1.800.456.4350 info@prgweb.com

Medical Industry Reimbursement News

Update to the Two-midnight Guidance Issued

March 13th, 2014

CMS plans to issue guidance to Medicare Administrative Contractors (MACs), Medicare Recovery Auditors (RACs), and other review contractors. This update will provide further guidance for the determination of the appropriateness of inpatient hospital admission.  CMS will instruct Medicare review contractors to assess the hospital’s compliance with three things – the admissions order requirements, the certification requirements, and he two-midnight benchmark.

For further details, the updated guidance can be viewed at http://cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/Downloads/ReviewingHospitalClaimsforAdmissionforPosting03122014.pdf.

HHS Releases Health Plan Standards Final Rule

March 7th, 2014

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule regarding certain payment parameters and standards for health insurers and the Health Insurance Marketplace for the 2015 benefit year. Based on a fact sheet released by CMS, the provisions pertain to premium stabilization programs, the open enrollment period for 2015, annual limitations on cost sharing, consumer protections, financial oversight, and the Small Business Health Options Program (SHOP). According to the final rule, the open enrollment period for the 2015 benefit year will begin on November 15, 2014 and extend through February 15, 2015.

The final rule can be viewed at http://www.ofr.gov/OFRUpload/OFRData/2014-05052_PI.pdf.

The CMS fact sheet can be found at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-03-05-2.html?DLPage=1&DLSort=0&DLSortDir=descending

Medicare Advantage Advanced Notice of Proposed Changes Released

February 24th, 2014

The Centers for Medicare & Medicaid Services (CMS) has issued an advanced notice  of proposed changes to Medicare Advantage (MA) rates and payment polices for calendar year 2015. The notice includes the preliminary estimates of the national per capita MA growth percentage and Medicare fee-for-service growth percentage, and changes in methodologies governing payment for health plan and prescription drug benefits.

The notice can be viewed at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-02-21-02.html.

Quality Data Added to Physician Compare Website

February 21st, 2014

The Centers for Medicare & Medicaid Services (CMS) has announced that, for the first time, quality measures have been added to Physician Compare, a website that helps consumers search for information about hundreds of thousands of physicians and other health care professionals.   In the first year, 66 group practices and 141 Accountable Care Organizations (ACO) now have quality data publicly reported on Physician Compare.  The data are reported at the group practice and ACO level.

The quality measures being added today include controlling blood sugar levels in patients with diabetes, controlling blood pressure in patients with diabetes, prescribing aspirin to patients with diabetes and heart disease, treating patients with diabetes who do not use tobacco, and prescribing medicine to improve the pumping action of the heart in patients who have both heart disease and certain other conditions.

For more information, go to http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-02-21.html

Joint Commission Appoints Four New Board Members

February 14th, 2014

The Joint Commission has appointed four new members to its Board of Commissioners. They are Grant Davies, CEO of North Bay Hospitals and executive vice president of California Pacific Medical Center, Gregg Meyer, M.D., chief clinical officer at Partners Healthcare System, and Jane Englebright, chief nursing officer, patient safety officer and vice president for the Clinical Services Group at Hospital Corporation of America. She will serve as the board’s at-large nursing representative.

For further details, go to http://www.jointcommission.org/four_new_members_appointed_to_joint_commission_board/

Open Payments Registration to Begin

February 8th, 2014

On February 7, the Centers for Medicare & Medicaid Services (CMS) issued a notice announcing that registration for Open Payments will begin on February 18, 2014. The Physician Payment Sunshine Act and accompanying rules require applicable drug and device manufacturers and group purchasing organizations (GPOs) to record payments and other transfers of value to physicians and teaching hospitals. The requirement applies to payments made on or after August 1, 2013. 

For more information about Open Payments, go to http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-payment-Transparency-Program/index.html

Final Rule Allows Patients Access to Lab Reports

January 31st, 2014

The Department of Health and Human Services (HHS) has issued a final rule allowing laboratories to give patients or their designated representative direct access to completed test reports. While patients can continue to get access to their laboratory test reports from their doctors, the rule amends the Clinical Laboratory Improvement Amendments (CLIA) and Health Insurance Portability and Accountability Act Privacy (HIPAA) Rule to provide patients a new way to obtain their test reports directly from the laboratory.

The final rule is available at http://www.gpo.gov/fdsys/pkg/FR-2014-02-06/pdf/2014-02280.pdf.

Two-midnight Partial Enforcement Delay Extended

January 31st, 2014

The Centers for Medicare & Medicaid Services (CMS) has extended the partial enforcement delay of the two-midnight policy for inpatient admission and medical review criteria for six months. According to CMS, recovery auditors and other Medicare review contractors will not conduct post-payment patient status reviews of inpatient hospital claims with dates of admission on or after October 1, 2013 through September 30, 2014. However, Medicare Administrative Contractors (MAC) will continue to conduct pre-payment “probe and educate” audits on select claims.

More information is available at http://cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/InpatientHospitalReviews.html.

Medicare ACO Savings and Bundled Payment Participants Announced

January 30th, 2014

The Centers for Medicare & Medicaid Services (CMS) has announced that Medicare accountable care organizations (ACOs) have generated more than $380 million in savings in the first year of the Shared Savings and Pioneer ACO programs. In addition, CMS announced that 232 additional acute-care hospitals, skilled nursing homes, physician group practices, long-term care hospitals, and home health agencies have entered agreements to participate in the Bundled Payments for Care Improvement initiative. The Medicare demonstration project includes four models of care that bundle payments for multiple services received during an episode of inpatient and/or post-acute care.

A press release is available at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2014-Press-releases-items/2014-01-30.html.

Eisenberg Quality Award Winners Announced

January 23rd, 2014

The National Quality Forum and Joint Commission have announced the 2013 John M. Eisenberg Patient Safety and Quality Award winners. The awards for innovation at the national level will go the Minnesota Hospital Association, Institute for Clinical Systems Improvement and Stratis Health for their partnership to reduce avoidable readmissions. The Hospital Association of Southern California, Hospital Association of San Diego & Imperial Counties, Hospital Council of Northern & Central California, Anthem Blue Cross, and National Health Foundation will receive an award for their quality improvement initiative. The award for innovation at a local level will go to Vidant Health in Greenville, SC., and the individual achievement award will go to Gail Warden, president emeritus of Henry Ford Health System in Detroit.

For more information, visit this link.