Insurance Reimbursement For Hospital Acquired Infections
So for instance if you are on medicare and you pick up a hospital acquired infection while you are being treated for something that is covered by medicare the extra cost of treating the hospital.
Insurance reimbursement for hospital acquired infections. Hospital acquired conditions section 5001 c of deficit reduction act of 2005 requires the secretary to identify conditions that are. The aim of the cms hospital acquired condition reimbursement policy is to drive changes in organizational structures that may facilitate process change including the development of care pathways and ultimately clinician behavior change such as adherence to hand hygiene. The hospital acquired condition hac reduction program. The centers for medicare and medicaid services cms has titled the program hospital acquired conditions and present on admission indicator reporting hac and published rules august 22 2007 revising the medicare hospital inpatient prospective payment system ipps to implement changes in the reimbursement system based on these identified conditions.
The penalty is up to 3 of total reimbursement with only 38 hospitals nationwide receiving the maximum penalty. Diff infection rates nationwide the centers for medicare medicaid services cms implemented the hac reduction program. Ii in some cases this is drawn out over the course of years depending on the infection severity and patient health status. Data on hospital acquired conditions is collected by medicare and each hospital receives a score based on their performance.
A high cost or high volume or both b result in the assignment of a case to a drg that has a higher payment when present as a secondary diagnosis and c could reasonably have been prevented through the application of evidence based guidelines. Infections that are acquired in hospitals or healthcare facilities result in patients with significant post discharge insurance claims related to medications primary care follow up lab work rehab and homecare. The hospital acquired condition hac reduction program in an effort to curb mrsa and c. The hac reduction program encourages hospitals to improve patients safety and reduce the number of conditions people experience from their time in a hospital such as pressure sores and hip fractures after surgery.
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