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Talk Ten Tuesdays

Hospital Star Ratings: How to Earn Back Fallen Stars

·31 min·3 clips
Why 40% of diagnoses that boost hospital star ratings have no effect on how Medicare pays the hospital.
The episode begins with host Chuck Buck and Dr. Erica Reamer introducing the panel for March 5, 2024. Tim Powell reports from the news desk on CMS's clarification of billing instructions for post-transplant blood tests used to monitor organ rejection, noting updates from March 2023 to combat improper billing. He explains the role of Medicare Administrative Contractors and the Molecular Diagnostic Services Program. Lori Johnson presents the coding report, highlighting National Kidney Month and the coding for chronic kidney disease, specifically stage 3 with hypertension, requiring codes I12.9 and N18.31. She mentions the importance of HCC risk adjustment starting at stage 3. Tiffany Ferguson covers social determinants of health, discussing the Biden administration's White House challenge that secured $1.7 billion in new commitments to end hunger and reduce diet-related diseases. She lists examples including Ascension's plan for hospital-based produce markets and Blue Cross Blue Shield of North Carolina expanding nutrition coaching. Michelle Wazorek reports on hospital star rating systems, explaining the five measure groups and how 46 measures are weighted. She reveals that 40% of diagnoses impacting the risk adjustment for star ratings do not affect MS-DRG assignment, leading to under-documentation. She advises hospitals to harmonize coding, CDI, and quality efforts, use the AHRQ measure specifications, and check ratings on the American Hospital Directory. Dr. Erica Reamer presents the Talkback segment, analyzing a query example for altered mental status in a patient with sepsis. She discusses how to structure query choices to be authentic to providers, including when to keep or remove terms like 'septic encephalopathy' or 'acute'. The episode concludes with Chuck Buck thanking the panelists.

As heard by us

A practical review of risk adjustment, documentation, and provider queries around hospital star ratings.

Hospital star ratings are treated less as a finished consumer score than as a problem of method. Michelle Wazarek reports on the rating systems, while Chuck Buck and Dr. Erica Reamer keep the focus on risk adjustment and the practical work behind better ratings.

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Why you'd press play

You want to know what hospital star ratings start asking once risk adjustment enters the room.

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