CMS Readmissions

One of the biggest topics with CMS right now is related to fines and take-backs for readmissions. For 2014, CMS includes four diagnoses to target for optimization of care; heart attack, heart failure, pneumonia, and COPD. The fines are CMS’s way of optimizing and promoting quality of care with the first admission. For 2014, the maximum fines go up to 2% of reimbursement (it was 1% in 2013).  Simply put, readmission within 30 days for one of these four DRGs will increase your vulnerability for a fine or take-back.  AccuReg is working with real-time, HL7 driven hospitals to immediately alert care managers through email or text messaging that a possible readmission is imminent.   If you’d like to learn more about how we are doing this, fill out the Request Info Form and put the word readmissions in the comments box.

-Penny Nydegger,
AccuReg Patient Access Solutions,
Director of Implementation (and 20+ year veteran of patient access)