2015 IPPS Proposed Rules Detailed

Michelle A. Leppert, CPC , May 1, 2014

The proposed rule does not contain any changes to the two-midnight  rule. However, CMS is asking for input on an alternative payment methodology for short stay inpatient cases that also may be treated on an outpatient basis, including how to define short stay.

"The continued expansion of CMS quality initiatives (value-based purchasing, readmission reduction, and HACs), puts even greater emphasis on the need for comprehensive documentation adequacy and coding accuracy," says Susan Wallace, MEd, RHIA, CCS, CDIP, CCDS, director of compliance/inpatient consultant for Administrative Consultant Service, LLC, in Shawnee, Oklahoma.

"Coders and CDI specialists need a solid understanding of the patient safety indicators, PSI-90 in particular, including knowledge of the impact of coded data and present on admission accuracy to PSI applicability. We should also all understand by now that this isn't about MS-DRG accuracy, it goes well beyond that to ensure appropriate credit in the CMS risk adjustment models, as they are integral to these new quality initiatives."

Because there were no proposed new, revised, or deleted diagnosis or procedure codes for FY 2015, CMS did not need to include tables 6A-6F in the proposed rule, says Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding for HCPro, Inc. a division of BLR, in Danvers, Massachusetts.

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