Reimbursement is a very important topic for hospitals as well as for practitioners. Reimbursement policies are complex and change frequently.
After October 1, 2008, Medicare will no longer reimburse certain CMS identified hospital-acquired conditions that were not present at the time of admission. This was mandated by Congress in The Deficit Reduction Act of 2005. The rationale for this change is that the costs of treating a condition acquired during a hospital stay that was reasonably preventable through compliance with evidenced based guidelines should be the responsibility of the hospital and not be paid either by Medicare or by the beneficiary.
The following is a list of CMS identified hospital-acquired conditions that Medicare will no longer reimburse hospitals for treating after October 1, 2008, if the conditions are not present at the time of admission:
- Serious Preventable Events (Objects Left in During Surgery, Air Embolism, Blood Incompatibility)
- Catheter-associated Urinary Tract Infections
- Pressure Ulcers
- Vascular Catheter Associated Infections
- Surgical Site Infection - Mediastinitis after Coronary Artery Bypass Graft
- Fall and Trauma - Fractures, Dislocations, Intracranial Injuries, Crushing Injuries and Burns.
Conditions being considered by Inpatient Prospective Payment System (IPPS) for fiscal year 2009 include:
- Staphylococcus aureus Septicemia
- Deep Vein Thrombosis (DVT)
- Pulmonary Embolism (PE)
Conditions needing further analysis:
- Ventilator-associated Pneumonia (VAP)
- Methicillin Resistant Staphylococcus aureus (MRSA)
- Clostridium difficile-Associated Disease (CDAD)
- Wrong Surgery
To keep up to date with reimbursement issues, this site offers a toll-free reimbursement hotline.
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Related Links:
Reimbursement Hotline
Questions about reimbursement?
To keep up to date with reimbursement issues, we offer a toll-free reimbursement hotline.
The Joint Commission
The Joint Commission's goal is to continuously improve the safety and quality of care provided to the public through the provision of healthcare accreditation and related services that support performance improvement in healthcare organizations.
- Joint Commission Home Page
- Improved Hand Hygiene to Prevent Health Care-Associated Infections
- Products Designed to Help Reduce HAC's
- CMS final rule on the fiscal year 2009 IPPS - July 31, 2008
Other Resources:
