Report asks HCFA to review Medicare policy

The Health Care Financing Administration (HCFA) soon may be reviewing hospitals with a high number of Medicare same-day readmissions.

A report released in February by the Depart-ment of Health and Human Services’ Office of Inspector General found that same-day readmissions were a cause of concern regarding quality of care issues, in addition to billing and overpayment problems.

The report, "Analysis of Readmissions Under the Medicare Prospective Payment System for Calendar Years 1996 and 1997" (A-14-99-00401), also recommended that HCFA:

• make the data in its report available to peer review organizations for use in determining the scope of their peer review activities;

• perform beneficiary-specific reviews on the claims of beneficiaries who had multiple continuous same-day readmissions;

• review a sample of same-day readmission claims in which the same-day readmission was coded with the same diagnosis-related group as the first hospital stay.

HCFA generally concurred with the recommendations but noted that only 61 providers had 30 or more readmissions in 1996 and 1997. HCFA will ask peer review organizations to investigate. HCFA, however, may suspend payment for same-day readmissions pending verification of their appropriateness. The full report is available at www.hhs.gov/progorg/oas/cats/hcfa.html.