Congress Urges CMS to Review Medicare Coding Change
July 21, 2010
Members of Congress are asking the Centers for Medicare and Medicaid Services (CMS) to review a proposal that would reduce Medicare payments to hospitals by changing the coding or classification system of patients which CMS believes results in illnesses appearing more severe than they are.
If adopted, the proposed change could reduce payments to hospitals by 2.9% - or $3.7 billion - in fiscal 2011.
Fifty-two senators signed on to the letter, sent to CMS administrator Don Berwick. An earlier letter from House members had 242 signatures.
In addition, the Medicare Inpatient Prospective Payment Rule (MIPPR) contains a smaller-than-usual update of 2.4%, however, this would be eliminated with the proposed coding offset, the letter said. Many hospitals are reporting, though, that a 2.4% adjustment will not bring them closer this year to the actual rate of cost increases that they have faced.
And, as more patients are being successfully cared for in outpatients departments, those patients who end up being admitted to hospitals are more likely to be seriously ill, the letter added. Therefore, if the proposed rule is enacted, it could cost hospitals across the country an estimated $3.7 billion in fiscal 2011.
Citing data from the Medicare Payment Advisory Commission that hospitals are paid substantially less than their cost of providing care to Medicare patients, the senators wrote that hospitals should receive an update in payments to cover inflation.