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Archive for January, 2011

Hospital VBP Program Proposed Rule Published

Friday, January 28th, 2011

The hospital value-based purchasing (VBP) program, which begins on October 1, 2012, will make value-based incentive payments to acute care hospitals, based either on how well the hospitals perform on certain quality measures or how much the hospitals’ performance improves on certain quality measures from their performance during a baseline period.  The higher a hospital’s performance or improvement during the performance period for a fiscal year, the higher the hospital’s value-based incentive payment for the fiscal year would be. 

To review a copy of the proposed rule, visit http://www.gpo.gov/fdsys/pkg/FR-2011-01-13/pdf/2011-454.pdf.

Guidance on Inpatient Admission Decisions Article Published

Friday, January 28th, 2011

In a new Medicare Learning Network® article, the Centers for Medicare & Medicaid Services (CMS) reviews the existing guidance on inpatient admission decisions. The article is in response to hospitals expressing concern about how CMS’ recovery audit contractors (RAC), Medicare administrative contractors, fiscal intermediaries and the Comprehensive Error Rate Testing contractor are using screening criteria to analyze medical documentation and make a medical necessity determination on inpatient hospital claims. The article refers hospitals to the Medicare Program Integrity (MIP) Manual’s section on screening instruments and to the Medicare Benefit Policy Manual for help with inpatient admission decisions.

The MedLearn matters article can be accessed at http://www.cms.gov/MLNMattersArticles/Downloads/SE1037.pdf.

Berwick Re-nominated as CMS Administrator

Friday, January 28th, 2011

President Obama has re-nominated Donald Berwick, M.D. as the administrator of the Centers for Medicare & Medicaid Services (CMS). Berwick was nominated as CMS administrator in April and then appointed to the position in July because of the President’s authority to make interim appointments while Congress is in recess. To remain in the post beyond 2011 his nomination must be confirmed by the Senate.

More information can be obtained at  http://www.whitehouse.gov/the-press-office/2011/01/26/presidential-nominations-sent-senate

MedPAC Post-Acute Payment Recommendations Made to Congress

Friday, January 14th, 2011

The Medicare Payment Advisory Commission (MedPAC) recommended that Congress provide no payment update in fiscal year 2012 for inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities or home health providers. For home health, the commission also recommended that Health and Human Services (HHS) should begin a two-year rebasing of rates to reflect the average cost of providing care in 2013; revise the home health case mix system to rely more on patient characteristics; implement a per-episode copay for home health episodes not preceded by hospitalization or post-acute service; and allow the Centers for Medicare & Medicaid Services (CMS) to suspend payment or enrollment of new providers if it finds significant problems. In addition, the commission recommended that dialysis facilities and hospice providers each receive a 1.0% update.

The document can be located at http://www.medpac.gov/.

HIT Committee Seeks Comments on Stage 2 MU Requirements

Thursday, January 13th, 2011

The Health Information Technology Policy Committee (HITPC) is seeking comments on an initial set of proposed requirements for Stage 2 meaningful use (MU) of electronic health records (EHR). The committee plans to hold public hearings this spring, and will issue final recommendations to Health and Human Services (HHS) this summer. The American Recovery and Reinvestment Act of 2009 provided Medicare and Medicaid incentive payments for hospitals and physicians that become “meaningful users” of EHRs. HHS released its final rule defining Stage 1 meaningful use in July.

More information is available at http://healthit.hhs.gov/media/faca/MU_RFC%20_2011-01-12_final.pdf.

Joint Commission Proposes Performance Standards for Quality Measures

Wednesday, January 12th, 2011

The Joint Commission seeks comments through February 22 on a proposed accreditation requirement that would set performance targets for certain quality measures for hospitals, referred to as ORYX accountability measures. The proposal would set an initial composite performance target of 85% compliance on the selected heart attack, heart failure, pneumonia, surgical and children’s asthma care measures. The Joint Commission currently requires accredited hospitals to submit performance data on ORYX measures on a quarterly basis, but they are not required to achieve a specific level of performance on the measures.

More information is available at http://www.jointcommission.org/standards_information/field_reviews.aspx?StandardsFieldReviewId=V9u2VQXt2lDXL18OUXWTuCKXijad2wwhBWQUCnlFyxg%3d

Proposed Rule on Hospital VBP Program Issued

Friday, January 7th, 2011

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule regarding its policies for the hospital value-based purchasing (VBP) program. Under the Patient Protection and Affordable Care Act (ACA), the VBP program will pay hospitals based on their actual performance on quality measures beginning in fiscal year 2013. The VBP program will apply to all acute-care prospective payment system hospitals, except those that do not have a sufficient number of patients within the related conditions.

The proposed rule can be found at http://frwebgate3.access.gpo.gov/cgi-bin/TEXTgate.cgi?WAISdocID=fRimZR/0/1/0&WAISaction=retrieve

US Health Care Spending Growth Slows

Thursday, January 6th, 2011

According to a report published by the Centers for Medicare & Medicaid Services (CMS), U.S. spending on health care grew 4.0% in 2009, which is the slowest rate in 50 years. A major reason behind the slower growth is that the recession slowed private spending for health services. However, health spending continued to outpace overall economic growth and climbed to 17.6% of gross domestic product (GDP). Spending for hospital services grew at 5.1%, down from 5.2% in 2008. According to CMS, private spending growth slowed to 2.7% because consumers decreased their use of hospital services due to lost employer-based coverage or reduced income. The report also notes that many hospitals report reduced non-operating income and access to capital as a result of the recession.

 For more information, go to this link.

First Phase of Physician Compare Website Launched

Tuesday, January 4th, 2011

The Centers for Medicare & Medicaid Services (CMS) launched the first phase of the Physician Compare website. The website is an online tool providing information on physicians and other health professionals who treat Medicare patients. Required by the Patient Protection and Affordable Care Act (ACA), the tool currently serves as a provider directory and indicates whether physicians and other eligible providers report data to CMS through the voluntary Physician Quality Reporting System (PQRS).

The information can be viewed at http://www.medicare.gov/find-a-doctor/provider-search.aspx.

DMEPOS Competitive Bidding Procedures for Upgrades

Monday, January 3rd, 2011

The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Billing Procedures for Upgrades Fact Sheet is now available to download from the Medicare Learning Network®.


Once the DMEPOS Competitive Bidding Program became effective on January 1, 2011, beneficiaries with Original Medicare who obtain competitively bid items in competitive bidding areas (CBAs) must obtain these items from a contract supplier for Medicare to pay, unless an exception applies.  This fact sheet contains helpful information on Competitive Bidding Program rules that apply when a beneficiary wants to obtain an upgrade. This means that an item or a component of an item that exceeds the beneficiary’s medical need.  It includes information on which DMEPOS suppliers can provide the item, how the item will be paid, beneficiary liability, and Advance Beneficiary Notice (ABN) requirements.

To view the fact sheet, please visit the DMEPOS Competitive Bidding Educational Resources page at http://www.cms.gov/DMEPOSCompetitiveBid/04_Educational_Resources.asp.