The owner of two Hudson County hospitals, Hudson Hospital Holdco LLC, is targeting a third hospital in the county. In a letter sent to Christ Hospital CEO Peter Kelly dated Dec. 23, Hudson Hospital Holdco LLC, the parent company of Bayonne and Hoboken medical centers, made what it termed an "initial" offer of $91.6 million for the debt-ridden Jersey City hospital. The offer was quickly rejected by Christ Hospital officials, who are in the process of selling the hospital to California-based Prime Healthcare Services for $15.8 million. The terms of the sale are currently under review by the state Department of Health and Senior Services.
Georgia has established itself as an innovator in telemedicine technology—using it to expand access to healthcare, transform the way care is delivered and cut overall costs. The Georgia Partnership for TeleHealth network has rapidly expanded in recent years to include nursing homes, school clinics, emergency departments, primary care and other providers with 175 physicians in 40 specialties. Statewide, telemedicine sessions have soared from roughly 200 in 2006 to more than 40,000 this year.
In 2012, we will see new and successful accountable care organizations, hospital CIOs tackling increasing security risks brought on by clinicians' use of mobile technology, and a majority of providers using electronic health records. These are a few of IDC Health Insights' top 10 predictions for 2012, based on year-long research and conversations with health industry executives. There are five overarching themes impacting the healthcare industry which will affect the future of health IT, according to IDC: health reform, analytics and big data, cloud computing, mobile devices, and social media.
First-year surgery residents, called interns - in notoriously the toughest year of training in the toughest specialty - have "admitted'' Santa Claus every December since the early 1950s, dreaming up dire medical problems, conducting exams and tests on a costumed actor or life-size doll, and filling out medical forms. What began as an attempt at comic relief late on a slow night in the emergency room has blossomed into a 60-year tradition. This month, Dr. Andrew Warshaw - who led "Santa Rounds'' as an intern in 1963 and later became chief of surgery - and Dr. Gregory Ruhnke of the University of Chicago published a paper detailing the history of Santa's admissions in the Archives of Surgery.
On November 15, CMS announced that it will launch a number of demonstration programs that are set to begin in January 2012, one of which is its recovery auditor prepayment review initiative. On December 21, CMS held a special open door forum to further discuss the program.
Each year as part of its financial reports, CMS produces an estimate of its improper payments in the Medicare program. In fiscal year 2011, the rate of error in the Medicare program was 8.6%, which translates to roughly $29 billion in error, according to George Mills,director of provider compliance group at the office for financial management at CMS, who spoke on the call.
The goal of the prepayment recovery auditor demonstration, as stated on the open door forum by Amy Cinquegrani, Division of Recovery Audit Operations at CMS, is to prevent improper payments before they are made and to thereby lower this error rate.
Areas of Focus CMS identified short hospital stays in its CERT (comprehensive error rate testing) report as a problematic area. The prepayment review demonstration will address these short stays.
Specifically, the three CMS focus areas of short hospital stays are:
Incorrectly coded claims
Patients who came through the emergency department but should have subsequently gone to observation rather than being admitted
Patients who received elective surgery during short-day stays when they should have been outpatient procedures
CMS extracted a number of short stay DRGs from analytics within the CERT report that present billing problems for providers that will come under focus in the demonstration project. These DRGs represent the first group of DRGs that will be held for prepayment reviews. As the project moves forward, there will be additional DRGs added to the list, according to Mills. The initial list is as follows:
January 1: MS-DRG 312, syncope and collapse
March 1: MS-DRG 069, transient ischemia and MS-DRG 377, gastrointestinal (GI) hemorrhage with MCC
May 1: MS-DRG 378, GI hemorrhage with CC and MS-DRG 379, hemorrhage without a CC or MCC
July 1: MS-DRG 637, diabetes with MCC, MS-DRG 638, diabetes with CC, and MS-DRG 639, diabetes without a CC or MCC
In addition, James Cope, MD,a medical director with the CERT testing program ran through some of the problems that the report identified with these specific DRGs. For a more detailed summary, an audio recording and transcript of the call will be posted and will be accessible for download beginning on or around December 29. It will be available for 30 days.
How the process will work The demonstration will begin on January 1, 2012 and will run through the end of 2014. It will be applicable to 11 states, seven of which are HEAT (Healthcare fraud prevention and enforcement action team) states: California, Florida, Illinois, Louisiana, Michigan, New York, and Texas; and four states with high volumes of short inpatient stays: Missouri, North Carolina, Ohio, and Pennsylvania. All facilities that bill to the FI/MAC within those states are subject to the program, according to Cinquegrani.
This demonstration will not replace the ongoing MAC prepayment review program and will serve as a separate entity that aims to help lower the error rate. Providers will not be subject to review for the same topic or issue by two different contractors, according to CMS.
Additional documentation requests will come from the FI/MAC and will contain specific details regarding where providers should submit documentation. Providers will have 30 days to do so; the claim will automatically be denied if documentation isn't received within 45 days. Provided that the recovery auditor receives the documentation, it will then review the claim and communicate a payment determination back to the FI/MAC, according to CMS. Providers will receive the payment determination on the remittance advice within 45 days. Recovery auditors will also send detailed review results letters.
Operational Details The following is a list of operational details that CMS clarified during the call:
Limits on prepayment reviews won't exceed current post-payment ADR (additional documentation request) limits.
Providers may appeal the denial and have the same appeal rights as with other denials. Appeal time frames start on the date of the denial as indicated in the remittance advice.
Medical records provided on appeal will be remanded to the recovery auditor for review. (This only applies to claims that were denied as a result of nonreceipt of medical records).
Claims will be off-limits from future post-payment reviews from MACs and recovery auditors
The American Telemedicine Association is appealing to Congress to amend the Social Security Act to allow states to expand the use of telemedicine for Medicaid enrollees with high-risk pregnancies and neonatal care needs. The ATA says the measure will save Medicaid up to $186 million over the next 10 years. In its legislative proposal, released this week, the ATA calls for the establishment of birthing networks where Medicaid coverage of telemedicine services would be provided to maternal-fetal and neonatal care patients.