CMS expands list of no-pay conditions

CMS has added three more hospital-acquired conditions to its list of those for which it won't reimburse as of October 1st. Beginning October 1, Medicare will require hospitals to include a complication code in DRGs that documents whether a given complication was present on admission. Medicare will then determine whether the complication developed due to hospital mistakes--and if so, it won't pay for care related to such mistakes. The new reimbursement policy, which brings the list to 11 conditions and events, is expected to save Medicare $20 million a year. CMS would like to add an additional five conditions to the list for fiscal 2009's inpatient prospective payment system rule.

At the same time, CMS announced its final 2009 rules for inpatient rehab and skilled nursing facility prospective payment systems. Medicare projects that payments rehab facilities will be $5.6 billion in fiscal 2009, based on case-mix groups weighing patient types and resources needed. Meanwhile, nursing home payments will rise by $780 million courtesy of a 3.4 percent increase in the annual market basket calculation for SNF stays.

To learn more about Medicare's plans:
- read this Modern Healthcare article (reg. req.)

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