More Changes
I attended an HIM workshop last week to hear the latest on the ever-changing world of government regulations. The workshop was an update on the Centers for Medicare and Medicaid Services (CMS) changes affecting coding and DRG assignment. For the last twenty years, hospitals were reimbursed under the old inpatient prospective payment system (IPPS). CMS has made major changes to the system, which is now called MS-DRGs (medical severity diagnostic related groups.) The new payment structure will be based on the severity of the patient's condition. The current 538 DRGs will be replaced with 745 MS-DRGs.
In addition to the changes with DRGs, hospitals must indicate on all Medicare claims if conditions were present on admission. Claims without the present on admission (POA) status will be returned to the facility. CMS developed a coding system for POA indicators:
Y-Yes-condition present on admission
N-No- condition not present on admission
U-Unknown- insuffienct documentation to determine POA
W-Clinically Undetermined-the provider cannot clinically determine if the condition was POA
As if POA indicators were not enough, certain hospital acquired conditions (HAC) will affect the reimbursement the hospital receives. On October 1, 2008, codes representing these HAC will not be included with calculating MS-DRG assignment.
Since these are the most sweeping changes to IPPS in over twenty years, many are concerned about how the changes will affect their bottom line. Although hospitals must be concerned about their reimbursement, the most important factor is to take the burden off coders. When DRGs were first implemented, coders had to worry about selecting the correct principle diagnosis, comorbidities and complications. Now, the coders must worry about assigning the correct principle diagnosis, comorbidities, complications, POA and HACs.
I have not worked in acute care in years. Now, I am convinced the decision to leave this area was a good one. In my years away from acute care, I have tried to keep up with what is happengning in this area. Now, that I am teaching I need to have more than a general knowledge of the world of IPPS. This area of HIM has always been subject to every changing government regulations. I spoke with coders who struggle to keep up with the changes. The biggest area of concern is the problem of continued lack of documentation. A major part of POA is having sufficient documentation to support the coding assignment. HIM managers must take the pressure off their coders and implement educational programs that will ensure compliance with the regulations.
References: MS-DRGs: CMS implements major revisions to IPPS (warning: PDF), BKD Healthgroup, by Tom Wolters
CCS Prep!, Advance for Health Information Professionals, by Cheryl D'Amato