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Archive for May, 2010

Policy on MSP Reporting Requirements for Clinical Trial Sponsors Announced

Friday, May 28th, 2010

On May 26, the Centers for Medicare & Medicaid Services (CMS) announced its policy on application of the Medicare secondary payer (MSP) reporting requirements under section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) to sponsors of clinical trials. This new policy may help to resolve years of confusion about whether clinical trial sponsors are considered to be liability insurers for purposes of the MSP requirements

In addition, CMS also released a new policy alert on risk management write-offs. The policies were posted on the CMS website on June 10.

The policies can be found at http://www.cms.gov/MandatoryInsRep/Downloads/AlertClinicalTrailsNGHP.pdf and at http://www.cms.gov/MandatoryInsRep/Downloads/AlertRiskMgmtWriteOffsNGHP.pdf

Safety Reporting Portal Launched

Tuesday, May 25th, 2010

The National Institutes of Health (NIH) and the Food and Drug Administration (FDA) have launched a website for reporting safety data to the federal government. The Safety Reporting Portal will be used to report safety concerns related to food and human gene transfer trials, and eventually to report safety concerns related to medical products and other clinical trials and products. According to both agencies, this is a first step toward a common electronic reporting system that will allow an individual to file a single report to multiple agencies that may have an interest in the event.

The Portal can be accessed at https://www.safetyreporting.hhs.gov/fpsr/WorkflowLoginIO.aspx?metinstance=BFA2883D9C18CA5B43D0D533086EB63486115045

Telemedicine Credentialing/Privileging Process Proposed

Monday, May 24th, 2010

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would revise its conditions of participation (COP) for hospitals and critical access hospitals to allow for a less burdensome credentialing and privileging process for physicians and other practitioners providing telemedicine services. Specifically, the rule allows hospitals whose patients receive telemedicine services from physicians located in a distant location to rely on information from the distant site in making credentialing and privileging decisions.

The proposed rule is available at http://edocket.access.gpo.gov/2010/pdf/2010-12647.pdf

MPFS Conversion Factor Updated

Tuesday, May 11th, 2010

In a CMS Transmittal issued on May 10, the Centers for Medicare & Medicaid Services (CMS) updated the Medicare Physician Fee Schedule (MPFS) conversion factor to $36.0791.  The Medicare Administrative Contractors (MACs) will use this 2010 conversion factor to calculate physician payments.  The CMS transmittal also announced increased payment for dual-energy x-ray absorptiometry (DEXA) scan imaging to around $97.00, a $36.00 increase over the previous payment of approximately $61.00.

The transmittal can be viewed at http://www.cms.gov/transmittals/downloads/R700OTN.pdf.

CMS Advises Providers on Claims Submission Deadline

Tuesday, May 11th, 2010

The Centers for Medicare & Medicaid Services (CMS) has released MLN Matters Article #MM6960 to advise providers who submit claims to Medicare contractors that, as a result of the Patient Protection and Affordable Care Act (PPACA), claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare.  

For more details, please read the MLN article at http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf

Guidance Published on Dependent Coverage

Friday, May 7th, 2010

The departments of Health and Human Services (HHS), Treasury and Labor issued an explanation of the new requirements for health insurers to extend coverage to young adults. The Patient Protection and Affordable Care Act (PPACA) mandates that plans offering dependent coverage make it available to dependents up to age 26, starting with plan years beginning on or after September 23. Under the rule, coverage cannot vary based on the dependent’s age and must be offered regardless of whether the dependent lives with his or her parents, is a dependent for income tax purposes, or the dependent’s marital status. Benefits and surcharges also must apply equally. Many insurers have announced plans to offer extended coverage ahead of the September 23 implementation date.

More information is available at http://www.hhs.gov/ociio/regulations/.

Rule Published Requiring Provider to Have PECOS Record and Documentation

Friday, May 7th, 2010

The Centers for Medicare & Medicaid Services (CMS) has published an interim final rule implementing several Medicare and Medicaid program integrity provisions of the Patient Protection and Affordable Care Act (PPACA). Effective July 6, the rule states that only physicians and other eligible health professionals enrolled in Medicare and having a record in the Provider Enrollment, Chain and Ownership System (PECOS) may order or refer for certain services, including durable medical equipment, home health, Part B laboratory, imaging and specialist services. The rule also requires Medicare providers and suppliers furnishing ordered services, as well as the ordering and referring physician or health professional, to maintain documentation for seven years from the date of service and to furnish that information to CMS on request. Also, the rule specifies existing Medicare and Medicaid requirements that fee-for-service providers include their National Provider Identifier (NPI) on Medicare enrollment applications and on Medicare and Medicaid claims.

The interim final rule is available at http://edocket.access.gpo.gov/2010/pdf/2010-10505.pdf.

Medicare Publishes Ruling on DSH Issues

Thursday, May 6th, 2010

The Centers for Medicare and Medicaid Services (CMS) published a ruling on  Medicare Disproportionate Share Hospital (DSH) issues. CMS has revised the data matching process used to determine a hospital’s Supplemental Security Income fraction. CMS will apply the new process to all properly pending appeals on the issue, as well as each “open” hospital cost report where there has not been an initial notice of program reimbursement issued. In addition, CMS revised its policy on the exclusion of non-covered and exhausted-benefit inpatient days for patients entitled to Medicare part A and its policy on the counting of labor/delivery room inpatient days.

The ruling can be accessed at http://www.cms.gov/Rulings/downloads/CMS1498R.pdf