New CMS Regulations
Reasonably Preventable Hospital-Acquired Conditions
Beginning October 1, 2008, the Centers for Medicare & Medicaid (CMS) will change how it reimburses hospitals for complications sustained during hospital treatment by Medicare beneficiaries. CMS has published a list of conditions - or events - considered to be "reasonably preventable" during a hospital stay and for which Medicare may refuse payment.
DRGs which include complication codes must have supporting documentation that the complication was present when the patient was admitted (POA). If it is determined that the complication was as a result of hospital error/mistake, the cost of care related to that complication will not be reimbursed.
Aside from reimbursement concerns, Joint Commission Resources believes these conditions represent opportunities to improve the quality and safety of patient care. To this end, JCR has organized articles containting tools, resources and tips to help support your organization in preparing for these revisions to be in effect.