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Archive for the ‘Medical Reimbursement News’ Category

CMS Announces Medicare Advantage Premiums

Thursday, September 18th, 2014

On September 18, the Centers for Medicare & Medicaid Services (CMS) announced that the average Medicare Advantage (MA) premium submitted by health plans for 2015 would increase by $2.94, to $33.90 per month. However, CMS estimates the actual 2015 MA average premium may increase by only $1.30, as more beneficiaries elect to enroll in lower cost plans. The vast majority of MA enrollees will experience little or no premium increase for next year, with 61% of beneficiaries not experiencing any increase. According to CMS, enrollment is projected to increase to a new all-time high.

The press release can be found at http://cms.hhs.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-09-18.html

Preview of Quality Data and HCAHPS Star Rating Available

Monday, September 15th, 2014

Hospitals can preview and validate their quality data through October 14th. The data are scheduled to be added to the Hospital Compare website in December.  Hospitals can also preview how their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data would appear in an HCAHPS star rating system which will be added to Hospital Compare in April 2015. In addition, they can provide feedback to the Centers for Medicare & Medicaid Services (CMS) on how to improve the star rating system. Hospitals may access their preview reports at the QualityNet portal.

For more information, go to http://www.hcahpsonline.org/home.aspx, and for assistance accessing reports, contact HospitalCompare@hsag.com

CDC Issues Enterovirus D68 Guidance

Monday, September 15th, 2014

The Centers for Disease Control and Prevention (CDC) has issued recommendations for clinical care, laboratory testing, infection control, and reporting for enterovirus D68. Hospitals in Missouri and Illinois have seen more children than usual with severe respiratory illness caused by the virus, which was first isolated in California in 1962 but has been rarely reported in the U.S. It primarily causes respiratory illness, although the full spectrum of disease remains unclear. There are no vaccines or specific treatments for the virus, and clinical care is supportive. Prevention tips include washing hands often with soap and water.

For more on the recommendations, visit http://emergency.cdc.gov/HAN/han00369.asp

Voluntary EHR Certification Final Rule Released

Wednesday, September 10th, 2014

The Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (HIT) has released a final rule governing voluntary updates to the certification criteria for 2014 edition electronic health record technology. The 2014 Edition Release 2, previously named the Voluntary 2015 Edition Electronic Health Record Certification Criteria, provides voluntary alternative approaches, including 10 optional and two revised certification criteria for EHRs

The rule is available at https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-21633.pdf.

Marketplace Navigator Grants Awarded

Tuesday, September 9th, 2014

The Department of Health and Human Services (HHS) has awarded $60 million in navigator grants to 90 organizations in states with federally-facilitated and state partnership Health Insurance Marketplaces. The navigators serve as an in-person resource for those who require additional assistance with Marketplace enrollment. In addition, they will provide unbiased information to help eligible individuals and families enroll in coverage, compare their coverage options, and determine whether they are eligible for public programs. The grant recipients must also maintain a physical presence in the Marketplace service area, be trained on and comply with security and privacy standards, and submit weekly progress reports to HHS. This year’s required training includes a course on advanced Marketplace issues, among other new elements, HHS said. In addition to navigators, Marketplaces will again make other resources available to help consumers access Marketplace coverage, such as certified application counselors (a role played by many hospitals), non-navigator assistance personnel (also known as in-person assisters), and agents and brokers.

For further details, go to http://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/navigator-list-09-08-2014.pdf

ICD-10 Testing Weeks Announced

Tuesday, September 2nd, 2014

The Centers for Medicare & Medicaid Services (CMS) has announced three weeks of ICD-10 acknowledgement testing. CMS is instructing all Medicare Administrative Contractors (MAC) to promote the testing with their health care providers and suppliers. The weeks are November 17-21, 2014, March 2-6, 2015, and June 1-5, 2015. CMS stated that during the testing weeks, test claims will receive the appropriate acknowledgement to confirm that the claim was accepted or rejected by Medicare. MAC help desks will also be staffed to handle increased call volume.

For more information on the testing process, go to http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8858.pdf

HHS Senior Counselor Named

Wednesday, August 13th, 2014

Health and Human Services (HHS) Secretary Sylvia Burwell has named Kevin Thurm as a senior counselor in the department. Thurm served as deputy secretary under former HHS Secretary Donna Shalala and has held various leadership positions at Citigroup since 2001. As a senior counselor reporting to Burwell, he will work with senior staff on strategic initiatives, policy challenges, and engagement with external partners.

The press release can be found at http://www.hhs.gov/news/press/2014pres/08/20140813a.html

Limited Restart of RAC Reviews Announced

Wednesday, August 6th, 2014

The Centers for Medicare & Medicaid Services has announced that they will allow current Recovery Audit Contractors (RACs) to restart a limited number of claim reviews. CMS stated that most reviews will be done on an automated basis. However, a limited number will be complex reviews on certain claims, including spinal fusions, outpatient therapy services, durable medical equipment, prosthetics, orthotics and supplies, and cosmetic procedures. RACs will not review claims to determine whether the care was delivered in the appropriate setting during the restart.

For more information, go to http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Recent_Updates.html

Medicare Releases 2015 IPPS and LTCH Final PPS Rule

Monday, August 4th, 2014

On August 4, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating the fiscal year (FY 2015) Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals (LTCH). CMS announced that the payment rate update to general acute care hospitals will be 1.4% in FY 2015. The rate update for long-term care hospitals will be 0.9%. The difference in the updating is accounted for by different statutory and regulatory provisions that apply to each system.

Some key provisions included in the 2015 Inpatient Prospective Payment System (IPPS) final rule are:

  • For FY 2015, CMS is increasing the applicable percentage reduction to the Hospital Value-Based Purchasing (VBP) Program adjusting to 1.5% of the base operating MS-DRG payment amounts to all participating hospitals. CMS estimates that the total amount available for the value-based incentive payment will be approximately $1.4 billion.
  • Hospital Readmissions Reduction Program will see a maximum reduction increase from 2 to 3 percent. For FY 2015, CMS will assess hospitals’ readmissions measures endorsed by the National Quality Forum. CMS estimates that hospital readmissions for Medicare declined by a total of 150,000 from January 2012 through December 2013.
  • CMS is implementing the Affordable Care Act’s (ACA) Hospital Acquired Condition (HAC) Reduction Program. Beginning in FY 2015, hospitals scoring in the top quartile for the rate of HACs will have their Medicare inpatient payments reduced by one percent. This new program builds on the progress in this area achieved through the existing HAC program, which is currently saving $30 million annually.
  • CMS is revising the labor market areas used for the wage index based on the most recent Office of Management and Budget (OMB) Core-Based Statistical Area delineations that are based on 2010 Census data. In order to mitigate potential negative payment impacts, CMS is adopting a one-year transitional during FY 2015 that would be based on a 50/50 blend of the former wage index and the new wage index. The new wage index will take effect in full in FY 2016.

The display copy can be found by going to https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-18545.pdf

FY 2015 SNF and IRF Final Rules Released

Thursday, July 31st, 2014

On July 31, the Centers for Medicare & Medicaid Services (CMS) released the final rules updating Medicare fee-for-service payments for skilled nursing facilities (SNF) and inpatient rehabilitation facilities (IRF) for fiscal year (FY) 2015. The SNF final rule provides an overall 2.0% update, with a 2.1% update for hospital-based SNFs, for FY 2015 compared to FY 2014. The IRF final rule increases FY 2015 payments by 2.4% overall compared to FY 2014 payments. In the IRF rule, CMS finalized two new health care-associated infection measures for the FY 2017 IRF quality reporting program. These measures assess the rates of Methicillin-resistant Staphylococcus aureus and Clostridium Difficile infections.

The SNF rule is available at http://www.ofr.gov/OFRUpload/OFRData/2014-18335_PI.pdf and the IRF rule at  http://www.ofr.gov/OFRUpload/OFRData/2014-18447_PI.pdf