RESUMEN
This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, in this final rule with comment period, we are making changes to tolerance thresholds for clinical outcomes for solid organ transplant programs; to Organ Procurement Organizations (OPOs) definitions, outcome measures, and organ transport documentation; and to the Medicare and Medicaid Electronic Health Record Incentive Programs. We also are removing the HCAHPS Pain Management dimension from the Hospital Value-Based Purchasing (VBP) Program. In addition, we are implementing section 603 of the Bipartisan Budget Act of 2015 relating to payment for certain items and services furnished by certain off-campus provider-based departments of a provider. In this document, we also are issuing an interim final rule with comment period to establish the Medicare Physician Fee Schedule payment rates for the nonexcepted items and services billed by a nonexcepted off-campus provider-based department of a hospital in accordance with the provisions of section 603.
Asunto(s)
Atención Ambulatoria/economía , Atención Ambulatoria/legislación & jurisprudencia , Registros Electrónicos de Salud/economía , Registros Electrónicos de Salud/legislación & jurisprudencia , Tabla de Aranceles/economía , Tabla de Aranceles/legislación & jurisprudencia , Medicare/economía , Medicare/legislación & jurisprudencia , Trasplante de Órganos/economía , Trasplante de Órganos/legislación & jurisprudencia , Sistema de Pago Prospectivo/economía , Sistema de Pago Prospectivo/legislación & jurisprudencia , Centros Quirúrgicos/economía , Centros Quirúrgicos/legislación & jurisprudencia , Documentación , Healthcare Common Procedure Coding System/economía , Healthcare Common Procedure Coding System/legislación & jurisprudencia , Humanos , Clasificación Internacional de Enfermedades/economía , Clasificación Internacional de Enfermedades/legislación & jurisprudencia , Notificación Obligatoria , Evaluación de Resultado en la Atención de Salud/economía , Evaluación de Resultado en la Atención de Salud/legislación & jurisprudencia , Indicadores de Calidad de la Atención de Salud/economía , Indicadores de Calidad de la Atención de Salud/legislación & jurisprudencia , Reembolso de Incentivo/economía , Reembolso de Incentivo/legislación & jurisprudencia , Estados Unidos , Compra Basada en Calidad/economía , Compra Basada en Calidad/legislación & jurisprudenciaAsunto(s)
Biopsia/economía , Examen de la Médula Ósea/economía , Accesibilidad a los Servicios de Salud , Healthcare Common Procedure Coding System/economía , Reembolso de Seguro de Salud/economía , Calidad de la Atención de Salud , Biopsia/instrumentación , Examen de la Médula Ósea/instrumentación , Humanos , Estados UnidosAsunto(s)
Healthcare Common Procedure Coding System/economía , Radiocirugia/economía , Mecanismo de Reembolso/economía , Escalas de Valor Relativo , Actitud del Personal de Salud , Neoplasias Encefálicas/clasificación , Neoplasias Encefálicas/economía , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/cirugía , Conducta Cooperativa , Accesibilidad a los Servicios de Salud/economía , Humanos , Comunicación Interdisciplinaria , Neoplasias Primarias Múltiples/clasificación , Neoplasias Primarias Múltiples/economía , Neoplasias Primarias Múltiples/cirugía , Neurocirugia/economía , Grupo de Atención al Paciente/economía , Oncología por Radiación/economía , Radiocirugia/clasificación , Neoplasias de la Columna Vertebral/economía , Neoplasias de la Columna Vertebral/secundario , Neoplasias de la Columna Vertebral/cirugía , Estados UnidosAsunto(s)
Grupos Diagnósticos Relacionados/economía , Grupos Diagnósticos Relacionados/legislación & jurisprudencia , Healthcare Common Procedure Coding System/economía , Healthcare Common Procedure Coding System/legislación & jurisprudencia , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/legislación & jurisprudencia , Ultrasonografía/economía , Medios de Contraste/administración & dosificación , Costos y Análisis de Costo , Diagnóstico Diferencial , Ecocardiografía Doppler en Color/economía , Ecocardiografía de Estrés/economía , Alemania , Humanos , Cobertura del Seguro/economía , Cobertura del Seguro/legislación & jurisprudenciaRESUMEN
BACKGROUND: The objective of this study was to survey Trauma Center (TC) members of the National Foundation for Trauma Care/Trauma Center Association of America to determine usage and consistency of trauma team response charge codes and critical care accommodation charges for severely injured patients. Potential over- and underutilization of these enhanced reimbursements was assessed. METHODS: All TC members of the National Foundation for Trauma Care/Trauma Center Association of America were surveyed (2007) on usage of codes Universal Billing (UB) 68x; Field Locator (FL) 19 (now FL 14) patient type 5 "TC," UB 208 and Centers for Medicare and Medicaid Services codes G0390 and Ancillary Procedure Codes 0618. Data were collected on the use of 68x "Trauma Response" in combination with emergency room UB 450 Healthcare Common Procedure Coding System Critical Care E/M Level of Service 99291, as well as the daily accommodation (bed) charge code 208 for trauma critical care. RESULTS: We received 57 responses of 217 requests (response rate, 26.3%). Most responding TCs are charging for either full (86%) or partial (79%) trauma activation. Fewer are charging for trauma team evaluation fees (51%) and UB 208, trauma critical care accommodation code (33%). Charges are extremely variable between and across TC levels and among regions. Full trauma activation fees ranged from $837 to $24,964 with level II TCs charging more on average than level I TCs. As many as 63% of TCs failed to use or did not recognize combining codes 68x with ED 450 Healthcare Common Procedure Coding System 99291. CONCLUSION: Significant underused opportunities exist for enhanced revenue by improved implementation of trauma response codes. Wide ranges in charges and the low frequency of full implementation suggest that education and coordination are needed among hospital departments involved, as well as among the trauma care community at large, to realize optimal reimbursement for trauma care services.
Asunto(s)
Healthcare Common Procedure Coding System/economía , Centros Traumatológicos/economía , Centers for Medicare and Medicaid Services, U.S. , Distribución de Chi-Cuadrado , Administración Financiera de Hospitales/economía , Precios de Hospital , Humanos , Reembolso de Seguro de Salud/economía , Modelos Lineales , Medicaid/economía , Medicare/economía , Encuestas y Cuestionarios , Estados UnidosAsunto(s)
Healthcare Common Procedure Coding System/economía , Reembolso de Seguro de Salud/economía , Medicare/economía , Administración de la Práctica Médica/economía , Análisis Costo-Beneficio , Current Procedural Terminology , Documentación/economía , Documentación/normas , Medicina Familiar y Comunitaria/economía , Medicina Familiar y Comunitaria/normas , Control de Formularios y Registros/economía , Control de Formularios y Registros/normas , Humanos , Reembolso de Seguro de Salud/normas , Administración de la Práctica Médica/normas , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/normas , Medición de Riesgo , Sensibilidad y Especificidad , Estados UnidosRESUMEN
BACKGROUND: Falling reimbursement rates for trauma care demand a concerted effort of charge capture for the fiscal survival of trauma surgeons. We compared current procedure terminology code distribution and billing patterns for Subsequent Hospital Care (SHC) before and after the institution of standardized documentation. METHODS: Standardized SHC progress notes were created. The note was formulated with an emphasis on efficiency and accuracy. Documentation was completed by residents in conjunction with attendings following standard guidelines of linkage. Year-to-year patient volume, length of stay (LOS), injury severity, bills submitted, coding of service, work relative value units (wRVUs), revenue stream, and collection rate were compared with and without standardized documentation. RESULTS: A 394% average revenue increase was observed with the standardization of SHC documentation. Submitted charges more than doubled in the first year despite a 14% reduction in admissions and no change in length of stay. Significant increases in level II and level III billing and billing volume (P < .05) were sustainable year to year and resulted in an average per patient admission SHC income increase from $91.85 to $362.31. CONCLUSIONS: Use of a standardized daily progress note dramatically increases the accuracy of coding and associated billing of subsequent hospital care for trauma services.
Asunto(s)
Honorarios Médicos , Healthcare Common Procedure Coding System/economía , Precios de Hospital/normas , Reembolso de Seguro de Salud/economía , Centros Traumatológicos/economía , Análisis Costo-Beneficio , Documentación/economía , Documentación/normas , Femenino , Administración Financiera de Hospitales/economía , Encuestas de Atención de la Salud , Precios de Hospital/tendencias , Humanos , Reembolso de Seguro de Salud/tendencias , Masculino , Cuerpo Médico de Hospitales/economía , Credito y Cobranza a Pacientes , Probabilidad , Sensibilidad y Especificidad , Centros Traumatológicos/estadística & datos numéricos , Traumatología/economía , Estados UnidosAsunto(s)
Vendajes/economía , Medicare/economía , Opinión Pública , Mecanismo de Reembolso/organización & administración , Heridas y Lesiones/enfermería , Actitud Frente a la Salud , Comunicación , Servicios Contratados/economía , Current Procedural Terminology , Tabla de Aranceles/organización & administración , Healthcare Common Procedure Coding System/economía , Humanos , Cobertura del Seguro , Internet , Cuidados de la Piel/economía , Cuidados de la Piel/instrumentación , Cuidados de la Piel/enfermería , Estados UnidosAsunto(s)
Antiinfecciosos Locales/economía , Vendajes/economía , Medicare Part B/economía , Sistema de Pago Prospectivo/economía , Compuestos de Plata/economía , Carboximetilcelulosa de Sodio/economía , Equipo Médico Durable/economía , Guías como Asunto , Healthcare Common Procedure Coding System/economía , Humanos , Poliésteres/economía , Polietilenos/economía , Plata/economía , Cuidados de la Piel/economía , Cuidados de la Piel/instrumentación , Estados UnidosAsunto(s)
Estomía , Sistema de Pago Prospectivo/economía , Succión , Heridas y Lesiones/terapia , Vendajes/economía , Drenaje/economía , Drenaje/instrumentación , Equipo Médico Durable/economía , Healthcare Common Procedure Coding System/economía , Humanos , Medicare Part B/economía , Estomía/economía , Estomía/instrumentación , Succión/economía , Succión/instrumentación , Estados UnidosAsunto(s)
Healthcare Common Procedure Coding System/economía , Medicaid/economía , Medicare/economía , Cuidados de la Piel/economía , Ahorro de Costo , Femenino , Costos de la Atención en Salud , Healthcare Common Procedure Coding System/normas , Humanos , Masculino , Formulación de Políticas , Calidad de la Atención de Salud , Cuidados de la Piel/normas , Estados Unidos , Cicatrización de Heridas/fisiologíaRESUMEN
BACKGROUND: The trauma response fee (UB-92:68x) recently has been approved, to be used by hospitals to cover expenses resulting from continuous trauma team availability. These charges may be made by designated trauma centers for all defined trauma patients when notification has been received before arrival (eligible pt). This study compares two trauma centers' performance in collecting this fee help define methodologies that can enhance reimbursement. METHODS: Our trauma system uses two hospitals (A and B) that are designated as the Level I trauma center for the region on alternate years. This allows hospital performance comparisons with relatively consistent patient demographics, injury severity, and payer mix. Data were collected for a one-year period beginning on January 1, 2003 and included charges, collections, and payer source for the trauma response fee. This time frame allowed the comparison of two six-month sequential periods at each trauma center. RESULTS: Out of a total of 871 trauma patients, 625 were eligible for the trauma response fee (72%): hospital A = 65% and hospital B = 77%. Total trauma response fee charges for both centers were 1,111,882 dollars with collections of 319,684 dollars (28.8%). The following payer sources contributed to the collections: Indemnity insurance (77.4%), Managed Care (22.1%), Medicare (0.3%), and Medicaid (0.2%). No collections were obtained from any self-pay patient. Eligible patients were charged a trauma response fee much less frequently in Hospital A than B (29.35% versus 95.2%) but revenue / charge ratios were equivalent at both hospitals (0.32 versus 0.28). These differences resulted in markedly enhanced revenue for each eligible patient in Hospital B compared with A (735 dollars versus 174 dollars) CONCLUSIONS: Enhanced collection by hospital B was a result of a higher charge, compulsive billing of all eligible patients, and emphasis on pre-admission designation of trauma patients. Effective billing and collection process related to trauma response fees results in substantial additional revenue for the trauma center without additional expense.