CMS Miscalculates Readmissions Rates, More Than 1K Hospitals to Face Higher Penalties

CMS has issued a notice admitting to technical errors that caused the agency to miscalculate penalties under the federal readmissions reduction program.

Under the readmissions reduction program, aggregate payments for excess readmissions and aggregate payments for all discharges are calculated using data from Medicare claims occurring from July 1, 2008, to June 30, 2011. In calculating readmissions penalties, CMS incorrectly included claims occurring prior to July 1, 2008.

The technical error means 1,422 hospitals will lose more money than previously expected and 55 hospitals will lose less money, according to a Kaiser Health News analysis.

The readmissions reduction program, which is required under healthcare reform and effective this month, reduces payments to hospitals participating in the Inpatient Prospective Payment System with high levels of preventable readmissions. In the FY 2012 IPPS final rule, CMS finalized the readmission measures for acute myocardial infarction, heart failure and pneumonia and the calculation of the excess readmission ratio, which is used, in part, to calculate the readmission payment adjustment under the Hospital Readmissions Reduction Program.

More Articles on Readmissions:

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Value-Based Purchasing, Readmissions Reduction Programs Effective Today

CMS to Replay Failed Call on Readmissions Measure

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