HCPro.com: Health Care Auditing Strategies

August 2008 (Volume 7, Issue 8)	view entire issue

CMS stops payment for eight HACs; more to come
Beginning in October, hospital staff members need to be more conscious of patients' conditions at admission. In 2007, CMS proposed to stop paying for eight hospital-acquired conditions (HAC) previously included in the higher-weighted DRG in the inpatient prospective payment system (IPPS), including: Foreign objects retained after surgery Air embolisms Blood incompatibility Stage III and IV pressure ulcers Falls and trauma in the hospital Catheter-associated urinary tract infections Vascular catheter-associated infections Surgical site infections

A four-step approach to a risk management plan
In an attempt to reduce government spending, state and federal agencies are taking a fine-tooth comb to organizations that receive Medicaid funding. That means having an effective compliance policy is more important than ever. The escalation of Medicaid costs-an expected $204 billion in fiscal year (FY) 2008 and $400 billion in 2009-raised red flags in Congress, said Michael F. Mangano, a former principal deputy and acting inspector general in the OIG and senior vice president at Strategic Management in Alexandria, VA.

Methods of issuing IM on discharge appeal rights vary
Hospital staff members have a few choices when deciding how to distribute the Important Message from Medicare (IM) regarding discharge appeal rights. However, the hospital operational staff should find the method that best suits the size of the hospital and the roles of the staff members. In 2007, CMS required hospitals to give Medicare inpatients a revised version of the IM to explain beneficiaries' hospital discharge appeal rights.

A proactive approach to self-disclosure
The cost to healthcare organizations that do not comply with federal healthcare laws and regulations can be enormous, resulting in large fines and penalties and possibly corporate integrity agreements (CIA) and/or certification of compliance agreements (CCA). Ultimately, CMS can exclude an organization from working with federal healthcare programs. This affects the financial viability of an organization and its reputation within its community.

Conducting an internal investigation interview
When conducting an internal investigation interview, don't try to mimic the television show Law and Order's interrogation style. Compliance officers conduct interviews, not interrogations, says Michael Johnson, Esq., former DOJ attorney and copresident of Global Compliance's Brightline Learning Division, based in Charlotte, NC. Approach the interview more like a journalist than a prosecutor. Aggressive and accusatory tones do not produce good information. Rather, it puts the interviewee on the defensive.

CMP may serve as solution to patient status concerns
Editor's note: This article is the second in a two-part series on patient status. Developing clear patient status indicators helps improve quality of care. Creating a case management protocol (CMP) based on these clinically approved indicators helps clinical and admissions staff members determine the appropriate patient status, which in turn helps reduce admissions claims denials. "I can't imagine that hospitals wouldn't want to get their auditing strengthened and use something like a case management protocol to determine the correct patient status," says Suzanne K. Powell, BSN, RN, MBA, CPHQ, CCM, of Florida's Quality Improvement Organization (FQIO).

Other recently-published articles from Health Care Auditing Strategies:

Three HACs added in IPPS rule

Proceed to EHR with caution, planning

RAC guinea pigs give glimpse of what’s to come

Work Plan focuses on quality

Take a long-term approach to short-stay audits

Encoder software may lead to clinically inaccurate coding

Beware when developing gift-giving policies

Hectic ERs present audit challenges, compliance risks

Timing is important when auditing observation status

Five tips to audit coders for compliant claims

Be prepared for RACs with internal audits

Medicaid integrity contractor audits soon to follow RACs

Clinical documentation programs result in fewer errors, improved compliance

CMP may serve as solution to patient status concerns

Conducting an internal investigation interview

ABOUT HCPRO

PRESS

CAREERS @ HCPRO

ADVERTISING OPPORTUNITIES

ONLINE STORE

200 HOODS LANE

P.O. BOX 1168

MARBLEHEAD, MA 01945, USA

PHONE: 800/650-6787

FAX: 781/639-7857

Copyright Statement	Privacy Policy

*MAGNET™, MAGNET RECOGNITION PROGRAM®, and ANCC MAGNET RECOGNITION® are trademarks of the American Nurses Credentialing Center (ANCC). The products and services of HCPro, Inc. and The Greeley Company are neither sponsored nor endorsed by the ANCC