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Archive for June, 2010

3-day Payment Window Changes Clarified

Tuesday, June 29th, 2010

On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.”  Among other provisions, this law clarifies Medicare’s policy for payment of services provided in hospital outpatient departments on either the day of or during the three days prior to an inpatient admission (known as the 3-day payment window). 

The new law clarifies Medicare’s policy to be consistent with how hospitals have largely been billing the program as far back as 1991.  Under this policy, a hospital (or an entity wholly owned or operated by the hospital) includes in its charges for the inpatient hospital stay charges for all diagnostic services and non-diagnostic services “related” to the inpatient stay that are provided during the 3 day payment window. 

In the very near future, CMS expects to provide instructions to the hospital community through its contractors advising them how to bill for related therapeutic services provided during the 3- or 1-day payment window.  Until the instruction is issued, hospitals should include charges for all diagnostic services and all non-diagnostic services that it believes meet the requirements of this provision.  If a hospital believes that a non-diagnostic service is truly distinct from and unrelated to the inpatient stay, the hospital may separately bill for the service provided that it has documentation to support that the service is unrelated to the admission, consistent with the new provision.  

For further details, go to this link.

ICD-10 Update

Friday, June 25th, 2010

The Centers for Medicare & Medicaid Services (CMS) released MLN Matters Special Edition Article #SE1019 which provides updated information about the implementation of the International Classification of Diseases, 10th Edition, Clinical Modification and Procedure Coding System (ICD-10-CM/ICD-10-PCS) code.  The first ICD-10-related compliance date is January 1, 2012. At that time, the standards for electronic health transactions changes from Version 4010/4010A1 to Version 5010. 

The MLN article can be found by going to http://www.cms.gov/MLNMattersArticles/downloads/SE1019.pdf on the CMS website.

Proposed Rule Issued on Visitation Rights

Thursday, June 24th, 2010

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule requiring hospitals and critical access hospitals (CAH) that participate in the Medicare and Medicaid programs to have written policies and procedures regarding the visitation rights of patients. Under the proposed rule, hospitals must inform patients or their representatives of their visitation rights, any clinical restrictions on those rights and their right to receive any visitors they designate. CMS will accept comments on the proposed rule through August 27.

More information is available at http://www.hhs.gov/news/press/2010pres/06/20100622d.html.

Final Rule Published on EHR Certification Process

Friday, June 18th, 2010

The Office of the National Coordinator for Health Information Technology released its final rule establishing a temporary federal process to certify electronic health records (EHR). Hospitals and physicians must use certified EHRs to receive Medicare and Medicaid incentive payments. Additional requirements to demonstrate “meaningful use” of EHRs and to qualify for the incentives have not yet been finalized but are expected to be issued shortly by the Centers for Medicare & Medicaid Services (CMS).

The final rue can be accessed at http://www.federalregister.gov/OFRUpload/OFRData/2010-14999_PI.pdf.

AMA Names New President-Elect

Wednesday, June 16th, 2010

The American Medical Association (AMA) has named as its president-elect Peter Carmel, M.D., a pediatric neurosurgeon who serves as chairman of the Department of Neurological Surgery at the New Jersey Medical School and co-medical director of the Neurological Institute of New Jersey. Carmel will become AMA president in June 2011. He was first elected to the AMA Board of Trustees in 2002.

For further details, go to http://www.ama-assn.org/ama/pub/news/news/president-elect-carmel.shtml

MedPAC Report to Congress Released

Wednesday, June 16th, 2010

The Medicare Payment Advisory Commission (MedPAC) has released its annual June report to Congress. The report reviews the Centers for Medicare & Medicare Services (CMS) role in reforming the health care delivery system, including recommendations for changing Medicare financing of graduate medical education. The Commission recommends giving CMS greater flexibility to implement certain payment reforms because, at present, the agency lacks clear legal authority to implement policies. The report also discusses the commission’s deliberations, including payment accuracy, the need to move away from volume incentives in fee-for-service Medicare, and systemic changes to better align provider incentives with a reformed delivery system.

The report is available at http://medpac.gov/documents/Jun10_EntireReport.pdf.

Community Health Data Initiative Launched

Thursday, June 3rd, 2010

The Department of Health and Human Services (HHS) and Institute of Medicine (IOM) have launched an initiative to provide community health data to the public through web-based and other tools. Users will be able to download HHS data for free and integrate it into their own websites and applications. HHS has posted the initial data sets on the Centers for Disease Control and Prevention (CDC) website. The new website will include national and local data on rates of smoking, obesity, diabetes, access to healthy food and health care services utilization.

For further details, go to http://www.hhs.gov/open/datasets/communityhealthdata.html