Hospital readmission penalties off to a rocky start

The new penalty phase for the Hospital Readmission Reduction Program, launched Monday by the Centers for Medicare & Medicaid Services (CMS), is already being revised due to miscalculations and multiple technical errors.

According to a CMS correction document effective October 1, several calculation errors were included in the final published rule delineating the penalties, including “a technical error in the dollar amount by which the Hospital Readmission Reduction Program will reduce payments to hospitals.”

A major correction applies to Table 15, “FY 2013 Final Readmissions Adjustment Factors,” where CMS “inadvertently included Medicare inpatient claims from the FY 2008 MedPAR file with discharge dates occurring prior to July 1, 2008 in determining the base operating DRG payment amounts in the calculation of aggregate payments for excess readmissions and aggregate payments for all discharges that were used to calculate the readmissions adjustment factors” rather than basing calculations on discharge dates from July 1, 2008 and June 30, 2011.  The mistake will change the claims data pool by which the reimbursement amounts are calculated.

In addition, the document states that CMS is “correcting the website for obtaining the MedPAR files referenced in our discussion of aggregate payments for excess readmissions and aggregate payments for all discharges under the Hospital Readmission Reduction Program.” The correct website, according to the document, is here.

Other errors were noted in the hospital reclassification and redesignation tables.

The corrections apply to the final rule known as "Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific Providers and for Ambulatory Surgical Centers," published in the August 31 Federal Register.

Topics: Accountable Care Organizations (ACOs) , Executive Leadership , Medicare/Medicaid , Regulatory Compliance