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Medical Industry Reimbursement News

Quality Payment Program Final Rule Issued

October 14th, 2016

On October 14, the Centers for Medicare & Medicaid Services issued a final rule with comment period implementing key provisions of the new physician payment system required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA, which repealed the Medicare sustainable growth rate (SGR) methodology and required the establishment of a new physician quality and value-based payment program. The new program, the Quality Payment Program (QPP), begins calendar year 2019. The regulation establishes rules for clinician participation in the Merit-Based Incentive Payment System (MIPS). It also details how clinicians can qualify for incentive payments based on participation in Advanced Alternative Payment Models (APMs).  The rule also finalizes policies related to blocking of health information and electronic health record (EHR) surveillance that apply to all hospitals, critical access hospitals, and physicians.

For further details, go to https://qpp.cms.gov/docs/CMS-5517-FC.pdf

CMS Announces New Initiative

October 13th, 2016

The Centers for Medicare & Medicaid Services (CMS) has announced a new initiative to improve the clinician experience with the Medicare program. Acting Administrator Andy Slavitt is appointing Dr. Shantanu Agrawal to lead the development of this function and its implementation, which will cover documentation requirements and existing physician interactions with CMS, among other aspects of provider experiences. To ensure CMS is hearing from practicing physicians, each of the ten CMS regional offices will oversee local meetings to take input from physician practices within the next six months, with regular meetings thereafter.

The first action is the launch of an 18-month pilot program to reduce medical review for certain physicians while continuing to protect program integrity. Under the program, providers practicing within specified Advanced Alternative Payment Models (APMs) will be relieved of some scrutiny under certain medical review programs. Advanced APMs were identified as a potential opportunity for this pilot because participating clinicians share financial risk with the Medicare program. Two-sided risk models provide powerful motivation to deliver care in the most efficient manner possible, greatly reducing the risk of improper billing for services. After the results of the pilot are analyzed, CMS will consider expansion along various dimensions including additional Advanced APMs, specialties, and provider types.

For more information, visit https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-10-13.html

Corrections to FY 2017 Hospital Inpatient Final Rule Issued by CMS

September 30th, 2016

On September 30, the Centers for Medicare & Medicaid Services (CMS) issued a correction notice for the fiscal year (FY) 2017 inpatient and long-term care hospital (LTCH) prospective payment system (PPS) final rule. The correction notice corrects errors and omissions of several diagnosis and procedure codes related to the FY 2017 Medicare Severity-Diagnosis Related Group and MS-Long-Term Care-DRG updates. For the inpatient PPS, the corrections slightly decrease operating and capital rates, reduce almost all wage indexes, lower uncompensated care adjustments for many hospitals receiving Disproportionate Share Hospital (DSH)payments, and increase the outlier fixed-loss threshold.  In addition, the revisions require CMS to recalculate all of the budget neutrality factors.

The correction notice is available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page-Items/FY2017-IPPS-Final-Rule-Regulations.html

New Health IT Resources Released

September 26th, 2016

The Office of the National Coordinator (ONC) for Health Information Technology (IT) has released two new resources to help health care providers implement and use health IT. The Health IT Playbook offers implementation strategies, recommendations, and best practices from a variety of clinical settings. The electronic health record contracting guide offers strategies to help providers compare EHRs and negotiate key terms with EHR vendors.

The Health IT Playbook is found at https://www.healthit.gov/playbook/ and the Contracting Guide is available at https://www.healthit.gov/sites/default/files/EHR_Contracts_Untangled.pdf


PCORI Board Members Named

September 23rd, 2016

The Government Accountability Office (GAO) has named two new members to six-year terms on the Patient-Centered Outcomes Research Institute (PCORI) Board of Governors: Russell Howerton, M.D., chief medical officer and vice president of clinical operations at Wake Forest Baptist Medical Center in Winston-Salem, NC; and Kathleen Troeger, director of outcomes research at Hologic Inc. Reappointed to the board were: Christine Goertz, vice chancellor for research and health policy at Palmer College of Chiropractic in Davenport, IA; Sharon Levine, M.D., associate executive director for The Permanente Medical Group of Northern California; Ellen Sigal, chairperson and founder of Friends of Cancer Research; Robert Zwolak, M.D., vascular surgeon at Dartmouth-Hitchcock Medical Center in Lebanon, NH; and Grayson Norquist, M.D., chief of psychiatry service at Grady Health System in Atlanta.

The press released is available at http://www.gao.gov/press/pcori_2016sep.htm?utm_medium=email&utm_source=govdelivery

Cybersecurity Discussion Guide Released by CDC

September 22nd, 2016

The Centers for Disease Control and Prevention (CDC) has released a discussion guide to help hospitals and health care organizations identify issues to address when responding to a cyber breach or attack. The guide includes scenarios and questions to facilitate small group discussions on the issue for cybersecurity preparedness and response planning.

The guide can be found at, http://www.cdc.gov/phpr/healthcare/documents/healthcare-organization-and-hospital-cyber-discussion-guide.pdf

Medicare 30-day Hospital Readmissions Fall by 565,000

September 14th, 2016

Medicare 30-day readmission rates declined in 49 states between 2010 and 2015, resulting in an estimated 565,000 fewer hospital readmissions, according to data released by the Centers for Medicare & Medicaid Services (CMS).  According to CMS, rates fell by more than 5% in 43 states and by more than 10% in 11 states. While hospitals have reduced readmissions since 2010, the program has penalized them by $1.9 billion.

For further details, visit https://blog.cms.gov/2016/09/13/new-data-49-states-plus-dc-reduce-avoidable-hospital-readmissions/

Increase in Hospital Patient Access to EHR Information Reported by ONC

September 13th, 2016

According to a report released by the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology, seven in ten hospitals provided their patients with the ability to view, download, and transmit their health information electronically in 2015, a seven-fold increase from 2013. At least 40% of hospitals in every state had these patient engagement capabilities. Among other capabilities, about three-quarters of hospitals enabled patients to request an amendment to their health data and offered patients the ability to electronically pay their bills, while more than one-third enabled patients to submit patient-generated data.

The report can be found at http://dashboard.healthit.gov/evaluations/data-briefs/hospitals-patient-engagement-electronic-capabilities-2015.php

QIOs Resume Two-midnight Reviews

September 9th, 2016

The Centers for Medicare & Medicaid Services (CMS) has announced Quality Improvement Organizations (QIO) resumed claim audits under the two-midnight inpatient admissions policy. CMS temporarily paused the patient status reviews in May to improve standardization. CMS said it was lifting the pause in reviews because the Beneficiary and Family Centered Care (BFCC) QIOs have completed re-training on the two-midnight policy, re-reviewed claims that were previously formally denied, performed provider outreach on claims affected by the temporary suspension, and initiated provider outreach and education regarding the two-midnight policy. In addition, CMS said it examined and validated the BFCC-QIOs’ peer review activities related to short-stay reviews and will continue to review a sample of completed claim reviews each month, monitor provider education calls, and respond to individual provider inquiries and concerns.

For further details, visit http://qioprogram.org/end-temporary-suspension-bfcc-qio-short-stay-reviews-faq

Emergency Preparedness Final Rule Released

September 8th, 2016

The Centers for Medicare & Medicaid Services (CMS) has released a final rule increasing emergency preparedness requirements for hospitals and other critical facilities. Recent national disasters prompted the agency to increase requirements for health care facilities in the Medicare Conditions of Participation. In the rule, CMS finalizes its proposal requiring hospitals to conduct a comprehensive all-hazard risk assessment and act to mitigate the identified risks, and to work with their community to be ready. The agency provided flexibility to hospitals in locating new generators and not requiring relocation of existing generators.

The rule is available at https://www.federalregister.gov/documents/2016/09/16/2016-21404/medicare-and-medicaid-programs-emergency-preparedness-requirements-for-medicare-and-medicaid