Inpatient Facility Coding & Compliance Alert

Spearhead your work plan with these 3 foundational realities.

So, you think your facility strikes a perfect balance between the inpatient and outpatient services it offers? Well, think again!

This just in: The Medicare Payment Advisory Commission (MedPAC) discussed the adequacy of Medicare payments for hospital inpatient and outpatient services and other issues in a meeting on Dec. 18, 2014. MedPAC reviewed the trends in hospital services and reimbursement patterns from 2010-2013 and found the following:

1) Overall demand for hospital services: Stable, with the inpatient use falling 4 percent and the outpatient use rising 4 percent. However, the excess inpatient capacity is growing, with the occupancy down by 60 percent, though it varies by market and region.

2) The quality of care: Better, with a steady or declining in-hospital and 30-day mortality rate for prevalent conditions like stroke, hip fracture, CHF (congestive heart failure), and acute myocardial infarction. The readmission rates decreased concurrent with the readmission payment penalty.

3) The growth of outpatient services: This reflects distortions in the hospital payment systems as hospitals get paid more for a service that can also be performed in a physician office. The market share, therefore, is also shifting to hospitals compared to physician offices. According to MedPAC, “in 2013, hospitals billed for 7 percent more echocardiograms, while the physician offices billing fell by 8 percent.” This phenomenon is significant because altogether in 2013, “Medicare paid $1.2 billion more and the beneficiaries were paid $240 million more in coinsurance to hospitals,” than the amount payable to physician offices for the same services, says MedPAC. It therefore recommends reducing differences between hospitals and physician offices for selected outpatient services.

Take home message: MedPAC advises Medicare on future strategies and implementations. So this means that you need to take a stock of your facility’s inpatient to outpatient ratio, and also check whether your hospital has a balanced approach to the inpatient versus outpatient care.

Resource: For further information visit: http://www.medpac.gov/documents/december-2014-meeting-presentation-assessing-payment-adequacy-and-updating-payments-hospital-inpatient-and-outpatient-services-.pdf?sfvrsn=0