U.S. hospitals have a long list of requests for CMS in helping to reduce administrative burdens that make it difficult for healthcare organizations to maintain profitability during a time of healthcare reform.
Earlier this summer, CMS issued a request for information from stakeholders as part of its Patients Over Paperwork project. Looking for input on how the agency can help reduce the administrative burden on busy providers, their RFI received more than 560 comments from hospitals who were eager to share their ideas and suggestions – along with their gripes and complaints. With provider burnout all the buzz and healthcare organizations looking for ways to reduce operational expenses, this RFI couldn’t have come at a better time.
According to the American Healthcare Association (AHA), providers spend nearly $39 billion per year just to ensure compliance with regulatory guidelines – much of which is related to medical billing, conditions of participation and verification of coverage. The AHA submitted a detailed letter to CMS with many recommendations taken from feedback provided by their members and stakeholders.
While the comments submitted to CMS and shared by AHA varied, there were a number of common issues identified – many of which were related to medical billing, denials and audits. Anyone in healthcare knows the complexities of billing provides a major source of frustration and a drain on operational resources. Some specific elements identified as opportunities for the reduction of burden include:
• Eliminating the need for prior authorizations, which some call “the most burdensome requirement in Medicare” and can also lead to serious adverse events association with delays in care.
• Minimizing or eliminating the use of temporary Healthcare Procedure Coding System (HCPCS) level II codes, which causes confusion and additional work.
• Aligning billing requirements with Current Procedural Terminology (CPT) codes to ensure the exact same national CPT code is billed for the same service regardless of payer.
• Proactively identifying codes for complex new technologies – eliminating the need to patchwork multiple codes from different systems.
• Rescinding the “JW modifier” for certain drug claims, which requires complex coordination and specialized IT solutions – and more importantly, can lead to medical errors.
• Permanently eliminate the 96-Hour physician certification rule for critical access hospitals, which can have a negative impact on rural health.
• Revise RAC contracts to incorporate a financial penalty for poor performance to reduce costly appeal and denial processes.
• Reduce erroneous denials by refining OIG Audit protocols.
Fortunately, CMS’ efforts thus to reduce administrative burden through the Patients Over Paperwork initiative have been relatively successful to date – saving $5.7 billion since its inception and an estimated 40 million hours. With these changes, hospitals could realize a significant reduction in administrative burden.
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