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Archive for October, 2010

NCQA Seeks Comments On Draft Standards on ACOs

Wednesday, October 20th, 2010

The National Committee for Quality Assurance (NCQA) has released draft standards for accountable care organizations (ACOs). Public comments can be made through November 19th. Beginning in January 2012, the Affordable Care Act (ACA) will allow qualifying health care provider groups, including hospitals, to form ACOs to improve care coordination and quality for patients while sharing in cost savings they achieve for the Medicare program. NCQA is responsible for developing quality measures for health plans, including Medicare Advantage plans. The draft criteria were developed by an NCQA task force to assess “core capabilities” for ACO success.

The draft standards are available at http://www.ncqa.org/tabid/1266/Default.aspx.

CPR Guidelines Revised

Monday, October 18th, 2010

The American Heart Association (AHA) has issued revised guidelines for cardiopulmonary resuscitation (CPR) for lay and professional rescuers. Among other changes, the guidelines change the recommended sequence of CPR steps from airway-breathing-compressions to compressions-airway-breathing. The change applies to adults, children and infants, but excludes newborns. For more than 40 years, CPR training instructions have been to open a victim’s airway by tilting their head back, pinching the nose and breathing into the victim’s mouth, and only then giving chest compressions. However, this approach has caused significant delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body.

The new guidelines can be accessed at http://www.heart.org/HEARTORG/CPRAndECC/Science/Guidelines/Guidelines_UCM_303151_SubHomePage.jsp.

Quarterly Provider Compliance Newsletter Developed

Wednesday, October 6th, 2010

The Medicare Learning Network (MLN) has developed a new educational tool designed to advise physicians, suppliers and other fee-for-service providers about how to avoid common billing errors and other erroneous activities when dealing with the Medicare Program. The new tool, the Medicare Quarterly Provider Compliance Newsletter, will be issued on a quarterly basis and highlight the key issues of that particular quarter as identified through a variety of sources.

For more information, please read the first edition of the newsletter at http://www.cms.hhs.gov/MLNProducts/downloads/MedQtrlyComp_Newsletter_ICN904943.pdf on the CMS website.

MLN Articles Identify Common RAC Denials

Monday, October 4th, 2010

The Centers for Medicare & Medicaid Services (CMS) has published two Medicare Learning Network (MLN) articles that identify some of the most common conditions for payment denials during the Recovery Audit Contractor (RAC) demonstration program. One article lists common medical necessity denials, which include cardiac defibrillator and pacemaker implants, and the other article lists common coding-based denials, such as certain lung biopsies. The denial amounts cited do not include funds returned to hospitals on appeal.

The MLN articles are available at http://www.cms.gov/MLNMattersArticles/downloads/SE1027.pdf