Oops again: CMS finds more errors in its readmissions penalties

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If at first you don’t succeed, try, try again. That appears to be the mantra for the Centers for Medicare & Medicaid Services (CMS), which once again revised penalties for preventable hospital readmissions for MI, heart failure and pneumonia.

Previously, CMS corrected a published document for its Hospital Readmission Program. Beginning in October 2012, the program penalized hospitals that had higher-than-expected 30-day readmissions for MI, heart failure and pneumonia by withholding 1 percent of Medicare payment in fiscal year (FY) 2013. The penalty will increase to 2 percent and 3 percent in successive FYs. CMS reported that the correction addressed erroneous figures and data.

Apparently not. CMS admitted on March 7 that technical errors remained, and issued another correction. The agency reported that if flubbed in determining the amount that payments would be reduced and the number of hospitals whose payments would be reduced.

“[W]e inadvertently failed to properly include all of Medicare inpatient claims from the FY2008 MedPAR file and the FY 2009 MedPAR file in determining the base operating DRG [diagnosis-related group] payment amounts in the calculation of aggregate payments for excess readmissions and aggregate payments for all discharges that were used to calculate the readmissions adjustment factors,” CMS wrote. “Under the policy we adopted in that final rule, for FY 2013, aggregate payments for excess readmissions and aggregate payments for all discharges are calculated using data from MedPAR claims with discharge dates that are on or after July 1, 2008, and no later than June 30, 2011.”

CMS waived the notice and comment and effective date requirements that would have added a 30-day delay in implementation.