1.800.456.4350 info@prgweb.com

Archive for the ‘Medical Reimbursement News’ Category

Medicare Payment to Physicians to Increase July 1

Monday, June 15th, 2015

As part of the “Protecting Access to Medicare Act of 2014″, 2014 pricing policy for the Medicare Physician Fee Schedule was extended through March 31, 2015. The “Medicare Access and CHIP Reauthorization Act (MACRA) of 2015″ further extended the 0 percent update and other provisions through June 30, 2015. Starting July 1, the legislation provides for a 0.5 percent update to the Medicare Physicians Fee Schedule by increasing the conversion factor (CF) to 35.9335.

Further details of MACRA of 2015 can be found at https://www.congress.gov/bill/114th-congress/house-bill/2/text

Increased Transparency for Consumers on Health Insurance Coverage

Friday, June 12th, 2015

The Departments of Health and Human Services (HHS), Labor, and the Treasury have issued final regulations to make it easier for people and employers to compare their options when shopping for and renewing health insurance coverage.  These rules also implement streamlined processes to help health insurance issuers and group health plans provide consumers easy to understand information.  The final rules make few changes to the rules proposed in December, 2014. In continuing the goal of providing clear and straightforward information to consumers about health plans available in their area, health insurance issuers and group health plans must still provide a brief Summary of Benefits and Coverage (SBC) that includes coverage examples and a uniform glossary to consumers.  Revisions to the SBC, coverage examples, and a uniform glossary are anticipated to be finalized by January, 2016 after the Departments utilize consumer testing and receive additional input from the public, including the National Association of Insurance Commissioners (NAIC). The revisions will apply to SBCs for coverage beginning on or after January 1, 2017.

To view the Final Rules, visit https://www.federalregister.gov/articles/2015/06/16/2015-14559/summary-of-benefits-and-coverage-and-uniform-glossary


Medicare and Medicaid to Celebrate 50th Anniversary

Wednesday, June 10th, 2015

This summer will mark the 50th anniversary of the enactment of Amendments to the Social Security Act that established the Medicare and Medicaid programs. Over the next 50 days, the Centers for Medicare & Medicaid Services (CMS) will recognize the impact these two programs have had in transforming our nation’s health care system. By sharing daily facts and posts on Twitter (@cmsgov) and Medicaid.gov, CMS will highlight people, places, and progress that represent the Medicare and Medicaid programs. To commemorate this anniversary, in late July, regional CMS offices will host public events in addition to a national event in Washington, D.C.

The press release can be found by going to http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-06-10.html

ACO Final Rule Released

Friday, June 5th, 2015

On June 4, the Centers for Medicare & Medicaid Services (CMS) released a final rule on changes to the Medicare Shared Savings Program (MSSP) and provisions relating to Medicare payments to providers and suppliers participating in Accountable Care Organizations (ACOs) under the MSSP. CMS also finalized the ability to allow non-risk-bearing ACOs to participate for an additional agreement period. The agency will also change the methodology for assigning beneficiaries to ACOs, create a third track for MSSP participation, and provide additional data to help ACOs better manage care. These changes will apply to existing ACOs and approved ACO applicants participating in the program beginning January 1, 2016.

The final rule can be found at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-14005.pdf

2013 Medicare Payment Data Released

Monday, June 1st, 2015

The Centers for Medicare & Medicaid Services has released 2013 data on average charges and payments for hospitals, physicians and other suppliers under Medicare Parts A and B. The annual update includes hospital-specific data for the 100 most common inpatient Diagnosis Related Groups and 30 select outpatient Ambulatory Payment Classifications, as well as physician/supplier-specific data for services and products.

The press release is available at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-06-01.html

CMS Announces Payment Model Seeking to Reduce CV Risks

Thursday, May 28th, 2015

On May 28, The Centers for Medicare & Medicaid Services (CMS) announced that physician practices can apply through September 4 to participate in a CMS model that will test whether paying practices to identify and manage cardiovascular (CV) risks for Medicare patients reduces heart attacks, strokes, and Medicare costs. Practices will use an American College of Cardiology/American Heart Association calculator to measure cardiovascular risk for eligible patients and work with them to identify the best approach to reduce their risk. The five-year model seeks to enroll 720 practices and 300,000 beneficiaries.

The press release can be found at http://www.hhs.gov/news/press/2015pres/05/20150528a.html

AHRQ Awards $112 Million to Promote Heart Health

Wednesday, May 27th, 2015

The Agency for Healthcare Research and Quality (AHRQ) has awarded $112 million to create seven regional cooperatives to assist up to 300 small primary care practices improve heart health for their patients. The initiative, EvidenceNOW, will help these practices incorporate key evidence-based interventions to reduce cardiovascular risks: aspirin use by high-risk individuals, blood pressure control, cholesterol management, and smoking cessation. Services will include onsite coaching, consultation from experts, sharing best practices, and electronic health record support. An eighth awardee will evaluate the impact of the interventions on practice improvement and the delivery of cardiovascular care. The initiative is supported by the Patient-Centered Outcomes Research Trust Fund.

For more information, go to http://www.ahrq.gov/professionals/systems/primary-care/evidencenow.html

GAO Makes MedPAC Appointments

Tuesday, May 26th, 2015

Gene L. Dodaro, Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), has announced the appointment of a new member to the Medicare Payment Advisory Commission (MedPAC), as well as the reappointment of five current members and the designation of the Commission’s Chair. The newly appointed member is Susan Thompson, MS, RN, Chief Executive Officer of UnityPoint Health in Fort Dodge, IA. Her term will expire in April 2018.

The reappointed members, whose terms will also expire in April 2018, are Alice Coombs, MD, Critical Care Specialist and Anesthesiologist, South Shore Hospital, Weymouth, MA; Jack Hoadley, PhD, Research Professor, Health Policy Institute, Georgetown University, Washington, DC; David Nerenz, PhD, Director of the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI; Rita Redberg, MD, Professor, Clinical Medicine, University of California at San Francisco Medical Center, San Francisco, CA; and Craig Samitt, MD, Global Provider Practice Leader in Oliver Wyman’s Health & Life Sciences Practice. In addition, Commissioner Francis “Jay” Crosson, MD, has been designated as Chair of the Commission.

For further details, visit http://www.gao.gov/press/medpac_appointments2015may.htm

PQRS to Transition to New Portal

Friday, May 15th, 2015

On July 13, the Centers for Medicare & Medicaid Services (CMS) will transition the Physician Quality Reporting System (PQRS) to its Enterprise Identity Management System (EIDM). Current PQRS users, their data and roles will be moved to a new “PQRS Portal” portion of the CMS Enterprise Portal. Providers should ensure that their Individual Authorized Access to CMS Computer Services (IACS) account is active, current, and accessible to enable a successful transition. New PQRS users will need to register for an EIDM account.

To access to new portal, go to portal.cms.gov. For further assistance regarding IACS or EIDM, contact the QualityNet Help Desk at qnetsupport@hcqis.org.

CMS Issues Videos on ICD-10 Hospital Payment Impact

Friday, May 8th, 2015

The Centers for Medicare & Medicaid Services (CMS) has released a 29-minute video on estimating the impact of the transition to ICD-10 on Medicare inpatient hospital payments. The agency has also released a seven-minute video on Medicare’s testing plan for ICD-10. The Medicare Learning Network videos were recorded during a March 18 meeting of CMS’ ICD-10 Coordination and Maintenance Committee.

The videos can be found at https://www.youtube.com/watch?v=dZxilyTjfGI and https://www.youtube.com/watch?v=QJeHxPYirjA