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Hospital charges surge for common ailments, data shows
The New York Times
Charges for some of the most common inpatient procedures surged at hospitals across the country in 2012 from a year earlier, some at more than four times the national rate of inflation, according to data released by Medicare officials. While it has long been known that hospitals bill Medicare widely varying amounts — sometimes many multiples of what Medicare typically reimburses — for the same procedure, an analysis of the data by The New York Times shows how much the price of some procedures rose in just one year's time.
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'Since You Asked' committee update
Q: What are Medicare requirements for physician documentation?
The "Since You Asked" committee received a request to address the problem regarding physician documentation requirements. The requester is noticing a trend at her hospital that admitting physicians are not completing the history and physical on the day of admission; instead they are waiting until the next calendar day as well as not writing a progress note for hospital day 2. The physicians are under the impression that the history and physical written on hospital day 2 is sufficient. The concern expressed is the lack of physician documentation on day of admission may be insufficient to support hospital billing. The requester is seeking regulatory guidance.

Medicare published medical documentation guidelines for evaluation and management services in 1995 1, 3 and 1997 2, 3. General principles state medical record documentation is required to record pertinent facts, findings and observations about an individual’s health history including past and present illnesses, examinations, tests, treatments and outcomes. This serves as a chronological record of patient care and is an important element contributing to high quality care. Appropriate medical record documentation can reduce many of the hassles associated with claims processing and serves as a legal document to verify the care provided.

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AHA survey: Hospitals appealing half of RAC claim denials
AHA News Now
Hospitals continue to proactively appeal Recovery Audit Contractor claim denials, according to the latest results from the AHA's quarterly RACTrac survey. Hospitals participating in the survey report appealing 50 percent of all RAC denials, and half had an appeal overturned in their favor through use of the discussion period before a formal appeal. Lack of medical necessity and inpatient coding error were the top reasons Medicare RACs cited to deny claims; the percentage of hospitals experiencing denials related to inpatient coding increased by 8 percent during the last quarter. Hospital representatives are invited to attend a free June 24 webinar to review recent RAC policy developments and results from the survey, which helps hospitals monitor the impact of RACs and advocate for needed changes to the program. For more information, visit
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Study: Adding socioeconomic data to standardized measures affects calculated readmission rates
A recent study published by Health Affairs found that more meaningful comparisons can be made when socioeconomic data is added to standardized readmission measures. The researchers compared 30-day readmissions rates from hospitals that used one of two models. The first model was the current model used by the Centers for Medicare and Medicaid Services for public reporting of condition-specific hospital readmission rates of Medicare patients. The second model involved census tract-level socioeconomic data, such as poverty rate, education level and housing vacancy rate.

The results saw a noticeable effect on the calculated hospital readmission rates for several types of patients. The narrowed range of observed variation in readmission rates attributed to the inclusion of socioeconomic data includes:
  • Decrease for patients admitted for acute myocardial infarction from 6.5 to 1.8 percent
  • Decrease for patients admitted for heart failure from 14 to 7.4 percent
  • Decrease for patients admitted for pneumonia from 7.4 to 3.7 percent
Although the socioeconomic data narrowed the range of observed variation in calculated readmission rates, there was not a significant difference between the two models in the average readmission rates for these three conditions.

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Educate your staff with the Compass orientation program
Six thousand hospital case management professionals have used ACMA's Compass orientation program since its launch in May 2013. The program is a tool to train new case management staff and to refresh existing staff. Visit to see how Compass can benefit your department today!

Order Compass and Begin Training Today
The Compass program is available for purchase at The orientation system is available for training 24 hours a day, seven days a week, and there is no limit on the number of staff members who may be entered and trained in the system.

Watch the Demonstration Video
Before using Compass, be sure to watch the demonstration video so you can receive the maximum benefit from the program. This 11-minute video provides a comprehensive, step-by-step guide to Compass.

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ACMA recognizes 2013-2014 fundraising donors
ACMA thanks those who made donations to fundraising efforts throughout 2013-2014. Your contributions allow ACMA to continue to provide forums for case management continuing education, ACMA's advocacy and public policy efforts, research that advances the practice, certification development and the association's overall work in the practice of health care delivery system case management.

ACMA also recognizes the 2013-2014 Fundraising Committee for their hard work and contributions to another successful fundraising year. Committee members include: Angie Roberson, chair; Darren Anderson; Rhonda Colson; Rebecca Conley; Doreen Day; Shelley Dietz; Diana Doepp; Dorothy Fukas; Andra Griffis; Dora Sierra and Marsha Stein.

Click here to see the donors that have helped fund ACMA initiatives for 2013-2014.

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Our unique blend of expertise and experience makes PhoenixMed the premier choice as your hospital case management partner offering solutions for contemporary case management redesign and education.
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To find out how to feature your company in the ACMA briefCASE and other advertising opportunities, Contact Geoffrey Forneret at 469-420-2618.


Medicare could save billions on drug plan
A new study finds that Medicare is spending billions of dollars more than it needs to on prescription drugs for low-income seniors and disabled beneficiaries. In 2013, an estimated 10 million people who participate in the Medicare prescription drug program, known as Part D, received government subsidies to help pay for that coverage. They account for an estimated three-quarters of the program's cost. Most of those low-income enrollees are randomly placed in a plan that costs less than the average for the region where the person lives.
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New technologies, hospital strategies promote patient engagement
Healthcare Finance News
The American Customer Satisfaction Index released a report revealing that overall patient satisfaction with hospitals and ambulatory care stands at 77.6 percent, down 3 percent from a year ago. According to the report, ambulatory care, which includes office visits to doctors, dentists and optometrists, ranked higher — at 79 percent satisfaction — than hospital services — 76 percent. Nonetheless, both categories saw a drop from last year's ACSI.
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Feds to consider paying doctors for end-of-life planning
The Pew
The federal government may reimburse doctors for talking to Medicare patients and their families about "advance care planning," including living wills and end-of-life treatment options — potentially rekindling one of the fiercest storms in the Affordable Care Act debate. A similar provision was in an early draft of the federal health care law, but in 2009, former Republican vice-presidential candidate Sarah Palin took to Facebook to accuse President Barack Obama of proposing "death panels" to determine who deserved life-sustaining medical care. Amid an outcry on the right, the provision was stripped from the legislation.
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An update on diagnostics for invasive pulmonary aspergillosis
By Dr. Afsaneh Motamed-Khorasani
Invasive pulmonary aspergillosis, or IPA, is a fatal lung disease accounting for more than 200,000 infections per year and a mortality rate of 30-90 percent. This disease has been traditionally observed in immunocompromised patients; however, patients with chronic lung disease are also prone to it. Early diagnosis of IPA remains challenging with limited treatment options. Therefore, there is an urgent need for new methods based on genomic, proteomic and metabolomics approaches toward novel diagnostic procedures.
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Date Event Location More Info
June 30 Northern California Chapter Conference Napa, Calif. Details
July 19 Georgia Chapter Conference Atlanta Details
July 31-Aug. 1 Florida Chapter Conference ChampionsGate, Fla. Details
Aug. 23 MO/IL Gateway Chapter Conference St. Louis Details
Sept. 6 Kentucky/Tennessee Chapter Conference Nashville, Tenn. Details
Sept. 11-12 South Carolina Chapter Conference Columbia, S.C. Details
Sept. 18 Missouri-Kansas Chapter Conference Kansas City, Mo. Details
Sept. 29 North Carolina Chapter Conference Winston-Salem, N.C. Details
Sept. 27 Maryland Chapter Conference Baltimore Details
Oct. 3 Great Lakes Chapter Conference Novi, Mich. Details
Oct. 4 Western Pennsylvania Chapter Conference Pittsburgh Details
Oct. 11 Virginia Chapter Conference Richmond, Va. Details
Oct. 14 Wisconsin Chapter Conference Waukesha, Wis. Details
Oct. 25 Connecticut Chapter Conference Uncasville, Conn. Details
Oct. 28 Illinois Chapter Conference Rosemont, Ill. Details
Nov. 19-22 Leadership Conference and Medical Director Forum Orlando, Fla. Details

  For the full ACMA event map, click here.



Laura Chambers, ACMA Communications Coordinator, 501.907.2262
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Colby Horton, Vice President of Publishing, 469.420.2601

Ryan Clark, Content Editor, 202.684.7160  
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