RESUMO
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.
Assuntos
Assistência Ambulatorial/economia , Assistência Ambulatorial/legislação & jurisprudência , Registros Eletrônicos de Saúde/economia , Registros Eletrônicos de Saúde/legislação & jurisprudência , Tabela de Remuneração de Serviços/economia , Tabela de Remuneração de Serviços/legislação & jurisprudência , Medicare/economia , Medicare/legislação & jurisprudência , Transplante de Órgãos/economia , Transplante de Órgãos/legislação & jurisprudência , Sistema de Pagamento Prospectivo/economia , Sistema de Pagamento Prospectivo/legislação & jurisprudência , Centros Cirúrgicos/economia , Centros Cirúrgicos/legislação & jurisprudência , Documentação , Healthcare Common Procedure Coding System/economia , Healthcare Common Procedure Coding System/legislação & jurisprudência , Humanos , Classificação Internacional de Doenças/economia , Classificação Internacional de Doenças/legislação & jurisprudência , Notificação de Abuso , Avaliação de Resultados em Cuidados de Saúde/economia , Avaliação de Resultados em Cuidados de Saúde/legislação & jurisprudência , Indicadores de Qualidade em Assistência à Saúde/economia , Indicadores de Qualidade em Assistência à Saúde/legislação & jurisprudência , Reembolso de Incentivo/economia , Reembolso de Incentivo/legislação & jurisprudência , Estados Unidos , Aquisição Baseada em Valor/economia , Aquisição Baseada em Valor/legislação & jurisprudênciaAssuntos
Biópsia/economia , Exame de Medula Óssea/economia , Acessibilidade aos Serviços de Saúde , Healthcare Common Procedure Coding System/economia , Reembolso de Seguro de Saúde/economia , Qualidade da Assistência à Saúde , Biópsia/instrumentação , Exame de Medula Óssea/instrumentação , Humanos , Estados UnidosAssuntos
Healthcare Common Procedure Coding System/economia , Radiocirurgia/economia , Mecanismo de Reembolso/economia , Escalas de Valor Relativo , Atitude do Pessoal de Saúde , Neoplasias Encefálicas/classificação , Neoplasias Encefálicas/economia , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Comportamento Cooperativo , Acessibilidade aos Serviços de Saúde/economia , Humanos , Comunicação Interdisciplinar , Neoplasias Primárias Múltiplas/classificação , Neoplasias Primárias Múltiplas/economia , Neoplasias Primárias Múltiplas/cirurgia , Neurocirurgia/economia , Equipe de Assistência ao Paciente/economia , Radioterapia (Especialidade)/economia , Radiocirurgia/classificação , Neoplasias da Coluna Vertebral/economia , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Estados UnidosAssuntos
Grupos Diagnósticos Relacionados/economia , Grupos Diagnósticos Relacionados/legislação & jurisprudência , Healthcare Common Procedure Coding System/economia , Healthcare Common Procedure Coding System/legislação & jurisprudência , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Ultrassonografia/economia , Meios de Contraste/administração & dosagem , Custos e Análise de Custo , Diagnóstico Diferencial , Ecocardiografia Doppler em Cores/economia , Ecocardiografia sob Estresse/economia , Alemanha , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/legislação & jurisprudênciaRESUMO
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.
Assuntos
Healthcare Common Procedure Coding System/economia , Centros de Traumatologia/economia , Centers for Medicare and Medicaid Services, U.S. , Distribuição de Qui-Quadrado , Administração Financeira de Hospitais/economia , Preços Hospitalares , Humanos , Reembolso de Seguro de Saúde/economia , Modelos Lineares , Medicaid/economia , Medicare/economia , Inquéritos e Questionários , Estados UnidosAssuntos
Healthcare Common Procedure Coding System/economia , Reembolso de Seguro de Saúde/economia , Medicare/economia , Administração da Prática Médica/economia , Análise Custo-Benefício , Current Procedural Terminology , Documentação/economia , Documentação/normas , Medicina de Família e Comunidade/economia , Medicina de Família e Comunidade/normas , Controle de Formulários e Registros/economia , Controle de Formulários e Registros/normas , Humanos , Reembolso de Seguro de Saúde/normas , Administração da Prática Médica/normas , Padrões de Prática Médica/economia , Padrões de Prática Médica/normas , Medição de Risco , Sensibilidade e Especificidade , Estados UnidosRESUMO
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.
Assuntos
Honorários Médicos , Healthcare Common Procedure Coding System/economia , Preços Hospitalares/normas , Reembolso de Seguro de Saúde/economia , Centros de Traumatologia/economia , Análise Custo-Benefício , Documentação/economia , Documentação/normas , Feminino , Administração Financeira de Hospitais/economia , Pesquisas sobre Atenção à Saúde , Preços Hospitalares/tendências , Humanos , Reembolso de Seguro de Saúde/tendências , Masculino , Corpo Clínico Hospitalar/economia , Crédito e Cobrança de Pacientes , Probabilidade , Sensibilidade e Especificidade , Centros de Traumatologia/estatística & dados numéricos , Traumatologia/economia , Estados UnidosAssuntos
Bandagens/economia , Medicare/economia , Opinião Pública , Mecanismo de Reembolso/organização & administração , Ferimentos e Lesões/enfermagem , Atitude Frente a Saúde , Comunicação , Serviços Contratados/economia , Current Procedural Terminology , Tabela de Remuneração de Serviços/organização & administração , Healthcare Common Procedure Coding System/economia , Humanos , Cobertura do Seguro , Internet , Higiene da Pele/economia , Higiene da Pele/instrumentação , Higiene da Pele/enfermagem , Estados UnidosAssuntos
Anti-Infecciosos Locais/economia , Bandagens/economia , Medicare Part B/economia , Sistema de Pagamento Prospectivo/economia , Compostos de Prata/economia , Carboximetilcelulose Sódica/economia , Equipamentos Médicos Duráveis/economia , Guias como Assunto , Healthcare Common Procedure Coding System/economia , Humanos , Poliésteres/economia , Polietilenos/economia , Prata/economia , Higiene da Pele/economia , Higiene da Pele/instrumentação , Estados UnidosAssuntos
Estomia , Sistema de Pagamento Prospectivo/economia , Sucção , Ferimentos e Lesões/terapia , Bandagens/economia , Drenagem/economia , Drenagem/instrumentação , Equipamentos Médicos Duráveis/economia , Healthcare Common Procedure Coding System/economia , Humanos , Medicare Part B/economia , Estomia/economia , Estomia/instrumentação , Sucção/economia , Sucção/instrumentação , Estados UnidosAssuntos
Healthcare Common Procedure Coding System/economia , Medicaid/economia , Medicare/economia , Higiene da Pele/economia , Redução de Custos , Feminino , Custos de Cuidados de Saúde , Healthcare Common Procedure Coding System/normas , Humanos , Masculino , Formulação de Políticas , Qualidade da Assistência à Saúde , Higiene da Pele/normas , Estados Unidos , Cicatrização/fisiologiaRESUMO
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.