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Archive for the ‘Medical Reimbursement News’ Category

CMS Launches Next Phase of Quality Improvement Program

Friday, July 18th, 2014

The Centers for Medicare & Medicaid Services (CMS) has awarded additional contracts as part of a restructuring of the Quality Improvement Organizations (QIO) Program to create a new approach to improve care for beneficiaries, family, and caregivers. The new contracts, being awarded to fourteen organizations, represent the second phase of QIO restructuring. The initial phase was announced on May 9. The awardees will work with providers and communities across the country on data-driven quality initiatives. These QIOs will be know as Quality Innovation Network (QIN)-QIOs

For more information, go to http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-07-18.html

Health Care Innovation Grants Announced

Thursday, July 10th, 2014

Health and Human Services Secretary Sylvia Mathews Burwell has announced new prospective awardees to test innovative care models, bringing the total amount of funding to as much as $360 million for 39 recipients spanning 27 states and the District of Columbia. These models are designed to deliver better health care and lower costs under the Health Care Innovation Awards program.

The prospective awards range from an expected $2 million to $23.8 million over a three year period. These awards are made possible by the Affordable Care Act and round out the anticipated recipients for round two of the Health Care Innovation Awards program.  Examples include projects that promote better care for persons living with HIV/AIDS, reduce unnecessary use of emergency departments, improve pediatric dental care, promote prevention and management of cardiovascular disorders, and improve care coordination in rural areas of the country.  Earlier this year, HHS announced 12 prospective round two recipients receiving as much as $110 million in combined funding and testing models in 13 states.  Prospective recipients will receive their final Notice of Award later this summer.

The press release can be found at http://www.hhs.gov/news/press/2014pres/07/20140709b.html

2015 Medicare Physician Fee Schedule Proposed Rule Published

Thursday, July 3rd, 2014

On July 3, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the Medicare Physician Fee Schedule for calendar year (CY) 2015. Based on the propose rule, physicians will see no change in payment for the first 3 months of 2015 due to  the Protecting Access to Medicare Act of 2014. However, the sustainable growth rate (SGR) will take effect April 1, 2015, unless Congress intervenes. At that time physician would face a mandated 20.9% reduction.

Other provisions in the proposed rule include transitioning all 10- and 90-day global period codes to 0-day global periods staring in CY 2017, applying the value-based payment modifier to all physicians and physician eligible professionals, as well expanding public reporting of clinical quality measures. The agency also proposes to create a new code to report non-face-to–face chronic care management. In addition, CMS seeks a review of 65 services with Medicare allowed charges of $10 million or more as a prioritized subset of codes under the newly established statutory category of codes that account for the majority of spending under the fee schedule. The list includes SPECT, MPI, and transthoracic and stress echocardiography.

The proposed physician rule can be viewed at http://www.gpo.gov/fdsys/pkg/FR-2014-07-11/pdf/2014-15948.pdf

CY 2015 OPPS and ASC Medicare Proposed Rule Released

Thursday, July 3rd, 2014

On July 3, the Centers for Medicare & Medicaid Services released the Calendar Year (CY) 2015 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates proposed rule. CMS proposes to update the OPPS market basket by 2.1 percent for CY 2015. The increase is based on the projected hospital market basket increase of 2.7 percent minus both a 0.4 percentage point adjustment for multi-factor productivity and a 0.2 percentage point adjustment required by law.

The key proposals contained in the rule are:

  • Implementation of 28 Comprehensive Ambulatory Payment Classifications (APCs) after delaying them in 2014. Services assigned to the comprehensive APCs will be defined as primary services, with payment for all other services packaged under the primary service.
  • Requirements for physician certification of inpatient admissions would be revised to apply only for long-stay cases and costly outlier cases. CMS believe that in most cases, the admission order, medical record and notes contain sufficient information to support the medical necessity of an inpatient admission.
  • Hospitals and physicians would be required to report a modifier with each procedure code billed under the physician fee schedule and in the OPPS when services are provided in an off-campus provider-based department.

The proposed rule can be viewed at http://www.gpo.gov/fdsys/pkg/FR-2014-07-14/pdf/2014-15939.pdf

Joint Commission Authority Renewed

Tuesday, July 1st, 2014

The Centers for Medicare & Medicaid Services (CMS) has renewed for six years The Joint Commission as a national accrediting organization for hospitals that wish to participate in the Medicare or Medicaid program. As part of the approval, The Joint Commission made changes to some of its requirements effective July 1. CMS deems organizations accredited by an approved accrediting organization to be in compliance with all Medicare conditions of participation.

The Federal Register notice can be found at http://www.gpo.gov/fdsys/pkg/FR-2014-06-27/pdf/2014-15103.pdf

Home Health Proposed Rule Issued

Tuesday, July 1st, 2014

The Centers for Medicare & Medicaid Services (CMS) has released the proposed rule for the home health prospective payment system for calendar year 2015. This proposed rule updates Medicare payment rates to home health agencies and implements the second year of the four year phase-in of the rebasing of this payment system. The proposed rule would reduce home health payments by 0.3% from 2014 payment levels. The regulation also reports on CMS’s ongoing monitoring of the impact of the face-to-face encounter, and proposes to simplify the requirements for this policy.

The proposed rule can be found at https://www.federalregister.gov/articles/2014/07/07/2014-15736/medicare-and-medicaid-programs-cy-2015-home-health-prospective-payment-system-rate-update-home

Proposed Standards for Marketplace Enrollment Period Released

Thursday, June 26th, 2014

The Centers for Medicare & Medicaid Services (CMS) has released proposed standards for the next enrollment period for the Health Insurance Marketplaces (HIP) created under the Affordable Care Act (ACA). The proposed rule specifies additional options for annual eligibility redeterminations, and renewal and re-enrollment for qualified health plans offered through the HIP.

The proposed standards can be found at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/508_CMS-9941-P-OFRv-6-26-14.pdf

CMS Management Changes Announced

Friday, 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

Monday, 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

Tuesday, 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