CMS struggling to roll out new no-pay policy

For about a year now, the hospital industry has been struggling to prepare for the rollout of Medicare's strict reimbursement policy. Under the policy the Medicare won't pay for some hospital-acquired conditions. Now, it appears that even CMS is having a hard time dealing with the rollout of the new policy.

Managing and tracking coding issues, and deciding which conditions are "reasonably preventable," are proving to be difficult problems, admits Thomas Valuck, a physician who serves as medical officer and senior adviser in the CMS Center for Medicare Management. For example, CMS execs aren't sure how to detect when a condition that's coded as present on admission--a requirement under current Medicare rules--gets moved up into a higher payment group.

CMS is also working to improve its store of research on evidence-based guidelines, as execs aren't sure their definitions of no-pay conditions are precise enough, Valuck said.

To learn more about the status of CMS's no-pay policy:
- read this Modern Healthcare piece (reg. req.)

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