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January 2013


A Polsinelli Shughart Update:

What Hospitals Should Know About Payment Changes for 2013


In response to the government's continued focus on improving quality of care through payment policy, several changes to new and existing regulatory requirements recently came about through the 2013 Inpatient Prospective Payment System (IPPS), Outpatient Prospective Payment System (OPPS), and the Medicare Physician Fee Schedule (MPFS) Final Rules ("Final Rules"). As a result, hospitals will be faced with new challenges in 2013 and beyond.

What Hospitals Should Do

In 2013, hospitals should pay particular attention to these requirements in the Final Rules:

  • Closely monitor the IQR and OQR reporting requirements;
  • Understand the development of the Value Based Purchasing program and the new measures that will apply in future years;
  • Immediately focus on strategies to reduce readmission rates to avoid future penalties;
  • Know the process for appealing CMS decisions related to quality-based payment programs;
  • Immediately implement mechanisms to respond to changes in the 3-day payment window and its impact on hospital-owned physician practices; and,
  • Be aware of other payment policies that could change in the future.

Click here for a discussion of important updates to payment programs and policies contained in the Final Rules, as every hospital should know about these changes to position themselves for success in the upcoming year.



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