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HANYS Opposes CMS’ Proposed Inpatient Coding Adjustments

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HANYS submitted comments to the Centers for Medicare and Medicaid Services (CMS) on June 25 opposing its proposal to increase the prospective coding reduction in federal fiscal year (FFY) 2013.  As in past years, HANYS concludes that the CMS methodology fails to properly differentiate between case-mix increases due to changes in coding behavior and case-mix changes that reflect real changes in patient characteristics and treatment patterns.


In addition, HANYS urged CMS to address other payment inequities caused by the Recovery Audit Contractors (RACs) and other audits.  HANYS noted that CMS fails to take into account the increase in claim reviews and denials by RACs and other auditors subsequent to FFY 2010.  As a result, CMS overstates the coding reductions and creates additional payment inequities that should be addressed.  Contact:  Melanie Graham

Published July 5, 2012