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Archive for December, 2009

Most Hospitals Will Receive Full Medicare Outpatient Payment Update

Tuesday, December 22nd, 2009

The Centers for Medicare & Medicaid (CMS) has announced that ninety-seven percent of hospitals eligible to participate in the hospital outpatient quality data reporting program have qualified to receive a full Medicare payment update for calendar year 2010. Those hospitals’ CY 2010 payment update will be 2.1 percentage points, compared to 0.1 percentage point for hospitals that did not qualify for a full update. 

For further details, visit http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier3&cid=1228694344014

Changes to the 2010 Medicare Physician Fee Schedule

Monday, December 21st, 2009

The President has signed the Department of Defense Appropriations Act of 2010 which provides a two-month zero-percent (0%) update to the 2010 Medicare physician fee schedule (MPFS), effective only for dates of service January 1, 2010 through February 28, 2010. 

Legislation has eliminated the proposed negative 21.2-percent update to the MPFS and has provided for a zero-percent update for the services rendered in the months of January and February 2010. In addition, there have been revisions to the physician fee schedule conversion factor (CF) and practice expense relative value units (RVUs).

The Conversion Factor for this interim fee schedule is set at $36.0846. The CF used for the 2009 fee schedules was $36.0666. The RVUs in this interim fee schedule utilize the 2010 RVUs. In addition, any code changes for 2010 are included in this interim fee schedule.

Explanation of Consultation Services Payment Policy Published

Tuesday, December 15th, 2009

On December 14, the Centers for Medicare & Medicaid Services (CMS) published an article explaining the revisions to the consultation services payment policy. As noted in Change Request (CR) 6740, effective January 1, consultation codes will not longer be recognized for Medicare Part B payment. Effective for services furnished on or after January 1, providers should code a patient evaluation and management (E/M) visit with an E/M code that represents where the visit occurred and that identified the complexity of the visit performed. The article also reviews other key points of CR 6740.

The Medlearn article is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf

MedPAC Considers Draft Recommendations

Friday, December 11th, 2009

The Medicare Payment Advisory Commission (MedPAC) has considered a draft recommendation to Congress that would provide a full “market basket” update for fiscal year 2011 outpatient and inpatient hospital payments. The market basket update is used to adjust hospital payments for inflation. The draft recommendation would provide hospitals with a full Medicare payment update that would take effect along with adoption of a quality incentive program. MedPAC staff project that overall Medicare margins will be a negative 5.9% in FY 2010. The commission also reported that hospitals’ Medicare margins dropped to a negative 7.2% in 2008 from negative 6% the previous year.

MedPAC is also considering recommending that inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities and home health providers receive no Medicare payment update in 2011.  The draft recommendations would also rebase home health payment rates to reflect the average cost of providing care. MedPAC’s draft recommendations may be revised before the commission votes on them in January

Further information can be accessed at http://www.medpac.gov/.

CMS to Cover HIV infection Screening

Tuesday, December 8th, 2009

The Centers for Medicare & Medicaid Services (CMS) has announced its decision to cover Human Immunodeficiency Virus (HIV) infection screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service. The decision is effective immediately.

The decision memo can by found at http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=229&

Limits on RAC Medical Record Requests Announced

Thursday, December 3rd, 2009

The Centers for Medicare & Medicaid Services (CMS) has announced limits on the number of medical records that may be requested by recovery audit contractors. RACs will use these records to validate diagnosis related groups, coding and the medical necessity of care provided by hospitals. Under the new guidelines, a 45-day record request limit will be established for each hospital campus, based on the organization’s tax identification number and selected zip code information.

For details, see the CMS notice at http://www.cms.hhs.gov/RAC/Downloads/DRGvalidationADRlimitforFY2010.pdf

The Joint Commission Accreditation Recognized by CMS

Tuesday, December 1st, 2009

The Centers for Medicare & Medicaid Services (CMS) has approved the continuation of deeming authority for The Joint Commission’s hospital accreditation program through July 15, 2014. The designation means that hospitals accredited by The Joint Commission may choose to be “deemed” as meeting Medicare and Medicaid certification requirements. CMS found that The Joint Commission’s standards for hospitals meet or exceed those established by the Medicare and Medicaid program.

The press release can be found by going to http://www.jointcommission.org/NewsRoom/NewsReleases/nr_11_30_09.htm