Group Appeal on .7% Reduction for Documentation & Coding Adjustment / by Joe Furia

Jim Haynes, Senior Vice President and Chief Operating Officer

AzHHA is working with Hall, Render, Killian Heath & Lyman on a group appeal challenging CMS’s decision not to restore in Federal Fiscal Year (FFY) 2018 what should have been a one-time 0.7% decrease in the acute care inpatient prospective payments system (IPPS) standardized amount it made in FFY 2017 related to the MS-DRG documentation and coding adjustment. This decision reduces national IPPS payments by an estimated $650 million in FFY 2018. This reduction will carry over to FFY 2019 and be compounded in subsequent years if not corrected. If successful, this appeal could result in an increase in IPPS payments of up to 0.7% for each participating hospital, with an average impact of over $200,000 per affected provider number. The reduction affects all IPPS payments except some sole community hospitals paid under their hospital specific rate in a given year. If your hospital has been negatively impacted by CMS’ decision and would like to join the group appeal please contact Jim Haynes.