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Center for Medicaid & Medicare Services Shows Georgia Hospital Charges Vary

Center for Medicare & Medicaid ServicesA new study released by the Center for Medicaid and Medicare Services demonstrates that hospital charges for in-patient surgical and life threatening procedures vary greatly – including those in Georgia. The report looks at hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2011. These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges.

Discrepancies for in-patient services in Georgia include:

Joint replacement or reattaching a limb:

  • Saint Josephs: up to $28,000
  • Northside: on average $62,000
  • Grady: up to $85,000

Treatment of pneumonia or pleurisy:

  • Grady: up to $19,000
  • Atlanta Medical Center: up to $41,000
  • North Fulton Regional in Roswell: up to $55,000

Admissions and treatment for life threatening conditions such as heart failure and stroke:

  • DeKalb Medical Center: up to $15,000
  • Atlanta Medical Center: up to $40,000
  • North Fulton: up to $58,000

The Center for Medicaid and Medicare Services issued the report in response to President Obama’s efforts to make the country’s health care system more affordable and accountable. To review the Center’s findings in Excel, click here. 

 

 

Jeyaram & Associates Volunteers in Local Community

Georgia Mision of MercyPlease join Jeyaram & Associates at the Georgia Mission of Mercy from June 13-16 , to provide free dental care for low and no income adults. Georgia Mission of Mercy’s goals are to:

  • Provide free access to dental care for 2,000 low- and no-income adults while placing a high priority on patients suffering from dental infections or pain.
  • Educate patients and family members in attendance about the importance of obtaining and maintaining optimal oral health.
  • Raise awareness of the increasing difficulty low-income Georgia adults face in accessing critical dental care.
  • Challenge patients, policymakers, and dental professionals to work together to improve the oral health of those who have been promised care by the state.

Jeyaram & Associates’ attorneys will assist the dentists and dental assistants and register patients. You can learn more by watching a short documentary here.

Dental DashAlso, on March 30, 2013, Jeyaram & Associates sponsored the Dental Dash at Dawn, a 5K run/walk benefiting the DDD Foundation. The DDD Foundation supports a dental office that solely treats patients that have developmental disabilities. To learn more about the Dental Dash at Dawn, you can view a mini documentary here.

Healthcare Providers Unprepared for New ICD-10 Codes

ICD-10 CodesAccording to the latest edition of Georgia’s Department of Community Health’s newsletter, most healthcare providers are not ready for the conversion for the ICD-10 Code set.

ICD-10 survey* says most providers are ill-prepared!

  • 62% of Georgia physicians have not begun to prepare for the conversion to ICD-10 Code Sets.
  • 83% said that they have either been too busy with other priorities to embrace and implement ICD-10 or are unaware of where to start and what they need to do.
  • 11% know ICD-10 is coming but don’t think it will be difficult to handle.

*Physician Survey of ICD-10 Awareness and Readiness, Medical Association of Georgia and the Department of Community Health (2/2013)

DCH is offering a free Webinar on March 26, 2013, to help providers prepare. Visit http://dch.georgia.gov/icd-10 for more information

Georgia Senate Approves Hospital Medicaid Financing Program Act

On January 17th, the Georgia Senate passed Senate Bill 24, also known as the Hospital Medicaid Financing Program Act.  The bill passed with a 46-9 vote, and authorizes the Department of Community Health to establish a financial structure to protect Georgia’s healthcare system and obtain additional federal funding for the state’s Medicaid program.

The bill was sponsored by Sen. Charlie Bethel (R – Dalton) who is quoted as saying “A failure to pass SB 24 would mean devastating cuts in reimbursement rates for medical providers. Hospitals could face up to a 32% percent reduction in Medicaid reimbursements, which could also mean a loss of services and jobs. The impact of hospital closures and layoffs as a result of reduced reimbursements on rural communities and local job markets would be devastating.”

Notably, the state’s hospital industry has been supportive. It has been reported that the proposed Act will raise $689 million in state and federal funds to help provide health care to about 100,000 additional low-income and disabled Georgians expected to join the Medicaid rolls as a result of federal health-care reform.

During his State of the State address, Governor Deal warned lawmakers that without the additional revenue, the state would be forced to slash Medicaid reimbursements to hospitals by 20 percent.

Introduced into the Senate on behalf of the governor, the legislation would turn over responsibility for assessing the 1.45-percent tax on adjusted gross patient revenues to the Georgia Department of Community Health (DCH).

The Georgia House of Representatives is expected to take up the bill when lawmakers return to the Capitol Jan. 28 following a week-long recess.

UPDATE 2/2/13: Georgia House of Representatives passed Bill 24, and Governor Deal is expected to sign the bill ensuring $450 million in federal money for the Medicaid insurance program.

Read more: http://www.sfgate.com/news/article/Ga-House-adopts-Medicaid-financing-fix-4242885.php#ixzz2JkwBESwB

Fiscal Cliff Compromise Impacts Healthcare Providers’ Bottom Line

Fiscal Cliff Impacts Healthcare ProvidersLast week, the President and Congress reached a last-minute compromise regarding the much-discussed “fiscal cliff.” The compromise was signed into law by the President and has several provisions that affect the healthcare industry.

1. A reduction in Medicare payment rates to physicians was postponed for an additional year; however, the avoidance of a rate cut is offset by cuts to other providers such as dialysis centers and hospitals.

2. Adjustments will be made resulting in a reduction in Medicare payments to hospitals over the next 10 years.

3. For therapy providers, payments for multiple therapy services provided on the same day will be reduced by 50% instead of 25% beginning in April.

Check back in with the Jeyaram & Associates blog to learn more about the effects of the new law.

Healthcare Providers Could See an Increase in Centers for Medicare and Medicaid Services Audits

On June 2012, the Department of Justice (DOJ) issued a report from its study of Home and Community Based Services (HCBS) waiver programs.  Seven of 25 states reviewed were found to have systems that were lacking in their ability to provide quality care to waiver program recipients.  In addition, the study found that the Centers for Medicare and Medicaid Services (CMS) did not use all means available to monitor the states’ programs.  As a result, the DOJ recommended that CMS implement additional requirements to ensure quality care.

Going forward, states may see more involvement and oversight on the part of CMS in enforcing compliance with the requirements of the HCBS waiver programs.  The increased attention paid by CMS could mean more site visits, audits, and compliance initiatives aimed at providers.  As with any audit or proposed adverse action, it is always to the provider’s benefit to consult with an experienced healthcare attorney immediately upon receipt of notice of an upcoming audit, audit results or overpayment demand letters.  The attorneys at Jeyaram & Associates have in-depth audit experience and are available for consultation.