The American Hospital Association is seeking more clarity regarding guidelines for payment denials related to conditions acquired in a healthcare setting, reports AHA News.
Although the Centers for Medicare and Medicaid Services is allowed to prohibit payments to providers for hospital-acquired infections and complications stemming from medical errors, state agencies are allowed leeway in determining these conditions. The AHA is concerned that the CMS may be overstepping guidelines under the Patient Protection and Affordable Care Act to prohibit payments by not focusing on what it calls a "core set of healthcare-acquired conditions."
Of particular concern are multi-state systems. "If states are able to finalize completely different lists of healthcare-acquired conditions, it would be extremely difficult to manage across a health system," said AHA Executive Vice President Rick Pollack in a letter to CMS Director Donald M. Berwick.
To prevent such an overreach, the primary lobbying group for non-profit hospitals wants a clear list of healthcare-acquired conditions that would lead to a payment prohibition.
The AHA also expressed apprehensions over the lack of a risk-adjustment mechanism, which could prevent hospitals from defending themselves for an improper penalty, according to Pollack.
For more:
- read the AHA News article
- read the Becker's ASC Review article