AUSTIN, Texas — Hospitals and other medical care providers face financial and legal risks for patients who are readmitted within 30 days after their release, lawyers said Wednesday at the American Society for Healthcare Risk Management conference.
James Hofert, capital partner at Hinshaw & Culbertson L.L.P. in Chicago, and Linnea Schramm, an associate at the law firm, said Medicare providers face a maximum 2% penalty this year and a 3% penalty next year for patients who are readmitted within 30 days — even if the readmission has nothing to do with the previous treatment — under Centers for Medicare and Medicaid Services rules.
While medical providers have 30 days from the date of receipt of a report from CMS on a particular case to correct any errors, there is no other administrative or judicial review available, Ms. Schramm said. “Basically, you don't have much recourse,” she said.
In addition to the financial risk, legal liabilities arise from potential violations of the Health Information Portability and Accountability Act for CMS-required communication activities with the patient and third parties when a patient is released, Mr. Hofert said.
Another potential liability is software that does not meet CMS requirements under the health care reform law that it be “interoperable” with outside systems to collect and disseminate information, he said during a panel presentation at the Austin, Texas, conference.
In addition, liability issues may arise for medical facilities and medical professionals that provide follow-up care, Mr. Hofert said.
Expansion of risks
Both said the potential risks for hospitals and other medical providers could grow beyond Medicare in the future.
2015 could see more conditions that would be subjected to readmission penalties, Ms. Schramm said. Federal authorities “may be looking at all hospital readmissions, not just Medicare,” she said.
The “odds are pretty good” that readmission penalties could be extended to all medical care in the future, Mr. Hofert said.
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