IPPS: Planning for the Second Half of 2024

IPPS: Planning for the Second Half of 2024

As we begin the second half of the year, it is a convenient time to make plans and take stock of our coding operations. There will be much to do when the Inpatient Prospective Payment System (IPPS) Final Rule is released.

For example:

  1. Review your facility-specific coding guidelines with coding staff and other key departments. You should determine if there are any questions about the guidelines. Are you capturing more (e.g., transfusions, drug infusions, etc.) or less (e.g., social determinants of health, or SDoH) data than is needed? Remember that the goal of facility-specific coding guidelines is to promote data consistency and capture data needed by other departments. Everyone who is coding should follow these guidelines.
  2. Review the New Technology Add-On Payment (NTAP) list for new procedures, devices, or drug administration that may have started since your last review. You may also want to investigate if your billing software has the ability to charge the ICD-10-PCS codes for devices and drug administrations on inpatients, so that the coders do not have to look for and code those items. The NTAPs are frequently missed, and each time, a hospital leaves money on the table. The NTAPs for IPPS 2024 are listed in Medicare Administrative Contractor (MAC) Implementation File 8. The URL is listed in the resources below.
  3. Calculate your case mix index (CMI) from Oct. 1, 2023. The IPPS Proposed Rule for the 2025 fiscal year listed the median CMI by region, which appears below. How is your facility performing?
RegionMedian CMI
New England (CT, ME, MA, NH, RI, VT)1.49655
Mid-Atlantic (PA, NY, NJ)1.5563
East North Central (IL, IN, MI, OH, WI)1.6427
West North Central (IA, KS, MN, MO, NE, ND, SD)1.7216
South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV)1.6306
East South Central (AL, KY, MS, TN)1.59315
West South Central (AR, LA, OK, TX)1.7814
Mountain (AZ, CO, ID, MT, NV, NM, UT, WY)1.7804
Pacific (AK, CA, HI, OR, WA)1.7821
  • Audit MS-DRGs 981-983 and 987-989. These MS-DRGs focus on a mismatch between the principal diagnosis and principal procedure. Determine if these cases were coded accurately. Determine the frequency with which these MS-DRGs are assigned. Provide any education identified by the review.
  • Sample MS-DRGs that are without complication/comorbid condition (CC) or major complication/comorbid condition (MCC). Again, determine if the cases were coded accurately, and if education is needed.
  • Determine if the facility will be offering new services. July is normally the month for new residents and services. If so, plan coder education on the new service topics so that the coding process will speed up.

Take the time to do this review at the beginning of July. It will clean up any problems, as well as capture additional reimbursement, when appropriate.

Programming note:

Listen to Laurie Johnson report this story live during today’s Talk Ten Tuesday, 10 Eastern, with Chuck Buck and Dr. Erica Remer.

Resources:

IPPS FY25 Proposed Rule, pg.621, https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2025-ipps-proposed-rule-home-page

IPPS FY24 Final Rule, MAC Implementation File 8: https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Laurie M. Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10-CM/PCS Trainer

Laurie Johnson is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an AHIMA-approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and is a permanent panelist on Talk Ten Tuesdays

Related Stories

Remain Compliant – and Take the Money

Remain Compliant – and Take the Money

Our first topic today is local coverage determinations (LCDs) and variation. I have written in the past about national and local coverage determinations, and I

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Pediatric SDoH: An Essential Guide to Accurate Coding and Reporting

Pediatric SDoH: An Essential Guide to Accurate Coding and Reporting

This webcast, presented by Tiffany Ferguson, LMSW, CMAC, ACM, addresses the critical gap in Social Determinants of Health (SDoH) reporting for pediatric populations. While SDoH efforts often focus on adults, this session emphasizes the unique needs of children. Attendees will gain insights into the current state of SDoH, new pediatric Z-codes, and the importance of interdisciplinary collaboration. By understanding and applying pediatric-specific SDoH factors, healthcare professionals can improve data capture, compliance, and care outcomes. This webcast is essential for those looking to enhance their approach to pediatric SDoH reporting and coding.

August 8, 2024
Oncology and E/M Services: Compliance, Medical Necessity, and Reimbursement

Oncology and E/M Services: Compliance, Medical Necessity, and Reimbursement

Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, VP of CDM, for a webcast addressing oncology service coding challenges. Learn to navigate coding for infusions and injections alongside Evaluation and Management (E/M) services, ensuring compliance and accurate reimbursement. Gain insights into documenting E/M services for oncology patients and determining medical necessity. This webcast is essential to optimize coding practices, maintain compliance, and maximize revenue in oncology care.

July 30, 2024
The Inpatient Admission Order: Master the Who, When, and How

The Inpatient Admission Order: Master the Who, When, and How

During this webcast Dr. Ronald Hirsch delves into the inpatient admission order process including when to get it, when it becomes effective, its impact on billing and payment, who can write it, how to cancel it, the effects on the beneficiary, and more. You’ll leave with a clear understanding of inpatient orders and guidelines for handling improper orders that you can implement immediately.

June 20, 2024
Navigating AI in Healthcare Revenue Cycle: Maximizing Efficiency, Minimizing Risks

Navigating AI in Healthcare Revenue Cycle: Maximizing Efficiency, Minimizing Risks

Michelle Wieczorek explores challenges, strategies, and best practices to AI implementation and ongoing monitoring in the middle revenue cycle through real-world use cases. She addresses critical issues such as the validation of AI algorithms, the importance of human validation in machine learning, and the delineation of responsibilities between buyers and vendors.

May 21, 2024
Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Optimize your inpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. Participants will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.

June 26, 2024
Advanced Inpatient Clinical Documentation Integrity: Harnessing Technology, Analytics, and Compliance

Advanced Inpatient Clinical Documentation Integrity: Harnessing Technology, Analytics, and Compliance

Join expert Angela Comfort, MBA, RHIA, CDIP, CCS, CCS-P., as she helps you navigate advanced inpatient CDI technologies, regulatory changes, and system interoperability. Angela will provide actionable strategies for integrating AI and predictive analytics into CDI practices, ensuring seamless system interoperability, and maintaining compliance with evolving regulations. Attendees will learn to select and implement advanced EHR systems and CDI software, leverage data analytics to enhance documentation accuracy, and stay audit-ready with the latest compliance updates. Real-world case studies and practical tools will empower you to drive continuous improvement in CDI, improve patient outcomes, and enhance organizational efficiency. Don’t miss this opportunity to advance your CDI practices and stay ahead in this dynamic field.

July 11, 2024
Foundations of Inpatient Clinical Documentation Integrity: Enhancing Accuracy and Compliance

Foundations of Inpatient Clinical Documentation Integrity: Enhancing Accuracy and Compliance

Join expert Angela Comfort, MBA, RHIA, CDIP, CCS, CCS-P, for an insightful webcast on improving inpatient clinical documentation integrity (CDI). Inaccurate documentation can lead to misdiagnosis, improper treatment, and compromised patient safety. High workloads, lack of standardized practices, and outdated EHR systems contribute to these issues, affecting care quality and financial outcomes. Angela will offer practical strategies and tools to enhance accuracy, consistency, and timeliness in documentation. Attendees will learn to use standardized templates, checklists, and advanced EHR systems, while staying compliant with regulations. Improve patient care, ensure accurate billing, and reduce audit risks with actionable insights from this essential webcast.

June 26, 2024
Mastering E/M Coding: Navigating the Evolving Landscape

Mastering E/M Coding: Navigating the Evolving Landscape

Join industry expert, Kathy Pride, RHIT, CPC, CPMA, CCS-P, for an in-depth exploration of Evaluation and Management (E/M) coding, tailored for healthcare professionals navigating recent guideline changes. Dive into advanced topics beyond mere code selection, including shared visits, criteria for selecting E/M levels, and documentation best practices. Gain clarity on complex guideline terminology and ensure compliance with regulatory standards. This comprehensive session is essential for coders, auditors, educators, and practitioners seeking to enhance their proficiency in E/M coding and maximize revenue capture.

June 19, 2024

Trending News

Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!