Maine hospital attributes Medicare penalty to employee coding errors

CMS will penalize 751 hospitals in fiscal year 2018 for having the highest rates of hospital-acquired conditions. One of those hospitals, Southern Maine Health Care in Biddeford, says it is being penalized due to coding errors, according to the Journal Tribune.

Created under the ACA, the HAC Reduction Program aims to prevent harm to patients by providing a financial incentive for hospitals to prevent hospital-acquired conditions. Under the program, a hospital's total score is based on performance on six quality measures: central-line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections, methicillin-resistant Staphylococcus aureus infections, Clostridium difficile infections, and the Patient Safety Indicators 90 Composite, which includes 10 types of in-hospital injuries. Each year, Medicare cuts payments by 1 percent for hospitals that fall in the worst-performing quartile.

Nathan Wilson, MD, vice president of quality and safety at Southern Maine Health Care, said hospital officials were surprised SMHC was in the group of hospitals being penalized. He told the Journal Tribune employee coding errors are to blame, as a code for a medical condition was improperly added to several files for patients who did not have the condition.

The hospital is taking steps to ensure the same mistakes are not made in the future. To improve coding accuracy, Dr. Wilson said SMHC is implementing software that has safeguards against coding errors, according to the report.

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