“Finally Friday!” Short-Stay DRGs & Pay-to-Appeal

FRIDAY May 1, 2015:

Short-Stay DRGs & Pay-to-Appeal:

What to expect and when

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day egusquiza

Day Egusquiza joins us, full of passion, as always!

Day Egusquiza, a passionate and in-demand speaker and educator, told me last week that she thought the plans for a Short-Stay DRG were not getting enough attention. I agreed, so invited her to come chat with us on this week’s show. The plan, suggested by the American Hospital Association (AHA) and supported by MedPAC, is intended to replace the infamous 2-Midnight Rule, created by the FY2014 IPPS Final Rule, CMS-1599F, in October, 2013. If you haven’t heard much about it, you’re not alone!

Day will discuss the plan and what CMS intends to do with it and the implications, including:

  • the AHA letter that outlined the plan,
  • the possible new set of DRGs,
  • what the plan is missing,
  • how it misses the mark on exceptions and the 3-Day Rule (for SNF coverage),
  • and how this could all happen SOON.

As Day is fond of saying, “our lives are never boring!”

Day is also the Chair of one of the few conferences that we endorse, the National Physician Advisor & UR Team Boot Camp, coming up in July, here in my home town, San Antonio. Many of our faculty and speakers will be attending and speaking, and we’ll tell you all about the conference, in time for you to register for the Early Bird pricing.

Senator Stabenow (D-MI) dismayed at the use of contingency fees, actually seems to GET IT. Check out our article for short video clips.

Senator Stabenow (D-MI) dismayed at the use of contingency fees, actually seems to GET IT. Check out our article for short video clips.

Earlier this week, Dr. Ron Hirsch of Accretive, reminded me of a Senate Hearing, held Tuesday, April 28, entitled “Hearing on Creating a More Efficient and Level Playing Field: Audit and appeals Issues in Medicare” – it was one of those slap-your-forehead moments. My fascination with processes makes me watch those kind of things, and the recording was already posted, so watch it I did. That’s when I discovered a couple of things that we need to be watching for, not the least of which is the possibility that providers may have to pay a filing fee to submit an appeal to OMHA in the future. Read my new article, and then tune in for all the details on our show, including some commentary by Dr. Hirsch.

Listen to the discussion below!

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