Medical Industry Reimbursement News
April 27th, 2016
On April 18, the Centers for Medicare & Medicaid Services (CMS) released its hospital inpatient prospective payment system (IPPS) proposed rule for fiscal year (FY) 2017. The rule would increase rates by 0.85% in FY 2017 compared to FY 2016, after accounting for inflation and other adjustments. In the rule, CMS proposes two adjustments to reverse the effects of the 0.2% cut which was instituted when implementing the two-midnight policy in FY 2014. Specifically, the agency proposes a permanent adjustment of approximately 0.2% to remove the cut prospectively for FYs 2017 and onward; as well as a temporary adjustment of 0.6% to address the retroactive impacts of this cut for FYs 2014, 2015 and 2016. In addition, those hospitals that were meaningful users of electronic health records in FY 2015 and that submit data on quality measures, less a productivity cut of 0.5% and an additional market-basket cut of 0.75%, as mandated by the Affordable Care Act (ACA).
CMS also proposes a 1.5% cut that would fulfill the requirement of the American Taxpayer Relief Act of 2012 that the agency recoup the effect of documentation and coding changes from FYs 2010 -2012. The rule also includes ACA-mandated Medicare Disproportionate Share Hospital reductions, which would reduce overall Medicare DSH payments by $134 million in FY 2017 compared to FY 2016. For the FY 2018 Hospital-Acquired Condition Reduction Program, CMS proposes a new scoring methodology in which hospitals would be scored based on how their measured performance compares to the national mean, rather than on their own of performance.
The agency also proposes changes to the Inpatient Quality Reporting (IQR) Program, the Hospital Readmissions Reduction Program, the Value-Based Purchasing Program, the Inpatient Psychiatric Facility Quality Reporting Program, and the PPS-Exempt Cancer Hospital Quality Reporting Program. In addition, the rule includes proposals to implement the Notice of Observation Treatment and Implication for Care Eligibility Act, which requires hospitals and critical access hospitals to provide notification to individuals receiving observation services as outpatients for more than 24 hours.
The proposed rule was published in the April 27 Federal Register and comments will be accepted through June 17.
The proposed rule can be found at https://federalregister.gov/a/2016-09120
April 11th, 2016
On April 11, the Centers for Medicare & Medicaid Services (CMS) announced its largest-ever initiative to transform and improve how primary care is delivered and paid for in America. The effort, the Comprehensive Primary Care Plus (CPC+) model, will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve. The initiative is designed to provide doctors the freedom to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care.
Building on the Comprehensive Primary Care initiative launched in late 2012, the five-year CPC+ model will benefit patients by helping primary care practices:
- Support patients with serious or chronic diseases to achieve their health goals
- Give patients 24-hour access to care and health information
- Deliver preventive care
- Engage patients and their families in their own care
- Work together with hospitals and other clinicians, including specialists, to provide better coordinated care
Primary care practices will participate in one of two tracks. Both tracks will require practices to perform the functions and meet the criteria listed above, but practices in Track 2 will also provide more comprehensive services for patients with complex medical and behavioral health needs, including, as appropriate, a systematic assessment of their psychosocial needs, and an inventory of resources and supports to meet those needs.
For more details, visit https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-04-11.html
April 5th, 2016
The Centers for Medicare & Medicaid Services (CMS) has announced final changes to the Medicare Advantage (MA) and Part D prescription drug programs for 2017. These changes will increase payment rates in aggregate by a net 0.85%. CMS anticipates the MA plans and Part D sponsors will see an average revenue increase of 3.05%. In addition, CMS finalized several other policy changes, including modifications to the risk-adjustment model to more closely align reimbursement with costs for dually eligible beneficiaries, and refinements to a subset of the Star Ratings program measures to account for beneficiary socioeconomic and disability status.
For further details, visit https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2017.pdf
March 25th, 2016
According to a report released by the Department of Health and Human Services (HHS), Medicare spent $473.1 billion less on personal health care expenditures between 2009 and 2014 than what would have been spent if the 2000-2008 average growth rate had continued through 2014. Using data from the Treasury Department on Medicare benefit outlays in 2015, HHS estimates that per enrollee spending growth will continue to be low at around 1%, leading to a cumulative reduction in spending of approximately $648.6 billion between 2009 and 2015. In addition, the study found that Medicare spending on inpatient care and post-acute care remained flat in 2014.
For more information, visit https://aspe.hhs.gov/pdf-report/health-care-spending-growth-and-federal-policy
March 22nd, 2016
The Centers for Disease Control and Prevention (CDC) has released roughly 1,900 diagnosis codes that will be added to the ICD-10 coding system for health care claims in fiscal year 2017. 3,651 new ICD-10 PCS inpatient procedure codes for FY 2017 were posted earlier this month on the CMS website.
For more information, go to www.cdc.gov.
March 19th, 2016
The Food and Drug Administration (FDA) has issued a proposed rule that would ban most powdered medical gloves. The agency stated that aerosolized glove powder on natural rubber latex gloves can carry proteins that may cause respiratory allergic reactions, and powdered synthetic gloves are associated with airway and wound inflammation and post-surgical adhesions. The ban would apply to powdered surgeon’s gloves, powdered patient examination gloves, and absorbable powder for lubricating surgeon’s gloves. The agency does not expect the ban to cause a glove shortage or impact medical practice, noting that many non-powdered protective glove options are available. It will accept comments on the proposed rule for 90 days.
The proposed rule can be found by visiting https://federalregister.gov/a/2016-06360
March 8th, 2016
On March 8, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to test new models for how Medicare Part B pays for prescription drugs provided in physician offices and hospital outpatient departments. The proposed model would test whether changing the add-on payment to 2.5% plus a flat fee payment of $16.80 per drug per day changes prescribing incentives and leads to improved quality and value. CMS would update the flat fee at the beginning of each year by the percentage increase in the consumer price index for medical care for the most recent 12-month period. The test would begin in late 2016. Comments are being accepted through May 9.
This proposed rule can be found at https://federalregister.gov/a/2016-05459
March 4th, 2016
On March 3, the Medicare Payment Advisory Commission (MedPAC) discussed its pending report to Congress on a prototype payment system that, if approved by Congress, could replace the current payment systems for home health, skilled nursing, inpatient rehabilitation, and long-term care hospital services. Mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014, the prototype includes separate payment tiers for “institutional” and “home-based” post-acute care, and includes high-cost and short-stay outlier components. In April, MedPAC expects to vote on a final report for submission to Congress in June. CMS will then use the prototype to develop a new, unified payment system for post-acute care.
For more information, visit http://medpac.gov/-research-areas-/post-acute-care
March 4th, 2016
The Centers for Medicare & Medicaid Services (CMS) has released a toolkit to help health care providers track and respond to certain ICD-10 performance indicators in order to improve productivity and cash flow.
For more information, visit https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10NextStepsToolkit20160226.pdf
February 25th, 2016
Medicare Fee-For-Service (FFS) claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will continue to incur a 2 percent reduction in Medicare payment until further notice. Claims for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), including claims under the DMEPOS Competitive Bidding Program, will continue to be reduced by 2 percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013. The claims payment adjustment will continue to be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments. Though beneficiary payments for deductibles and coinsurance are not subject to the 2 percent payment reduction, Medicare’s payment to beneficiaries for unassigned claims is subject to the 2 percent reduction.
For more information, visit http://www.palmettogba.com/palmetto/providers.nsf/ls/JM%20Part%20B~9HTE2G2363?opendocument&utm_source=J11BL&utm_campaign=JMBLs&utm_medium=email