IPPS: Planning for the Second Half of 2024

As we begin the second half of the year, it is a convenient time to make plans and take stock of our coding operations. There will be much to do when the Inpatient Prospective Payment System (IPPS) Final Rule is released.

For example:

1. Review your facility-specific coding guidelines with coding staff and other key departments. You should determine if there are any questions about the guidelines. Are you capturing more (e.g., transfusions, drug infusions, etc.) or less (e.g., social determinants of health, or SDoH) data than is needed? Remember that the goal of facility-specific coding guidelines is to promote data consistency and capture data needed by other departments. Everyone who is coding should follow these guidelines.
2. Review the New Technology Add-On Payment (NTAP) list for new procedures, devices, or drug administration that may have started since your last review. You may also want to investigate if your billing software has the ability to charge the ICD-10-PCS codes for devices and drug administrations on inpatients, so that the coders do not have to look for and code those items. The NTAPs are frequently missed, and each time, a hospital leaves money on the table. The NTAPs for IPPS 2024 are listed in Medicare Administrative Contractor (MAC) Implementation File 8. The URL is listed in the resources below.
3. Calculate your case mix index (CMI) from Oct. 1, 2023. The IPPS Proposed Rule for the 2025 fiscal year listed the median CMI by region, which appears below. How is your facility performing?

• Audit MS-DRGs 981-983 and 987-989. These MS-DRGs focus on a mismatch between the principal diagnosis and principal procedure. Determine if these cases were coded accurately. Determine the frequency with which these MS-DRGs are assigned. Provide any education identified by the review.
• Sample MS-DRGs that are without complication/comorbid condition (CC) or major complication/comorbid condition (MCC). Again, determine if the cases were coded accurately, and if education is needed.
• Determine if the facility will be offering new services. July is normally the month for new residents and services. If so, plan coder education on the new service topics so that the coding process will speed up.

Take the time to do this review at the beginning of July. It will clean up any problems, as well as capture additional reimbursement, when appropriate.

Programming note:

Listen to Laurie Johnson report this story live during today’s Talk Ten Tuesday, 10 Eastern, with Chuck Buck and Dr. Erica Remer.

Resources:

IPPS FY25 Proposed Rule, pg.621, https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2025-ipps-proposed-rule-home-page

IPPS FY24 Final Rule, MAC Implementation File 8: https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page