR-T cell therapy reimbursement. Also in the proposal, CMS addresses the ongoing importance of discovering new antimicrobial products. In essence, CMS proposes add-on payments for the development of antimicrobial products even before FDA approval. Finally, for those desiring to comment on the proposed IPPS rule there is a comment period ending on July 10.

FairCode increases clean claim ratios by combining the domain expertise of experienced physicians with modern data science and analytics technologies to increase hospital revenue. FairCode bridges the gap between a hospital’s attending physicians and hospital coders. The result? Patient acuity and Case Mix Index (CMI) are more accurately captured with the correct DRG, and hospital reimbursements adjust accordingly. DRG Validation and physician conducted medical chart reviews happen in real time, significantly impacting hospital quality rankings, CMI)and bottom-line results. From clinical validation and chart reviews to payor denial defense, FairCode’s physicians and data scientists are part of a hospital’s coding team. Add FairCode to your existing CDI initiatives and see the difference. Outcomes are measurable and significant. FairCode averages greater than 4:1 Gross Return on Investment.

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