It’s important for hospitals to plan for coder productivity decreases as they near the Oct. 1 implementation date for MS-DRGs. Productivity rates are expected to drop by 20 to 25 percent as coders learn the new reimbursement system and spend more time querying physicians to gather the documentation needed to accurately code the encounter. A 20 to 25 percent productivity decrease could result in a one- to two-day delay in coding turnaround – a problem that could be compounded and worsen if not dealt with in a timely manner.

Here are some ideas to help hospitals cope with the expected productivity decreases:
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Hospitals need to understand that clinical documentation improvement is an ongoing effort and not a one-time event. This is especially true with the Oct. 1 arrival of MS-DRGs. Organizations cannot expect a one-time educational event on clinical documentation to completely change behaviors in clinicians or coders.

Current documentation improvement programs are based on the current CMS DRGs, making many elements of these programs outdated after the implementation of MS-DRGs. These programs need to be updated and hospitals should also plan for a series of physician educational events over the next few months as everyone adjusts to the new MS-DRG system.
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The U.S. House of Representatives voted yesterday to reduce by half Medicare's planned base rate cuts. The cuts, scheduled to take effect Oct. 1 when the Centers for Medicare & Medicaid Services' (CMS) 2008 fiscal year begins, may be limited to 0.6% in FY2008 and 0.9% in FY2009 and FY2010.

If the Senate passes the bill and it gets President Bush's signature, the overall base rate cuts would be reduced from 4.8% to 2.4%.
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Although MS-DRGs take effect Oct. 1, hospitals are not required to report present on admission (POA) indicators until Jan. 1, 2008.

However, hospitals should begin now with their POA preparations. Many hospitals have indicated that they will begin including POA information in their clinical documentation well in advance of Jan. 1. This will allow hospitals to improve their documentation and coding practices before they will impact reimbursement. The following are some tips to assist with your POA preparations:
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To further help organizations prepare for the upcoming changes to Medicare reimbursement, below are highlights from the question and answer portion of a Webinar that Ingenix hosted on Aug. 28 and 30, entitled “MS-DRG Readiness Webinar: Preparing to Code Effectively Under MS-DRGs."

Question: Does MCE percutaneous angioplasty have to be with intracranial or cardiac stents?
Answer: The non-covered procedure MCE edit change applies to intracranial vessels and stents. For FY 2008, CMS is "adopting as final our proposed revision of the coverage edit, recognizing procedure code 00.62 (Percutaneous angioplasty or atherectomy of intracranial vessel(s)) as a covered procedure when reported in conjunction with procedure code 00.65 (Intracranial stent)."
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With the Oct. 1, 2007 deadline right around the corner, hospitals need to load and test the new MS-DRG grouper as soon as possible. The new grouper can be purchased from a variety of sources, including the National Technical Information Service (NTIS).

Ingenix also has an MS-DRG grouper available for sale. It is engineered for easy implementation and is co-engineered for virtually any technical platform, including Web services, Windows, Unix, Mainframe, AS400, Linux, and others. For more information, call 866-222-1298 or email msdrg@ingenix.com
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The Oct. 1, 2007 implementation deadline for the new Inpatient Prospective Payment System (IPPS) is nearly upon us. Surprisingly, of the many hospitals that Ingenix has spoken with during its webinars and consulting engagements, many are still in the early stages of preparations. With Oct. 1 looming, hospitals should quickly assess the state of their preparations and implement any measures that can help them prevent unnecessary problems.

To help hospitals with their preparations, Ingenix is writing a series of “countdown” posts that will walk hospitals and their staffs through many of the preparations that need to take place before the deadline.
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A Sept. 10 Leapfrog Group survey of 1,256 hospitals concluded that 87 percent of U.S. hospitals do not have all the recommended policies in place to prevent many of the most common hospital-acquired infections.

The survey was conducted in response to CMS's new policy to not pay for specific hospital-acquired infections. The Leapfrog report stated:
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The new stance of CMS to not pay for hospital-acquired conditions has greatly increased media and public interest in the topic. As reported in previous blog posts, hospitals are increasing their efforts to reduce these incidents, and the public is demanding increased disclosure.

The New York City Health and Hospitals Corporation announced last week that it will now place this information on a new Web site, which can be found here. Although the effort to place this information online has been under development for quite some time, the timing of the announcement has additional relevance in light of CMS's new policies.
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A Sept. 5 Wall Street Journal article reported that hospitals are scrambling to implement new programs to prevent pressure ulcers, commonly known as bedsores, as a result of Medicare's new policy to not pay for specific conditions when they are acquired during a hospital stay.

(Previous posts on the topic of Hospital Acquired Conditions can be found here and here.)
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The National Technical Information Service (NTIS) announced Aug. 30 that the new MS-DRG grouper version 25.0 – based on the Final Rule – is now available.

The grouper consists of four programs. One of the programs consists of tables, which contain information for all valid diagnoses, procedures, and DRGs. The diagnosis and procedure tables were prepared from the CPHA ICD-9-CM codes and abbreviated description tape (December 1979 revision). The additional codes documented in the Federal Register detailed final grouper changes for versions 4.0 through 25.0. Plain-text (EBCDIC) versions of the tables are embedded in the programs and are supplied as well.
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By Michael Evans

Succeeding with MS-DRGs begins with complete and accurate clinical documentation. To learn more about the Final Rule’s ramifications on documentation and coding, I invite you to attend my Clinical Documentation under MS-DRGs webinar.
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Hospitals are on notice that they must step up their quality-improvement efforts in anticipation of Medicare’s “no pay” policy for specific hospital-acquired conditions, which was detailed in the Final Rule. In addition, reports indicate that many Medicaid and commercial insurance plans are expected to follow Medicare’s lead. For example, Pennsylvania’s Medicaid program plans to quickly adopt similar rules and may expand them to other preventable conditions, according to the article, “A financial ouch for hospitals,” published in the Aug. 31, 2007 issue of the Philadelphia Inquirer.

The article reported that the conditions within Medicare’s “no pay” policies appeared in bills for an estimated 35,156 hospitalizations last year, according to the analysis of records for general hospitals in the eight counties surrounding Philadelphia. Currently, however, the records do not note whether the condition existed before the patients entered the hospital or if they developed during the hospital stay.

Also, the article itemized the number of times (for the hospitals within the eight-county region) that these conditions appeared in Medicare bills during 2006:
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