CDM Code Verification

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BobCharron

Validating current CDM Codes

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Recursos literarios

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Although it was considered so terrible it was never going to happen, Sequestration is here. Hospitals are faced with absorbing a 2% reduction in Medicare reimbursement. For some hospitals this can amount to hundreds of thousands of dollars per year. Add to this change Value-based Purchasing, Readmission Penalties, reductions in DSH and UPL payments, increased RAC Reviews and hospitals across the country are facing an uphill climb. This puts a tremendous strain on all hospitals, even those with tax support.

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CEOs continue to express concerns about how they can maintain financial performance in the current economic climate. Nationally, hospital census numbers have declined. Medicare has implemented a 2% reduction in payments and many state Medicaid plans have reduced reimbursement rates. Lower volumes and decreased reimbursements have hit the hospital industry hard. Proactive C-suite staff members are modeling possible solutions. One common solution is to project increased revenues through new service lines to offset the lower reimbursements. A few have considered cost cutting as the best path for their organization. Both methods can work but some are harder to achieve than others.

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Stark rules and Hospital Compliance issues have been around for several years yet they are still a problem. Just remember, intent is not required to violate the statute, so violations occur frequently. Fair market value must be established by reference to other prices for the same services in the community and agreed upon by both parties in an arm’s-length transaction. The value must also be consistent with the “general market value.” Make your physician – hospital contractual relationships a high priority.

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