| Reimbursement |
| IPPS
October 1, 2007
President Bush signed legislation that prevents CMS from fully implementing $20 billion in prospective payment cuts to hospital inpatient Medicare services over the next five years. The cuts are part of a so-called "behavioral offset" contained in the IPPS in final rule which takes effect October 1, 2007. The legislation reduces the cuts in 2008 and 2009 by half, from 1.2%to 0.6% and from 1.8: to 0.9% respectively, but leave the 2010 cut of 1.8% intact.
October 17,2007
Medicare payment of inpatient claims for discharges in early October should begin flowing to providers by no later than Monday, according to CMS. CMS expects fiscal intermediaries to begin processing the claims by October 18th, after updating claims processing software to reflect changes to the fiscal year 2008 IPPS. |
|
Electronic Cash Posting The sheer size of bulk paper remits is challenging. Some facilities receive weekly Medicaid remits over 350 pages long-an all day manual job for one person. If received in an electronic format it would take approximately one hour to post. Other problems with paper remits is dealing with lost paper checks, storage,etc.
Benefits of ERA is the increase in level of accuracy, decrease in staff time, and gathering of information found on the remit and the ability to slice and dice data for claim status reporting.
|
| |
| Client Corner |
| UPMC uses Cirius to achieve quantifiable metrics
|
| |
 |
Cirius Newsletter
October/2007 Issue: 2 |
The power in technology is NOT the technology itself. The power in technology is taking your business and making it better than anyone could have ever considered it to be. It's making you faster in the healthcare marketplace. It's making you tougher in the healthcare marketplace. Technology is no longer an expense, it's a REQUIREMENT. |
| Revenue Cycle |
UB04 IMPLEMENTATION CALENDAR
Effective Date Form Locator
10/1/07 FL 15:Name change
to Point of Origin for
Admission or Visit;all codes
clarified/revised.
10/1/07 FL 42: New subcategory
added to 094X
1/1/08 FL 39-41:New Value Code
Clinical Trial Number
Facility IP Hospice Service
is delivered
1/1/08 FL 43:NDC Reporting for Medicaid
Drug Rebates
4/1/08 FL 17:Change to code 05
implementation of new code 70
More
CMS RAC ATTACK
CMS Recovery Audit Contractor Program will effect all hospital providers nationwide because CMS has given latitude to an outside contractor to identify Medicare overpayments and underpayments. The RAC program is unique, because the payment to contractor is based upon a percentage of overpayments identified. This program has been implemented in California, New York and Florida. Additional states will be added with full implementation by January 2010. Three primary focal points is reviewing medical necessity, improper coding and secondary payer issue. After 18 months over $303.5 million identified as improper payments.
|
|
| Managed Care |
Items to Track for Denials by payer:
# of Inpatients
# of Outpatients
# of Carve Out services
Implants
Prosthetics
# of High cost drugs
# of Days-medical necessity
$ of Charges-medical necessity
# of Days-overturned after
appeal and review
# of Timely Filing
# of Eligibility
# of Days-Authorization
$ of Charges-Authorization
# of Days Benefits exhausted
# of Days Denied Coverage
# of High Dollar Review
$ of High Dollar Review
# of Underpayments
$ of Underpayments
Averages for Overall Tracking of Denied Claims
Overall Denial Rate =4%
Clinical Denials = 5%
Technical Denials= 3%
Overturn Rate = 60%
|
We offer the BEST IN CLASS Revenue Cycle and Reimbursement software in the healthcare market. But, don't just take our word for it, see what providers have achieved with 'real world' financial performance improvements. Performance Results Jayne Kroner
Business Development
Cirius Group, Inc.
|
| Subscribe Free to Healthcare E-Newsletter |
| |
| |
