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Archive for November, 2010

DMEPOS Competitive Bidding Program Begins January 1

Tuesday, November 30th, 2010

The Centers for Medicare & Medicaid Services (CMS) is reminding Medicare providers who refer beneficiaries for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) that the competitive bidding program begins on January 1 in nine areas of the country. Under phase one of the program, traditional Medicare will only pay for items in nine product categories if the beneficiary obtains them from a contract supplier. The affected areas are: Orlando, Charlotte, Dallas, Cincinnati, Cleveland, Kansas City, Miami, Pittsburgh and Riverside, CA.

Medicare has a variety of resources available regarding the new program at www.cms.gov/DMEPOSCompetitiveBid.

The DMEPOS Competitive Bidding Program Medicare Learning Network® (MLN) Fact Sheets can be found at www.cms.gov/MLNProducts/downloads/DMEPOS_Competitive_Bidding_Factsheets.pdf.

Rule Issued on Medical Loss Ratio Rebates

Monday, November 22nd, 2010

The Department of Health and Human Services (HHS) has issued an interim final rule for calculating medical loss ratio rebates under the Patient Protection and Affordable Care Act (ACA). The ACA requires health plans to provide rebates to enrollees if their medical loss ratio, the percentage of premiums spent on clinical services and health care quality improvement activities, is less than 85% for large group health plan markets or 80% for small group and individual markets. The rule takes affect January 1.

The interim final rule can be viewed at http://edocket.access.gpo.gov/2010/pdf/2010-29596.pdf.

New Innovation Center Established

Tuesday, November 16th, 2010

The Centers for Medicare & Medicaid Services (CMS) has formally established the new Center for Medicare and Medicaid Innovation (CMMI). As part of the Affordable Care Act (ACA), CMMI will examine new ways of delivering health care and paying health care providers that can save money for Medicare and Medicaid while improving the quality of care.  CMS also announced the launch of new demonstration projects that will support efforts to better coordinate care and improve health outcomes for patients. 

More information on the CMMI is available at: http://www.innovations.cms.gov.

2011 Medicare Premiums and Deductibles Announced

Friday, November 5th, 2010

The Centers for Medicare & Medicaid Services (CMS) has announced the Medicare premiums and deductibles for beneficiaries in 2011. For Medicare Part A, which pays for inpatient hospital, skilled nursing facility, hospice and some home health care services, the deductible paid by the beneficiary when admitted as a hospital inpatient will be $1,132. This deductible is the cost for up to 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries must pay an additional $283 per day for days 61 through 90, and $566 per day for hospital stays beyond the 90th day in a benefit period.

The standard monthly premium for Medicare Part B will be $115.40. However, for most of the Part B beneficiaries, a “hold-harmless” provision prevents their net Social Security benefit from decreasing as a result of an increase in the Part B premium. Therefore, the majority of Medicare beneficiaries will continue to pay the same $96.40 premium they have paid since 2008.

 For more on the 2011 premiums and deductibles, go to this link.

DMEPOS Competitive Bidding Contracts Awarded

Thursday, November 4th, 2010

The Centers for Medicare & Medicaid Services (CMS) has awarded 356 supplier contracts to provide certain medical equipment and supplies to Medicare beneficiaries in nine regions at competitive bid rates. The first round of contracts in Medicare’s new competitive bidding program for durable medical equipment, prosthetics, orthotics and supplies take effect January 1, 2011 in the Charlotte, Cincinnati, Cleveland, Dallas, Kansas City, Miami, Orlando, Pittsburgh and Riverside, California areas.

Information regarding the competitive bidding program is available at http://www.cms.gov/DMEPOSCompetitiveBid/.

HCPCS Code Set Released

Wednesday, November 3rd, 2010

The Centers for Medicare & Medicaid Services (CM) has announced the scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set.  These changes have been posted to the HCPCS website at http://www.cms.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp.

CMS Publishes HOPPS/ASC Final Rule

Wednesday, November 3rd, 2010

On November 2, the Centers for Medicare & Medicaid Services (CMS) published the final rules updating Medicare payment policies and rates for hospital outpatient departments and ambulatory surgical centers for calendar year 2011. The Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) final rule with comment period will implement changes required by the Affordable Care Act (ACA), such as cost sharing for most Medicare-covered preventative services and implementation of the direct and indirect graduate medical education provisions. The rule also implements a provision of the ACA prohibiting the development of new physician-owned hospitals and the expansion of existing physician-owned hospitals.

The final rule makes several other significant changes in addition to those required by the ACA. These changes include:

  • Modifying a number of the supervision requirements for outpatient therapeutic services by:
    • Requiring direct physician supervision for only the initiation of certain services and allowing general supervision once the treating practitioner deems the patient medically stable. This two-tiered approach to supervision applies to a limited set of non-surgical extended duration services, including observation services.
    • Extending through CY 2011 the notice of non-enforcement regarding the direct supervision requirements for outpatient therapeutic services furnished in critical access hospitals (CAHs) and expanding the scope of the notice to include small rural hospitals with 100 or fewer beds.
    • Redefining direct supervision for all hospital outpatient services to require “immediate availability” without reference to the boundaries of a physical location.
    • Committing to establish through future rulemaking an independent committee to consider on an annual basis industry requests for the assignment of supervision levels other than direct supervision for certain individual services and to make recommendations to the agency.
  • Establishing four separate ambulatory payment classifications (APCs) for partial hospitalization programs (PHPs), two for community mental health center (CMHC) PHPs and two for hospital-based PHPs, while continuing to pay different per diem rates within each provider type depending on the number of PHP services provided each day; that is, one APC for three services and a separate one for four or more services.
  • Paying for the acquisition and pharmacy overhead costs of separately payable drugs and biologicals without pass-through status furnished in HOPDs at 105 percent of the manufacturers’ average sales prices.
  • Expanding the set of quality measures that must be reported by HOPDs to qualify for the full annual payment update factor.

The CY 2011 OPPS/ASC final rule with comment period will appear in the November 24, 2010 Federal Register. Comments on designated provisions are due by January 3, 2011.

The display copy can be found at http://www.ofr.gov/OFRUpload/OFRData/2010-27926_PI.pdf

2011 MPFS Final Rule Released

Wednesday, November 3rd, 2010

On November 2, the Centers for Medicare & Medicaid Services (CMS) released the final rule updating Medicare payment policies and rates for physicians. The Medicare Physician Fee Schedule (MPFS) final rule with comment period implements provisions in the Affordable Care Act (ACA) that expands beneficiary access to preventative services and provides coverage under the traditional fee-for-service program for an annual wellness visit.  In addition, the final rule implements an ACA provision that improves access to primary care and surgical services.

The MPFS final rule also announces a reduction to payment rates for physician services in 2011 under the sustainable growth rate (SGR) formula. The MPFS rates are currently schedule to be reduced under the SGR system on December 1, 2010 and then again on January 1, 2011 under current law. The total reduction in MPFS rates between November and January under the SGR system will be 24.9%.

The final rule will appear in the November 29, 2010 Federal Register and will be implemented on January 1, 2011. CMS will accept comments on certain aspects of the final rule until January 2, 2011.

The display copy can be found by going to http://www.ofr.gov/OFRUpload/OFRData/2010-27969_PI.pdf

CMS Publishes Revised MLN Article

Monday, November 1st, 2010

The Centers for Medicare & Medicaid Services (CMS) has published a revised Medicare Learning Network (MLN) article on common coding-based payment denials during the Recovery Audit Contractor (RAC) demonstration program. The revised article clarifies requirements for coding diagnosis codes by attending physicians consistent with the Official Guidelines for Coding and Reporting and Coding Clinic for ICD-9-CM.

The article can be viewed at http://www.cms.gov/MLNMattersArticles/downloads/SE1028.pdf.