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Medical Industry Reimbursement News

CMS Administrator Resigns

January 16th, 2015

In an email to her staff on January 16, the Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner announced that she will be leaving the agency at the end of February. Andy Slavitt, currently principal deputy administrator, will become acting administrator. Tavenner has been with the agency for five years and was confirmed as administrator in May of 2013.

Nearly 6.8 Million Enrolled in 2015 Federally-facilitated Marketplace

January 14th, 2015

According to preliminary data released by the Department of Health and Human Services (HHS), nearly 6.8 million individuals and families selected a health plan or were automatically re-enrolled through the federally-facilitated Health Insurance Marketplace (FFM) between November 15 and January 9.  The HHS update also includes an estimate of plan selections for each state in the FFM. Open enrollment in the Marketplace runs through February 15.

For more information, go to http://www.hhs.gov/healthcare/facts/blog/2015/01/open-enrollment-week-eight.html

MedPAC Finalizes 2016 Payment Recommendations

January 14th, 2015

The Medicare Payment Advisory Commission (MedPAC) has announced its final recommendation that Congress increase Medicare payment rates for the 2016 hospital inpatient and outpatient prospective payment systems by 3.25%. In addition, the commission recommended that Congress reduce or eliminate payment differences between physician office and hospital outpatient departments for certain  procedures, and reimburse long-term care hospitals the same rates as acute-care hospitals for patients who are not deemed “chronically critically ill”. The commission also recommended to freeze Medicare payments to physicians in 2016 in place of the sustainable growth rate formula (SGR), to establish a per- beneficiary prospective payment to replace the Primary Care Incentive Payment Program, and to freeze 2016 payments for home health, skilled nursing facilities (SNF), ambulatory surgical centers, dialysis facilities, hospice, inpatient rehabilitation facilities (IRF), and long-term care hospitals.

For more information, visit www.Medpac.gov

Joint Commission Launches Infection Prevention and HAI Portal

January 13th, 2015

On January 13, The Joint Commission announced that it is merging its two online infection prevention resources into one convenient, expanded tool: The Infection Prevention and Healthcare-associated Infection (HAI) Portal.

Previously, The Joint Commission offered both the Infection Control Page and the HAI Portal as separate resources. The new Infection Prevention and HAI Portal will contain information from The Joint Commission, Joint Commission Center for Transforming Healthcare and Joint Commission Resources. In addition, it will offer links to other nationally recognized resources on infection prevention issues.

The press release can be found at http://www.jointcommission.org/joint_commission_launches_infection_prevention_and_hai_portal/


RAC Program Changes Announced

January 5th, 2015

The Centers for Medicare & Medicaid Services (CMS) has announced changes to its Recovery Audit Contractor (RAC) Program. CMS believes these changes will reduce provider burden, enhance CMS’s oversight, and increase transparency in the program.  One major change will be the limitation on the RAC look-back period for patient status reviews to six months after the date of service if the hospital has submitted its claim within three months of the date of service. CMS believes this addresses concerns regarding its policy that limits hospitals’ ability to rebill certain denied Medicare Part A claims under Part B to one year after the date of service. These changes will be effective with each new RAC contract.

For more details, visit http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Downloads/RAC-Program-Improvements.pdf

Proposed Rule Issued to Help Consumers Compare Health Insurance Benefits

December 22nd, 2014

On December 22, the Departments of Health and Human Services, Labor, and the Treasury issued proposed rules to help people who are shopping for health insurance coverage better understand their options. The proposed rules would add features making the Summary of Benefits and Coverage (SBC) more user-friendly, and a new coverage example would better illustrate the cost of services for more consumers. The proposed rules would also significantly streamline and shorten the SBC by removing information that is not required by statute and has been identified through consumer testing to be less relevant for consumers purchasing health insurance.

The revised SBC would also assist employers in comparing plan options to find the best coverage for their businesses and employees, and the rules would clarify and streamline the requirements health insurers and group health plans must follow.

If finalized, the new requirements would be implemented for plan years on or after September 1, 2015.

For more information on the proposed rules, visit: http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/SBC-Proposed-Rule-Fact-Sheet-122214.pdf

New Quality Measures Added to Physician and Hospital Compare Websites

December 18th, 2014

The Centers for Medicare & Medicaid Services (CMS) has added new quality data to the Physician Compare website. Additionally, CMS has updated quality measures on the Hospital Compare website and released data on new measures. CMS posted the publicly reported 2013 PQRS Group Practice Reporting Option (GPRO) measures for 139 group practices, 214 Shared Savings Program Accountable Care Organizations (ACOs), and 23 Pioneer ACOs. The specific measures being reported are:

  • Controlling blood sugar levels in patients with diabetes
  • Controlling blood pressure in patients with diabetes
  • Prescribing aspirin to patients with diabetes and heart disease
  • Prescribing medicine to improve the pumping action of the heart in patients who have both heart disease and certain other conditions

The Hospital Compare measures being reported for the first time are:

  • Patient experience of care
  • Timely and effective care
  • Readmission, complications and deaths
  • Payment and value of care
  • PPS-exempt Cancer Hospital Quality Reporting Program

For more information on Physician Compare, visit http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/physician-compare-initiative/

For information on Hospital Compare, please visit: http://www.medicare.gov/hospitalcompare/search.html

MedPAC Considers 2015 Updates

December 18th, 2014

The Medicare Payment Advisory Commission (MedPAC) is considering a package of draft recommendations to Congress that would affect the inpatient, outpatient and long-term care hospital (LTCH) prospective payment systems (PPS). The recommendations would increase payment rates for the hospital inpatient and outpatient PPSs by 3.25% in 2015, reduce or eliminate payment differences between hospital outpatient departments and physician offices for selected procedures, and reimburse LTCHs at the same rates as acute care hospitals for certain patients. The commission also considered a draft recommendation that would freeze Medicare payments to physicians in 2015 and in place of the sustainable growth rate formula (SGR). The commission also is considering establishing a prospective per-beneficiary payment to replace the Primary Care Incentive Payment Program after it expires at the end of 2015.

For more information, visit http://medpac.gov/

CMS Releases Video Detailing ICD-10

December 16th, 2014

The Centers for Medicare & Medicaid Services (CMS) has released a video detailing the characteristics and unique features of the ICD-10-CM coding system. The video discusses the ICD-10-CM coding structure and explains how to assign diagnosis codes using ICD-10. In addition, the video highlights free resources that coders can use as they prepare for the transition to ICD-10.

The video can be viewed at https://www.youtube.com/watch?v=s86pXhhOG7c&list=UUhHTRPxz8awulGaTMh3SAkA

State Innovation Models Initiative Recipients Announced

December 16th, 2014

On December 15, the Centers for Medicare and Medicaid Services (CMS) announced the recipients of 11 Model Test and 21 Model Design awards under the second round of the State Innovation Models initiative. In round two, the State Innovation Models initiative is providing more than $665 million over the next four years to support state-led, multi-payer health care payment and service delivery models that will improve health system performance, increase quality of care, and decrease costs for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries, and for all residents of participating states. The States will engage a broad group of stakeholders including health care providers and systems, long-term service and support providers, commercial payers, state hospital and medical associations, tribal communities, and consumer advocacy organizations. Transformation efforts supported by this initiative must improve health, improve care, and lower costs for Medicare, Medicaid, and CHIP beneficiaries.

More information on the State Innovation Models initiative can be found at: innovation.cms.gov/initiatives/State-Innovations.