February 2012
Dear Colleagues,
The month of January has kept up the pace of 2011; see below for critical information on the prepayment audits, CMS grants and what you can do to assist.
PREPAYMENT AUDITS - INFORMATION SOURCE NOW UP ON www.accfl.org
As you may recall, our Medicare Carrier FirstCoast Service Options (FCSO) was scheduled to start prepayment audits on 15 DRGs, 11 of which involve cardiology procedures, on January 1, 2012. This was delayed for 30 days and is scheduled to start February 1st now 30% (not the 100% that was originally announced) of inpatient cardiology DRGs. We have had multiple conversations with Jim Corcoran, medical director of FCSO, and several important points have been made.
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Distinction between inpatient and outpatient hospitalization is crucial. Outpatient will not trigger a prepayment audit. If a scheduled elective cardiac procedure is maintained as an outpatient stay, it will not be audited.
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Audits will result from claim data and not date of service. If the hospital is submitting claims late that are from the end of 2011, those claims can be audited.
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With the cardiology DRGs, there are two distinct issues: a) medical necessity, and b) inpatient vs. outpatient.
We had a conference call (DRG Summit) with key Florida physicians and experts in the areas affected by the 11 DRGs. Your Third Party Reimbursement Committee and its chair Jerold Saef, MD, FACC have worked hard to provide documents we think will assist. Click here to go to our TAKE ACTION portion of the website and learn a great deal more; as we continue to find out more we will send updates and post information here.
SMARTCARE - CMS GRANT SUBMITTED
The FCACC, in partnership with the Wisconsin Chapter of the ACC and the ACC Foundation, has submitted a grant for consideration by CMS' Innovation Center; this is a major milestone as we are proving to CMS that we are not just talking about quality but willing to prove our performance. The grant specifically addresses documented clinical quality, resource use and cost variation in the treatment of stable ischemic heart disease (SIHD). The variation in care has been documented by sources such as the Dartmouth Atlas and clinical registries. Six private practices from Jacksonville, Orlando, St. Petersburg, Ft. Lauderdale and Gainesville have signed up to be a part of this project if awarded and it would include a patient population of about 50,000.
MEETING - CONFERENCE - OPPORTUNITY FOR YOU
As I meet and talk to members from all over Florida I consistently hear 'let me know if I can help.' You can. You can mark August 24-26 on your calendar now and join me in Orlando for the FCACC Annual Meeting. We are all so overwhelmed by patient loads, maintaining our various certifications and on call hours (and our family time when we get to that). Often it feels as if we are the only ones out there pushing every day. At this conference I relish the time I get to connect with each of you; we talk, commiserate, come up with ideas and solutions and things we need to get done at Heart House to make our profession and daily life better. This isn't a national conference - but it has national speakers like Bob Vogel - and you walk into the room and see familiar faces. Put August 24-26 on your calendar today (and tell the family they are invited to ALL the dinners) and register at http://www.accfl.org/meetings/meetings.html
Sincerely,
Juan Aranda, Jr., MD, FACC
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