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Archive for the ‘Medical Reimbursement News’ Category

CMS Announces $10 million in Grants

Friday, June 10th, 2016

On June 10, the Centers for Medicare & Medicaid Services (CMS) launched the second round of the Support and Alignment Networks under the Transforming Clinical Practice Initiative (TCPI). This opportunity will provide up to $10 million over the next three years to leverage primary and specialist care transformation work and learning that will catalyze the adoption of Alternative Payment Models on a large scale. The Support and Alignment Networks represents a significant enhancement to the TCPI network expertise and will help clinicians prepare for the proposed new Quality Payment Program. Eligible applicants include health care delivery systems and plans that provide quality improvement support to a large number of clinicians. CMS expects to award up to five grants of $500,000 to $2.5 million through cooperative agreements.

The fact sheet can be found at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-10.html

GAO Report Recommends Steps to Reduce Medicare Appeals

Thursday, June 9th, 2016

On June 9, the Government Accountability Office (GAO) issued a report that stated that the Department of Health and Human Services (HHS) should take certain steps to reduce the number of Medicare appeals and strengthen oversight of the Medicare fee-for-service appeals process. The report, which was requested by leaders of the Senate Finance Committee, examines trends in appeals for fiscal years 2010 through 2014, data HHS uses to monitor the appeals process, and HHS efforts to reduce the number of appeals filed and backlogged. It concludes by stating that without more reliable and consistent information, HHS will continue to lack the ability to identify issues and policies contributing to the appeals backlog, as well as measure the funds tied up in the appeals process.

The report can be found at http://www.gao.gov/products/GAO-16-366

CMS Provides Additional Information on Two-midnight Review

Monday, June 6th, 2016

The Centers for Medicare & Medicaid Services (CMS) has provided additional information on its temporary pause of Quality Improvement Organization (QIO) claim audits under the two-midnight inpatient admissions policy. During the pause, which began May 4, CMS will improve standardization around the QIO review process. This will include retraining the QIOs on the two-midnight policy, a re-review of claims denied by the QIOs, and any needed provider outreach and education. CMS advises hospitals to work with their QIOs to determine whether denied claims have been re-reviewed prior to appealing a claim denial. If a denied claim has been appealed, and upon re-review the QIO determines it was denied inappropriately, the QIO will share its re-review findings with the appeals adjudicators to be taken into consideration during the appeal process. CMS anticipates that QIOs will resume audit activities within 60-90 days, but will formally advise stakeholders once the pause is lifted.

For further details, go to http://qioprogram.org/temporary-pause-qio-short-stay-reviews

Final Rule for Medicare Shared Savings Program ACOs Released

Monday, June 6th, 2016

On June 6, the Centers for Medicare & Medicaid Services (CMS) released a final rule that makes technical changes to the way financial targets are calculated for accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP). CMS will account for differences in regional health care spending when updating ACOs’ financial targets, rather than considering only an ACO’s historical financial performance. CMS will phase in the new methodology to allow ACOs time to adjust over several performance periods.

The final rule can be viewed at https://federalregister.gov/a/2016-13651

MedPAC Appointments Announced

Monday, June 6th, 2016

The Government Accountability Office (GAO) has announced the appointment of five new members to the Medicare Payment Advisory Commission (MedPAC). They are Amy Bricker, vice president of supply chain strategy for Express Scripts Inc.; Brian DeBusk, CEO of DeRoyal Industries; Paul Ginsburg, Leonard Schaeffer chair in health policy studies at the Brookings Institution and professor of health policy at the University of Southern California; Bruce Pyenson, principal and consulting actuary at Milliman Inc.; and Pat Wang, CEO of provider-sponsored health plan Healthfirst.  Jon Christianson, professor of health policy and management at the University of Minnesota’s School of Public Health, has been reappointed to the commission and will continue to serve as vice chair.

The announcement can be found by visiting http://www.gao.gov/press/medpac_appointments2016jun.htm?utm_medium=email&utm_source=govdelivery

Notice Issued Correcting Stage 3 Health Information Exchange Measures

Tuesday, May 31st, 2016

The Centers for Medicare & Medicaid Services (CMS) has issued a notice correcting a Stage 3 health information exchange measure for hospitals. Under the correction, Stage 3 health information exchange measure 2 will require eligible hospitals and critical access hospitals to incorporate into the patient’s record an electronic summary of care document for more than 40% of transitions and referrals received, as well as encounters with new patients. The final rule originally included a requirement that the summary of care document come from a source other than the provider’s EHR system. The notice includes technical corrections to the final  rule modifying meaningful use for the Medicare and Medicaid Electronic Health Records Incentive Programs in 2015 through 2017.

The notice can be found at https://federalregister.gov/a/2016-128535/31/2016

CANDOR Process Toolkit Released

Monday, May 23rd, 2016

The Agency for Healthcare Research and Quality (AHRQ) has released a toolkit to help hospital leaders and clinicians communicate accurately with patients and families when something goes wrong with their care. The customizable toolkit uses an AHRQ-developed communication and resolution process called Communication and Optimal Resolution (CANDOR). This toolkit aims to assist everyone involved – patients, families, clinicians and administrators – in discussing what happened, agree on a resolution, and make care safer in the long run.

For further details, visit http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/candor/index.html

Patient Safety Act Guidance Issued by AHRQ

Monday, May 23rd, 2016

The Agency for Healthcare Research and Quality’s (AHRQ) Office for Civil Rights (OCR) has issued guidance to clarify what qualifies as Patient Safety Work Product (PSWP) under its final rule implementing the Patient Safety and Quality Improvement Act of 2005. In addition, it offers guidance on how health care providers can satisfy both the rule and external reporting or recordkeeping obligations. The law provides legal and confidentiality protections for PSWP, including information that health care providers report to Patient Safety Organizations to improve quality and patient safety.

The guidance can be found at https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-12312.pdf

Three New Members to Health IT Policy Committee Named

Thursday, May 5th, 2016

U.S. Comptroller General Gene Dodaro has named three new members to the Health Information Technology Policy Committee, which recommends policies and standards to the National Coordinator for Health IT. James Ferguson, Vice President of HIT Strategy and Policy at Kaiser Permanente in Oakland, CA, will fill the committee position representing payers. Carolyn Petersen, Senior Editor of Mayoclinic.org for Mayo Clinic in Rochester, MN, will fill the position of patient/consumer advocate. Karen van Caulil, President and CEO of the Florida Health Care Coalition, will fill the position representing employers.

The press release can be found at http://www.gao.gov/press/appointments_hcac_2016may.htm

Final Rule on Fire Safety Requirements Published

Tuesday, May 3rd, 2016

The Centers for Medicare & Medicaid Services (CMS) has published a final rule that updates health care facilities’ fire protection guidelines to improve protections for all Medicare beneficiaries in facilities from fire.

The new guidelines apply to hospitals, long term care (LTC) facilities, critical access hospitals (CAHs), inpatient hospice facilities, programs for all inclusive care for the elderly (PACE), religious non-medical healthcare institutions (RNHCI), ambulatory surgical centers (ASCs), and intermediate care facilities for individuals with intellectual disabilities (ICF-IID).

This rule adopts updated provisions of the National Fire Protection Association’s (NFPA) 2012 edition of the Life Safety Code (LSC), as well as provisions of the NFPA’s 2012 edition of the Health Care Facilities Code. CMS strives to promote health and safety for all patients, family, and staff in every provider and supplier setting. Fire safety requirements are an important part of this effort.

The final rule can be found at https://www.federalregister.gov/articles/2016/05/04/2016-10043/medicare-and-medicaid-programs-fire-safety-requirements-for-certain-health-care-facilities