Since the OIG only has two new Work Plan focuses this month, and because neither deal with hospital reimbursement on a broad level, this month I will only focus on a new Rule proposed by the CMS.
On September 20, 2018 the CMS released a new proposed rule with the purpose of reducing more of the documentation burdens on physicians and promoting efficiency. During the comment period, the CMS is looking for opinions on these reforms as well as any additional proposals or modifications you may have that would reduce the burden on providers dealing with federal programs. Comments are due November 19, 2018 Below is a summary of some of the proposals in the rule.
I would first like to highlight the leniency in requirements for emergency plans. No longer will providers and suppliers have to document efforts to contact local, tribal, regional, State, and Federal emergency preparedness officials when creating an emergency plan, but they will still be required to cooperate with these officials in emergency situations. Another proposed change is to only require facilities to train staff on their emergency plan once every two years, instead of annually, after initial training.
With these changes, it will be important to ensure that staff are fully aware of the emergency plan and well-versed in it during onboarding since it may be a long time until they are required to be trained on it again. Also, there is no rule against running training more often than every other year. Finally, ensure you actually are contacting the emergency preparedness officials you will have to work with in a tragedy to ensure you are all on the same page, even though you don’t have to tell anyone you’re talking to them.
Medical History and Physical Examination
Next up, hospitals will no longer have to create a comprehensive medical history and physical examination, commonly known as an H&P, and instead use a pre-surgery/pre-procedure assessment for outpatients if the medical staff deems it responsible. This assessment would have to be documented in the patient’s medical record. The reason to do this would have to factor in the patient’s age, diagnoses, the type and number of surgeries/procedures being performed, comorbidities, the level of anesthesia required for the surgeries/procedures, as well as “nationally recognized guidelines and standards of practice for assessment of specific types of patients prior to specific outpatient surgeries and procedures and applicable state and local health and safety laws.”
It is believed that this leniency will allow facilities to focus more on what makes clinical sense based on the individual instead of having to follow a strict national guideline for each patient. If your medical staff does go ahead with this, it will be important to teach revenue cycle staff that are used to reviewing H&Ps and to realize what documentation may be available on insurance appeals in cases where an H&P was substituted for the new assessment.
Finally, transplant centers will no longer be required to submit clinical experience, outcomes, and other data to obtain re-approval from Medicaid. It will still be required to do data submission, clinical experience, and outcome requirements for initial Medicare approval.
A 2016 study cited in the proposed rule found that these requirements had led to lower transplant rates and increased organ discard. The requirements also led to the removal of sicker patients from liver transplant wait lists. The belief now is that these lower quality requirements will allow for more patients to get transplants without increasing patient risk. On the reimbursement front, it should be possible to get more money from performing more procedures, but it will be important to see if these requirements face further changes.
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