Jim Petty, Director of Budget and Reimbursement for North Shore-Long Island Jewish Health System (North Shore LIJ).

North Shore LIJ Health System in New York is one of the largest healthcare providers in the region, with 14 hospitals, centers of progressive care, long-term care facilities and home health agencies. The system has more than 8,000 physicians, 7,000-plus nurses and other healthcare professionals.
Petty, who is responsible for cost reporting and government rates and reimbursement for LIJ, took time out recently to talk about the landscape for Medicare Payment during this unprecedented time of change in the nation's health system.

Question:  What's the most important information you obtain when a Medicare patient is admitted that ultimately makes a difference in the reimbursement you collect?

JP:  What we feel if most effective later in the cycle is to obtain proper documentation and coding in order to secure the most appropriate MS-DRG for the patient.

Question: Name one strategy you've implemented during the past year that has helped improve your Medicare reimbursements?

JP:   At our facilities, we emphasize education of staff and physicians about the importance of complete and thorough documentation as it relates to the effect on the MS-DRG determination.

Question:  How has the recession affected your hospital's Medicare payment cycle?

JP:  Of course, like everyone else, we've had to deal with the related rate cuts, and as a result of the economic difficulties apparent everywhere, we've seen an increase in Medicare bad debts.

Question: Do you think the house bill will have a positive or negative effect on Medicare reimbursement and why?

JP:  I believe if the bill is approved by Congress and ultimately becomes law, it will have several effects on Medicare payments. It is expected that the Medicare rates will have a reduced disproportionate share adjustment (at a minimum).  On the other hand, we may see reduced Medicare bad debts as more patients should be obtaining a secondary insurance.

Question:  What is the most controversial aspect of the health care proposals being considered by Congress?

JP:  I think the most controversial topics in the proposals are the public option and the mandate for people to obtain insurance.

Question:  What do you believe will be your greatest challenge in regard to Medicare reimbursement over the next year?

JP:  I think what will be essential to success of the health system reform process and what will constitute the greatest challenge to those of us involved in Medicare Payment issues will be to obtain successful compromises on the proposals being debated.

To learn more about North Shore-Long Island Jewish Health System, go to http://www.northshorelij.com/NSLIJ/Member+Hospitals.

Publication Date: Friday, November 13, 2009