When it comes to certain medical conditions, we all have wrestled with the conflagration of differing opinions and the discrepancies in provider documentation.
A common example: The emergency department physician states sepsis, the attending physician writes pneumonia, and the infectious disease specialist documents viral infection. What gives? CDI specialists need to address these situations head on to obtain accurate, specific, and clear documentation. Why do these discrepancies occur and how can we address them?
Though medical schools may vary in how they teach clinical indicators, they follow generally recognized standards and guidelines for clinical practice. These standards are established by professional medical organizations and are based on evidence-based medicine and clinical research.
A number of services in the E/M category are on track for big pay gains in CY 2024, led by behavioral health care management (99484), set for a 26% jump to $54 per service, and joined by two prolonged services codes (99415, 99416).
But the good news isn’t everywhere. While the pay increases are significant for some services, a total of nine codes in the E/M family are part of the gains, according to a Part B News payment analysis factoring in the conversion factor cut and changes to relative value units (RVU) from the proposed 2024 Medicare physician fee schedule. That contrasts with dozens of E/M codes that will see reduced fees in CY 2024.
A bipartisan coalition of 51 senators has issued a letter to Senate leaders Chuck Schumer and Mitch McConnell to address and avert an $8 billion cut to the Medicaid Disproportionate Share Hospital (DSH) program, slated to begin on October 1 and continue for the next four years.
The reduction in DSH is one result of a series of legislative proposals enacted in May, which had advanced through the House Energy and Commerce Subcommittee on Health unanimously, 27-0.
CMS is moving ahead with most of its proposed changes, including cuts to disproportionate share hospital (DSH) payments, in the fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS) final rule. The rule, released August 1, provides updates on inpatient hospital reimbursement, ICD-10-CM/PCS coding and diagnosis-related group (DRG) changes, quality and reporting programs, and more.
Payment changes
CMS finalized a 3.1% payment increase for hospitals that meet quality and reporting requirements for FY 2024, up from the 2.8% CMS floated in the proposed rule. This represents an increase in inpatient hospital payments of $2.2 billion compared to FY 2023. However, DSH payments will decrease by $957 million and CMS is projecting payments for new medical technologies will decrease by $364 million.
U.S. senators are urging their leadership to address impending Medicaid cuts that would have a negative impact Olean General Hospital and Bradford Regional Medical Center.
Chesapeake Regional Medical Center and health insurer Cigna reached an agreement that will allow Cigna members who get their insurance through their employer to continue to pay lower rates for services through the hospital system.
The new contract, which was announced Friday, will be effective through July 31, 2025. Under its terms, Chesapeake Regional will remain in the Cigna coverage network.