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On April 24, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule for FY 2013 reimbursement under the Inpatient Prospective Payment System (IPPS).
Early thoughts from the proposed Medicare payment update
On March 16, the Department of Health and Human Services released final rules for the Medicaid program expansion mandated by the Patient Protection and Affordable Care Act (ACA). As currently written, Medicaid would be available to individuals aged 19 through 64 with incomes up to 133% of the federal poverty level. That said, the Medicaid provisions of ACA could change substantially when the Supreme Court issues its ruling later this year.
Adding to the complexity, many states are cutting Medicaid reimbursement and issuing more selective eligibility requirements. Regardless of the outcome, health systems must ensure that they receive every dollar earned treating Medicaid-eligible patients. A critical component of this initiative is to improve the process for identifying and enrolling Medicaid-eligible self-pay patients.
Uncover potential Medicaid losses
Barrie Medical Center1, an academic medical center in the Northeast, is an excellent example of a provider that has already taken steps to improve its identification and enrollment processes. The hospital historically suffered losses from treating uninsured individuals who were actually eligible for Medicaid but had not enrolled in the program.
Barrie leadership identified two primary drivers of this phenomenon:
- Front office staff didn't see many individuals with a high probability of being Medicaid-eligible when they presented for care.
- Despite form distribution by the front office staff, many Medicaid-eligible patients failed to complete the paperwork in a timely manner.
Preparing for the Medicaid expansion: Is your registration process ready?
Pressure on hospital margins, the need for increased revenue capture, and documentation complexities of ICD-10 (both in specificity and scope) all require a continued focus on clinical documentation improvement (CDI) programs.
Our research has found that the strongest CDI programs have, among other qualities, robust tracking and accountability mechanisms in place, as well as a focus on driving accurate DRG assignments to reduce denials and increase revenue.
Clinical documentation programs: Resolving discrepancies through automation and collaboration