Inpatient Facility Coding & Compliance Alert

Take a look at how your competitors are billing. 

If you’ve ever wondered how your facility compares to others in terms of billing, look no further than the Center for Medicare and & Medicaid Services. CMS released its update on the Medicare 2012 Inpatient and Outpatient hospital charge data in early June, sharing information that compares the average billing costs of services typically provided in association with 100 types of inpatient stays across 3,000 hospitals from all 50 states.

“The release of these data sets furthers the administration’s efforts to increase transparency and support data-driven decision making which is essential for health care transformation,” said HHS Secretary Kathleen Sebelius.

“These public data resources provide a better understanding of Medicare utilization, the burden of chronic conditions among beneficiaries and the implications for our health care system and how this varies by where beneficiaries are located,” said Bryan Sivak, HHS chief technology officer.

 With the data of two years available, productive trend analysis can be done. For instance, average billing for back problems has risen nine percent from $ 23,000 to $ 25,000 whereas number of discharges decreased by nearly 7,000 from 2011 to 2012. We can use the information to improve care coordination and health outcomes by learning from the simultaneous performance of hospitals nationwide.

CMS has also released its latest information on chronic conditions, including:

• Geographic data summarized to national, state, county, and hospital referral regions levels for the years 2008-2012;
• Data for examining disparities among specific Medicare populations, such as beneficiaries with disabilities, dual-eligible beneficiaries, and race/ethnic groups;
• Data on prevalence, utilization of select Medicare services, and Medicare spending;
• Interactive dashboards that provide customizable information about Medicare beneficiaries with chronic conditions at state, county, and hospital referral regions levels for 2012; and
• Chart books and maps.

What does this mean for individual hospitals?  “While this data is informative in and of itself, the place where this information can be used is with benchmarking a hospital’s charges,” says Duane C. Abbey, Ph.D., of Abbey and Abbey Consultants Inc., in Ames, IA.  

Here’s why: Chargemaster coordinators struggle with charge structures and pricing of services, Abbey explains. “Even though the chargemaster charge data is at a highly detailed level, coordinators can check to see how high or how low a given hospital’s charges, for a particular type of service, are relative to this data. Such comparisons can provide some general guidance for setting charges.” 

Extra resource: This data is also available at the state level so that for a given state, some idea of charge structures can be determined. 

“While this data is useful, even knowing whether your hospital’s charge are relatively high or low may not aid in short-term pricing adjustments,” Abbey cautions. “In many cases, for hospitals to make major changes in their pricing structures would require renegotiating multiple contracts.  Thus this data from HHS is very welcome and hospital chargemaster personnel should use the data in every way possible.”

To ready the HHS press release, go to : http://www.hhs.gov/news/press/2014pres/06/20140602a.html.