1.800.456.4350 info@prgweb.com

Medical Industry Reimbursement News

CMS Management Changes Announced

June 20th, 2014

On June 20, Health and Human Services (HHS) Secretary Sylvia Burwell announced a series of management changes designed to strengthen the implementation of the Affordable Care Act (ACA).  The Centers for Medicare & Medicaid Services (CMS) will have a new operations-focused Principal Deputy Administrator for agency-wide policy and operational program coordination.  CMS will also have a single Marketplace Chief Executive Officer (CEO).  In addition to the Marketplace CEO, CMS is announcing and actively recruiting a Marketplace Chief Technology Officer (CTO).

Andy Slavitt will join the CMS as Principal Deputy Administrator.  Mr. Slavitt will be responsible for cross cutting policy and operational coordination for the agency’s Medicare, Medicaid, CHIP, and Marketplace initiatives, combatting health care fraud, reforming health care delivery, and improving health outcomes.

CMS is also recruiting two leaders to fill positions for a permanent Marketplace CEO and a Marketplace CTO. These individuals, who will also work directly with Secretary Burwell and CMS Administrator Marilyn Tavenner, will be accountable for policy development and technical operations of the federal Health Insurance Marketplace, working closely with a variety of stakeholders and states on ongoing implementation efforts.

The press release can be found at http://www.hhs.gov/news/press/2014pres/06/20140620a.html

CMS Launches National Initiative

June 16th, 2014

The Centers for Medicare & Medicaid Services (CMS) has launched a national initiative, “From Coverage to Care” (C2C), which is designed to help answer questions that people may have about their new health coverage and to help them make the most of their new benefits, including taking full advantage of primary care and preventive services. It also seeks to give health care providers the tools they need to promote patient engagement.

The press release can be found by going to http://cms.hhs.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-06-16.html


$60 Million in Grants to Support Marketplace Navigators Announced

June 10th, 2014

The Centers for Medicare & Medicaid Services (CMS) has announced that health care providers and other eligible entities can apply until July 10 for $60 million in grants. These grants will help support navigators in federally-facilitated and state partnership marketplaces in 2014-2015. The Affordable Care Act (ACA) established navigators to provide unbiased information to consumers about health insurance, the new health insurance marketplaces, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program (CHIP). Navigators have been an important resource for the millions of Americans who enrolled for coverage in 2014. This new funding will ensure that this program will continue next year. CMS issued a final rule updating requirements for navigators, health insurers, marketplaces and other ACA entities beginning in 2015.

The final rule can be viewed at http://www.gpo.gov/fdsys/pkg/FR-2014-05-27/pdf/2014-11657.pdf

CMS Establishes Provider Relations Coordinator

June 5th, 2014

The Centers for Medicare & Medicaid Services (CMS) has announced the establishment of a Provider Relations Coordinator to help increase program transparency and offer more efficient resolutions to providers affected by the medical review process.  CMS established the Provider Relations Coordinator to improve communication between providers and CMS.  Although providers should continue to take questions about specific claims directly to the Recovery Auditor or Medicare Administrative Contractor (MAC) who conducted the review, providers can escalate larger process issues to the Coordinator.

The agency states that health care providers may contact the coordinator, Latesha Walker, about RAC review process concerns/suggestions at RAC@cms.hhs.gov and MAC review process concerns/suggestions at MedicareMedicalReview@cms.hhs.gov.

Burwell Confirmed by Senate

June 5th, 2014

The Senate voted 78-17 to confirm the president’s nomination of Sylvia Mathews Burwell as Health and Human Services secretary. Currently director of the White House Office of Management and Budget (OMB), Burwell previously served as president of the Walmart Foundation and president of the Global Development Program at the Bill & Melinda Gates Foundation. She also has served on the board of the University of Washington Medical Center in Seattle. In April, HHS Secretary Kathleen Sebelius announced she will step down after five years of service.


CMS Releases Annual Update on Hospital Charges

June 2nd, 2014

The Centers for Medicare & Medicaid Services (CMS) released its first annual update to data on hospital charges. The data include inpatient and outpatient hospital charge data for 2012, as well as 2011. It also shows what different hospital in all 50 states and Washington, D.C. charge for similar services. The data include information comparing the average hospital charges for services that may be provided in connection with the 100 most common Medicare inpatient stays, such as services provided in connection with joint replacements or services provided to treat chest pain.

More information can be accessed at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html

GAO Makes MedPAC Appointments and Designates Vice Chair

May 29th, 2014

The Government Accountability Office (GAO) has named three new members to the Medicare Payment Advisory Commission (MedPAC) and reappointed two members. The new members, whose terms will expire in April 2017, are Warner Thomas, president and CEO of Ochsner Health System in New Orleans, Francis “Jay” Crosson, M.D., a group vice president for the American Medical Association, and Kathy Buto, an expert in U.S. and international health policy. As the president and CEO of Ochsner Health System, Thomas oversees the Ochsner Medical Center in New Orleans, the Ochsner Clinic group practice, rurally-based and sub-acute care hospitals, skilled nursing and rehabilitation facilities, and hospices. The reappointed members are Willis Gradison, Jr., formerly a Scholar in Residence in the Health Sector Management Program at Duke University’s Fuqua School of Business, and William Hall, M.D., director of the Center for Healthy Aging at the University of Rochester School of Medicine. Jon Christianson, professor in the Division of Health Policy and Management at the University of Minnesota School of Public Health, was named vice chair of the commission.

For more details, visit http://www.gao.gov/press/medpac_appointments_vice_chair2014may29.htm

Medicare Prior-authorization Process Proposed

May 23rd, 2014

The Centers for Medicare & Medicaid Services (CMS) has proposed creating a Medicare prior-authorization process for durable medical equipment (DME), prosthetics, orthotics and supplies that are frequently subject to unnecessary utilization. The prior-authorization process would not create new clinical documentation requirements; however, it would ensure that existing documentation, coverage and coding requirements would be met before items would be furnished to beneficiaries and claims submitted for payment. The proposed rule would also expand Medicare’s prior-authorization demonstration for power mobility devices from seven states to 19, and establish similar demonstrations for certain non-urgent ambulance transport and hyperbaric oxygen therapy.

The proposed rule is available at https://www.federalregister.gov/articles/2014/05/28/2014-12245/medicare-program-prior-authorization-process-for-certain-durable-medical-equipment-prosthetics

ICD-10 and ICD-9-CM Code Sets Unchanged for 2015

May 22nd, 2014

The partial freeze on updates to the ICD-10 and ICD-9-CM diagnosis and procedure codes will continue until October 1, 2015, the Centers for Medicare & Medicaid Services (CMS) announced. Regular updates to ICD-10 will begin on October 1, 2016, one year after the new planned implementation date, the agency said. CMS expects to release an interim final rule soon specifying a new ICD-10 compliance date of October 1, 2015. The 2015 ICD-9-CM, ICD-10-CM and ICD-10-PCS files contain no updates to the codes, CMS said. The agency expects to release the 2015 General Equivalence Mappings this summer.

More information is available at http://www.cms.gov/Medicare/Coding/ICD10/Downloads/Partial_Code_Freeze.pdf

Proposed Rule Issued Allowing Meaningful Use Flexibility

May 20th, 2014

The Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (HIT) have released a proposed rule that would allow hospitals and eligible professionals multiple pathways to meet meaningful use in 2014, including using the 2011 Edition Certified Electronic Health Record Technology (CEHRT) to meet the meaningful use requirements in place for 2013. CMS stated that, beginning in 2015, all eligible hospitals and professionals would be required to use the 2014 Edition CEHRT to report meaningful use. The rule also proposes beginning stage 3 meaningful use in fiscal year 2017.

The proposed rule can be viewed at https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-11944.pdf