News | Business | November 09, 2017

SCAI Successful in Securing Inpatient Status for AMI-PCI Patients

Designating all AMI-PCI patients as inpatients will eliminate the practice of shorter hospitals stays to avoid CMS audits

SCAI Successful in Securing Inpatient Status for AMI-PCI Patients

November 9, 2017 — In the Society for Cardiovascular Angiography and Interventions’ (SCAI) comment letter to the Centers for Medicare & Medicaid Services (CMS) regarding the 2018 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule, SCAI took the opportunity to ask CMS to add the acute myocardial infarction percutaneous coronary intervention (AMI-PCI) Current Procedural Terminology (CPT) code (92941) to the inpatient-only (IPO) list.

SCAI believes it is reasonable that the hospital stay for a typical AMI-PCI patient is expected to be two midnights or longer. The society believes heart attack patients would expect their experience to be considered an inpatient event.

In the 2018 Hospital Outpatient Prospective Payment System (HOPPS) Final Rule, CMS has provided notice that they agree with the request to add AMI-PCI code 92941 to the inpatient-only list for CY 2018.

In recent years, CMS Recovery Audit Contractors (RACs) targeted claims for various “short hospital stays,” which lead to sharp increases in patients being relegated to “observation status” in attempts to avoid an audit. However, extended observation status brought with it seriously negative ramifications for Medicare patients, often significantly driving up their copay amounts and in some instances leading to denial of coverage for post-hospital rehabilitation care provided in a skilled nursing facility. Also, for patients with a recent inpatient stay, there may be penalties for readmissions within 30 days, leading facilities to inappropriately relegate patients returning for care to outpatient status in an attempt to avoid readmission penalties. CMS did provide some relief with the “two-midnight rule” which took effect in 2015, ruling that physicians could admit patients expected to stay two midnights or longer as inpatients. But concerns remain, and Medicare utilization statistics for the AMI-PCI code find that 6.3 percent of AMI-PCI patients were relegated to outpatient status in 2016.

SCAI’s Advocacy Committee, led by Osvaldo Gigliotti, M.D., FSCAI, chair, and Dmitriy Feldman, M.D., FSCAI, co-chair, has been monitoring these developments for years. SCAI leaders sought to clearly establish that AMI-PCI procedures are an inpatient experience for the facility and the patient. By having the AMI-PCI code added to the IPO list, Medicare will only reimburse hospitals if these procedures are provided within the inpatient setting. This should dissolve fears of RAC audits for these claims by facilities and should put a halt to any attempts by facilities that may be seeking to “game the system” by using outpatient status to avoid readmission penalties. As CMS moves forward with episode-based cost measures that are slated to directly impact physician reimbursement with increased weighting, it will be imperative that everyone is playing on a level playing field, according to SCAI.

The association said that by drawing a line firmly in the sand that patients being treated with PCI for AMI are “inpatient-only,” hospitals, providers and patients should experience immediate relief.

For more information:

Related Content

Amazon, Berkshire Hathaway and JPMorgan Chase to Form New Healthcare Company
News | Business | January 30, 2018
January 30, 2018 — Amazon , Berkshire Hathaway and JPMorgan Chase & Co.
News | Business | January 16, 2018
American College of Cardiology (ACC) Chief Executive Officer Shalom “Shal” Jacobovitz will be leaving the College...
CMS Launches New Voluntary Bundled Payments Model
News | Business | January 10, 2018
The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center)...
Toshiba Medical Systems Changes Name to Canon Medical Systems Corp.
News | Business | January 08, 2018
January 8, 2018 — Canon Inc. and Canon Medical Systems Corp.
CMS Announces Final Changes, Cancellations of Mandatory Bundled Payment Models
News | Business | December 21, 2017
The Centers for Medicare & Medicaid Services (CMS) last week finalized the cancellation of the mandatory hip...
Catheter reprocessing can reduce costs in the cath and EP lab.
Feature | Business | December 19, 2017 | Lars Thording
As payers and other healthcare entities look to better manage costs, especially in the acute care setting, it is impo
FDA Issues Final Guidance on Investigational Device Exemption Categorization
News | Business | December 19, 2017
The U.S. Food and Drug Administration (FDA) recently issued a final guidance, “FDA Categorization of Investigational...
Congressional Budget Office Finds cutting ACA insurance mandate will cause 13 million people to become uninsured, higher insurance premiums. American Heart Association (AHA), #AHA2017
News | Business | December 06, 2017
December 6, 2017 — At the American Heart Association (AHA) annual meeting in November, a group of 16 non-partisan pat
5 Tips for Medical Device Engineers on FDA Design Controls
Feature | Business | November 24, 2017 | Jon Speer
If you are an engineer in the medical device industry, you probably have a love/hate relationship with the FDA-mandat
Videos | Business | November 09, 2017
A discussion with Peter L.
Overlay Init