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Archive for September, 2010

Physician Self-Referral Disclosure Protocol Released

Thursday, September 23rd, 2010

The Centers for Medicare & Medicaid Services (CMS) has released the protocol for voluntarily self-disclosing actual or potential violations of the physician self-referral statute, as required by the Affordable Care Act (ACA). When a Medicare service provider or supplier electronically submits a disclosure under the self-referral disclosure protocol, CMS will review the circumstances surrounding the matter disclosed to determine a resolution. The provider or supplier’s ACA obligation to return any potential overpayment within 60 days will be suspended until they enter a settlement agreement, withdraw or are removed from the protocol.

The protocol is available at http://www.cms.gov/PhysicianSelfReferral/Downloads/6409_SRDP_Protocol.pdf.

Proposed Rule on Fraud Measures Published

Monday, September 20th, 2010

On September 20, the U.S. Department of Health and Human Services (HHS) issued a proposed rule to help fight waste, fraud and abuse in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP). These new tools were made possible by the Affordable Care Act (PPACA), which includes a series of provisions to fight fraud in the health care system. The rules will strengthen and expand CMS’ fraud prevention efforts – stopping fraud on the front end by keeping out criminals who pose as providers and prey on Medicare, Medicaid and CHIP, and saving the Medicare Trust Fund money by avoiding fraudulent claims.

The Affordable Care Act includes new provider screening and enforcement measures to help prevent and fight fraud.  In addition, the proposed rule contains important new authority to suspend payments when a credible allegation of fraud is being investigated.

The press release can be found by going to http://www.hhs.gov/news/press/2010pres/09/20100920e.html

Validation of Hospital Outpatient Quality Data Begins

Wednesday, September 15th, 2010

The Centers for Medicare & Medicaid Services (CMS) has begun validating data submitted to Medicare’s hospital outpatient quality data reporting program. CMS plans to validate a random sample of 7,300 cases submitted to the OPPS Clinical Warehouse. Hospitals must supply medical documentation for sampled cases within 45 days of request to prevent a 2% reduction in their calendar year 2011 annual payment update.

For more information, visit www.qualitynet.org.

Healthcare Spending Estimates Reflect Health Reform

Thursday, September 9th, 2010

The Centers for Medicare & Medicaid Services (CMS) has projected national health spending will grow an average 6.3% annually through 2019. This represents 0.2 percentage point more than projected in February because of health care reform and other recently enacted legislation. The agency projects health care will account for 19.6% of gross domestic product by 2019, 0.3 percentage point higher than anticipated before reform. CMS expects spending growth to slow from 5.1% in 2010 to 4.2% in 2011 if a 23% physician payment cut takes effect in December 2010 and COBRA premium subsidies expire. The agency also expects spending to rise by 9.2% in 2014, primarily because of expansions of health coverage through Medicaid and the state health insurance exchanges. By 2019, private health coverage is expected to account for 32% of national health spending. Government administrative costs for health reform are estimated at $71.1 billion through 2019.

For more information go to, the article in Health Affairs at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2010.0788

IRS Draft Form for Small Employer Health Care Tax Credit Issued

Wednesday, September 8th, 2010

The Internal Revenue Service (IRS) released a draft version of the form that eligible small businesses and tax-exempt organizations will use to calculate their health care tax credit under the Patient Protection and Affordable Care Act (PPACA). The credit is designed to encourage small employers to offer or maintain health insurance coverage. Small businesses will claim the tax credit as part of the general business credit on their income tax returns. Tax-exempt organizations will claim the credit on a revised Form 990-T, currently used to report and pay the tax on unrelated business income. The final Form 8941 and its instructions will be available later this year.

The draft form is available at http://www.irs.gov/pub/irs-dft/f8941–dft.pdf.

National ICD Registry 2009 Annual Report Released

Wednesday, September 8th, 2010

The National ICD Registry, a repository of Implantable Cardiac Defibrillators (ICD) implantation data developed through a partnership of the Heart Rhythm Society (HRS) and the American College of Cardiology (ACC) Foundation, has released the National ICD Registry Annual Report for 2009.

The annual report includes data that span over four years and is the largest repository for ICD implantation data. The Registry is accruing ICD implants at the rate of 10,000 per month with 79 percent of implants in the Registry being performed in hospitals that enter all data on patients regardless of device indication or patient age. The 2009 report includes data on 486,025 ICD implantations from 1,434 participating hospitals and 5,246 implanting physicians. Key findings in the report are:

  • Total complications for new implants (including death in the laboratory) have decreased over time from 3.77% in 2006 to 2.87% in 2009.
  • Medicare beneficiaries accounted for 68 percent of patients.
  • The device was placed for primary prevention in 78 percent of patients, two-thirds with coronary artery disease, the average left ventricular ejection fraction (LVEF) was 29 percent, and 82 percent were NYHA Class II-III.
  • Among physicians that provided information about their training, 56 percent completed an electrophysiology fellowship, accounting for 83 percent of ICD implants. 
  • Of patients receiving cardiac resynchronization therapy with defibrillation backup (CRT-D), 68 percent were shown to meet published national guidelines. 
  • Of patients receiving an ICD for primary prevention of sudden death, 78 percent met published national guidelines.   

For more information about this study, please visit www.heartrhythmjournal.com.