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Welcome to Craneware's blog.

This blog is the place to go for discussions related to the many facets of healthcare revenue integrity. Here, Craneware experts share their thoughts and report on industry trends… and encourage you join the conversation with your own unique experiences and opinions. Craneware client or not, there's something for everyone to learn and discuss.

The ICD-10 bill has no delay; is this bill a Revenue Safe Harbor or an Error Bay?

by Craneware19. May 2015 14:44

“Hurry up and wait,” is the theme of U.S. healthcare’s advance from ICD-9 to ICD-10 transactions. A new bill introduced before the U.S. House on May 12, 2015, which actually calls for an ICD-10 transition period, has some in the industry wondering if this indicates another delay will occur in the ICD-10 implementation deadline. However what the bill, H.R. 2247, actually proposes is a longer transition period during which errors will not be considered fraudulent.

A key aspect of this new bill is that it would provide a “safe harbor” period for healthcare providers. After all, a significant increase in specialized knowledge encompassing clinical information codes is required for success in ICD-10 coding. Yet, a transition period also creates a broader window during which there would be a higher potential for fraudulent claims.

After so many delays, it isn’t surprising there is confusion.

For more about the new bill, read the article, “New House Bill Calls for ICD-10 Transition Period, But Not a Delay” by Chris Dimick in Journal of AHIMA, May 13, 2015, found online here:

The debate is covered in the Healthcare IT News article “Should HHS delay ICD-10 penalty for two years?” which can be read online here:

For more about this issue and how your organization can be prepared to prevent revenue distuption, check out Finally Friday! “ICD-10 Possibilities: Delay, Transition, or Enforcement Moratorium?” This May 15, 2015 episode and its slides are online at appealacademy. com.

Be sure to share your thoughts with this forum.


“It don’t mean a thing if you ain’t got that swing” bed, HHS claims

by Craneware10. March 2015 15:24

Industry is abuzz about the many critical access hospitals (CAH) that may have to close operations if the OIG HHS recommendation made to CMS forces the CAHs (many of which are in under-served and rural U.S. communities) into a different payor reimbursement plan for their swing beds than was previously agreed.

What’s all this buzz about?

In the headlining report of the OIG HHS March 9, 2015 e-mail sent to its followers, HHS made the following three points.

  • OIG HHS said, “We recommend that CMS seek legislation to adjust CAH swing-bed reimbursement rates to the lower SNF PPS rates paid for similar services at alternative facilities."
  • OIG HHS acknowledged concerns with the conclusions it has drawn, which include assumptions about the availability of skilled nursing services at nearby alternate facilities and its calculation of potential savings.
  • OIG HHS said their conclusions are based on data they possess from calendar years 2005 through 2010, which indicates, “swing-bed usage at critical access hospitals significantly increased,” during those years.

Share your thoughts on these latest developments with us.


About that HAC, and that hacking cough…if you snooze, you lose in 2015

by Craneware20. February 2015 15:32

Did you know 1% of your total Medicare DRG payments are at stake in 2015?

Not to take away from actual hospital acquired conditions (HACs), like the recent endoscopy superbug infections that manufacturers’ sterilization protocols won’t prevent, which are making headlines. Yet, it appears that one fourth of US hospitals are now coughing up their inpatient reimbursement, plus suffering penalties, often unknowingly and needlessly. Why? For HACs that often may not be Hospital Acquired Conditions at all, but rather a coding and documentation problem.

In 2015, CMS’ HAC Reduction Program begins. This is a pay-for-performance initiative, which penalizes DRG reimbursement for those in the lowest quartile of the HACs with the most incidences.

HACs carry nasty implications of sub-standard care, and certainly everyone wants those incidences reduced. The thing is that often the problem is not actually the quality of care, but instead that the documentation and coding that unknowingly make it look as if HACs are being treated.

Here is how this is happening. When medical issues are present upon the patient’s admission, but are not documented as such; then subsequent treatments are often coded as if the first-time that the medical conditions presented was during the hospital stay.

To avoid lost reimbursement, penalties, and perceptions of poor quality, the people responsible for coding and documentation must correctly represent the conditions present at the time of admission, and specify the conditions that treatments are addressing.

Today’s 2015 performance, will determine the penalties assessed in 2017.

Read more in the AIS Report on Medicare Compliance. Volume 24, Number 3. January 26, 2015.

We all work so hard to ensure quality care, but when something like the recent unforeseeable endoscopy problem in Calif. happens, it will hurt you financially.

If your margins are low, simply because you’re not effectively capturing charges and pricing appropriately, this affects your ability to weather the inevitable ups and downs any health system will experience. Revenue integrity processes help you understand the real state of your revenue cycle.

We appreciate you participating by sharing your thoughts with this community.




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