Issue link: https://beckershealthcare.uberflip.com/i/1119391
50 HEALTHCARE NEWS CMS cuts payments to 800 hospitals for patient safety incidents By Ayla Ellison C MS will trim 800 hospitals' Medicare payments in fiscal year 2019 for having the highest rates of patient injuries and infections. Four things to know: 1. Created under the ACA, the Hospital Acquired Condi- tions Reduction Program aims to prevent harm to patients by providing a financial incentive for hospitals to prevent hospital-acquired conditions. Under the program, a hos- pital's total score is based on performance on six quality measures. Each year, Medicare cuts payments by 1 percent for hospitals that fall in the worst-performing quartile. 2. Eight-hundred hospitals will have their Medicare pay- ments reduced for patients discharged between last Octo- ber and this September, according to Kaiser Health News. The penalties will be applied as hospitals submit claims to Medicare for reimbursement. 3. The hospital industry has argued the methodology used for the HAC Reduction Program doesn't recognize improvement, because roughly 700 to 800 hospitals will lose money every year even if they improved their safe- ty records. According to Kaiser Health News, 110 hospi- tals are being penalized in fiscal year 2019 for the fifth straight time. 4. The hospital industry also argues the HAC Reduction Program's design causes hospitals that do the best job of testing for infections to appear among the worst based on statistics, while those with less thorough testing might ap- pear better than they should, according to Kaiser Health News. n HCA accused of billing fraud: 3 things to know By Ayla Ellison A former nurse at Regional Medical Center in San Jose, Calif., filed a federal lawsuit alleging the hospi- tal and its owner, Nashville, Tenn.-based HCA Healthcare, submitted false claims to Medicare. ree things to know: 1. e lawsuit, which was filed in 2017 and was unsealed, alleges Regional Medical Cen- ter and HCA billed for certain services on an inpatient basis when the patients were still waiting in the ED. "e Regional Medical Center is frequently out of beds in its units and the emergency department is frequently well over capacity," the complaint states. "When this happens, patients that have been admitted to the hos- pital from the emergency department are le waiting in the emergency department. ese patients that are admitted into fabricated rooms but that are still physically waiting in the emergency department for a bed in their admitted unit are known as 'holds.'" 2. e whistle-blower alleges that claims submitted to Medicare on an inpatient basis while the patient is still in the ED are fraud- ulent. "When emergency department nursing staff chart patients as if the patient is located in the ICU, medsurge or telemetry units, [Medi- care audit contractors] and other government claims processers have no way of knowing that the patient was physically located in the emergency department. us, any claims for 'holds' that seek reimbursement at greater than emergency department rates are fraud- ulent," the complaint states. 3. According to the complaint, hospital ad- ministrators also directed staff to upcode claims to inflate reimbursement. "Placing the ER patients in fraudulent rooms allows defendants to upcode as many revenue codes and revenue code units on the UB04 forms and make the final bill as high as pos- sible," the complaint states. "Defendants then benefit by receiving additional outlier reim- bursements that they would otherwise not qualify for under CMS' standards." n