1.800.456.4350 info@prgweb.com

Archive for August, 2010

Initial EHR Certification Bodies Named

Tuesday, August 31st, 2010

The Certification Commission for Health Information Technology (CCHIT), Chicago, Ill. and the Drummond Group Inc. (DGI), Austin, Texas, were named today by the Office of the National Coordinator for Health Information Technology (ONC) as the first technology review bodies that have been authorized to test and certify electronic health record (EHR) systems for compliance with the standards and certification criteria that were issued by the U.S. Department of Health and Human Services (HHS) earlier this year.

Announcement of these ONC-Authorized Testing and Certification Bodies (ONC-ATCBs) means that EHR vendors can now begin to have their products certified as meeting criteria to support meaningful use, a key step in the national initiative to encourage adoption and effective use of EHRs by health care providers.

A news release is available at http://www.hhs.gov/news/press/2010pres/08/20100830d.html.

RACs Begin Medical Necessity Reviews

Monday, August 30th, 2010

The Centers for Medicare & Medicaid Services’ (CMS) New Issue Review Board has given the four regional Medicare Recovery Audit Contractors (RACs) approval to begin medical necessity reviews for 18 inpatient hospital conditions. RACs are authorized to begin requesting medical charts for medical necessity review audits after announcing the audits on their websites. To date, RACs in all but Region A have announced medical necessity review audits.

For more information, go to http://www.cms.gov/RAC/

New Web Tool Helps Users Locate Coverage Options

Wednesday, August 25th, 2010

The Department of Health and Human Services (HHS) released a Web tool to help the public search for coverage options. The Insurance Finder “widget” enables anyone with a website or blog to embed the tool on their site. After answering initial questions, users are directed to a page that continues the insurance finder process based on answers to specific questions.

To view the widget, visit www.healthcare.gov/stay_connected.html.

Final Rule on MACPAC Payment Error Rates Published

Wednesday, August 11th, 2010

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule implementing changes to the Medicaid Eligibility Quality Control and Payment (MACPAC) Error Rate Measurement programs, which estimate improper payments in Medicaid and the Children’s Health Insurance Program. The rule changes the process for reviewing cases in which states have used simplified enrollment efforts such as self-declaration for eligibility cases, eliminates duplication of effort between eligibility reviews administered in the same fiscal year, extends the timeframe for providers to submit documentation, and gives states additional time to submit corrective action plans.

The rule is available at http://edocket.access.gpo.gov/2010/pdf/2010-18582.pdf.

CMS Issues NCD for PET

Tuesday, August 10th, 2010

The Centers for Medicare and Medicaid Services (CMS) has issued a decision memo for PET for initial treatment strategy in solid tumors and myeloma. The memo states that:

  1. the National Coverage Determinations (NCD) manual will be changed to remove the current absolute restriction of coverage to ‘only one’ FDG PET scan to determine the location and/or extent of the tumor for the therapeutic purposes related to the initial treatment strategy as described above; 
  2. CMS will continue to nationally cover one FDG PET scan to determine the location and/or extent of the tumor for the therapeutic purposes related to the initial treatment strategy as described above; and 
  3. local Medicare administrative contractors will have discretion to cover (or not cover) within their jurisdictions any additional FDG PET scan for the therapeutic purposes related to the initial treatment strategy as described above. 

 

For more information, visit http://www.cms.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=237&

RACs Begin Medical Necessity Reviews

Tuesday, August 10th, 2010

The Centers for Medicare & Medicaid Services’ (CMS) New Issue Review Board has approved the first “medical necessity review” audits for Medicare’s permanent recovery audit contractor (RAC) program. The newly approved audits include 18 types of inpatient hospital claims and one type of durable medical equipment claim. Before issuing requests to hospitals for these reviews, each RAC must post on its website the particular audits it will conduct, including citations for the related Medicare policy. CMS expects the RACs to post the new audits and begin issuing Additional Documentation Requests (ADRs) shortly.

For further information, go to http://www.cms.gov/RAC/Contact information

3-Day Payment Window Rule Clarified

Friday, August 6th, 2010

President Obama recently signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010″. One of the provisions the law clarifies is Medicare’s policy for payment of outpatient services provided on either the date of a beneficiary’s inpatient admission or during the three calendar days immediately preceding the date of a beneficiary’s admission (known as the 3-day payment window).  Under the payment window policy, a hospital (or an entity that is wholly owned or wholly operated by the hospital) must include the diagnoses, procedures and charges for all outpatient diagnostic services and admission-related outpatient non-diagnostic services that are furnished to the beneficiary during the 3-day payment window on the claim for a beneficiary’s inpatient stay. The new law makes the policy pertaining to admission-related outpatient non-diagnostic services more consistent with common hospital billing practices. 

To view the CMS fact sheet, click here.