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Archive for March, 2011

HAC Data Posted to CMS Website

Thursday, March 31st, 2011

The Centers for Medicare & Medicaid Services (CMS) has released the first data on Medicare hospital-acquired conditions (HAC) reported by hospitals participating in the inpatient quality-reporting program. The downloadable file contains hospital-level data for eight HAC measures, calculated using administrative data for Medicare patients discharged between October 1, 2008 and June 30, 2010.

The file is available at www.cms.gov.

ACO Proposed Rule Released

Thursday, March 31st, 2011

The Centers for Medicare & Medicaid Services (CMS) has released the proposed rule for the new accountable care organization (ACO) program. In addition, CMS and the Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG), the Department of Justice (DOJ) in conjunction with the Federal Trade Commission (FTC), and the Internal Revenue Service (IRS) issued proposed policy statements regarding the legal issues around establishment of ACOs. The Patient Protection and Affordable Care Act (ACA) requires the establishment of an ACO program that will measure quality and total cost of care for assigned beneficiaries, beginning in calendar year 2012. ACOs would share in savings with the Medicare program if quality and cost objectives were met. The ACO program is voluntary and requires a three-year agreement from participating providers.

The rule was published can be viewed at http://www.access.gpo.gov/su_docs/fedreg/a110407c.html

IOM Makes Recommendations on Clinical Guidelines Standards

Thursday, March 24th, 2011

The Institute of Medicine (IOM) has recommended eight standards for developing clinical practice guidelines and twenty-one standards for conducting systematic reviews of the comparative effectiveness of medical or surgical interventions. 

The standards can be viewed at http://www.iom.edu/Reports/2011/Finding-What-Works-in-Health-Care-Standards-for-Systematic-Reviews.aspx

CMS Re-launches Innovation Center Website

Monday, March 21st, 2011

The Center for Medicare & Medicaid Innovation (“the Innovation Center”) re-launched its website – Innovations.cms.gov. In addition to providing information about the Center’s mission and operating process, the website provides ways for the Center to gather new ideas to improve the health care system for Medicare, Medicaid and CHIP beneficiaries. The Innovation Center, established by the Affordable Care Act (ACA), has the flexibility and resources to rapidly test innovative care and payment models and scale up successful models

More information is available at http://innovations.cms.gov

ICD-10 Conversion Update

Wednesday, March 16th, 2011

The ICD-10 Medicare Code Editor v27 and a text version of the ICD-10-CM/PCS MS-DRGv28 Definitions Manual are now available on the Centers for Medicare & Medicaid Services (CMS) website. In addition, there are links to order the MS Grouper with Medicare Code Editor ICD-10 Pilot Software Version 28 on CD-ROM from National Technical Information Service (NTIS) in the “Related Links Outside CMS” section of the web page.

For more information, visit the website at http://www.cms.gov/ICD10/17_ICD10_MS_DRG_Conversion_Project.asp in the “Downloads” section.

MedPAC Issues March Report

Tuesday, March 15th, 2011

The Medicare Payment Advisory Commission (MedPAC) has issued its March report to Congress which details its fee-for-service payment recommendations for fiscal year 2012.The recommendations, which were approved by the Commission in January, include an update of 1.0% for fiscal year 2012 inpatient hospital payments. This represents a 2.5% update with a 1.5 percentage point reduction which reflects a documentation and coding offset. The commission also recommends that Health and Human Services (HHS) recover all overpayments made because of documentation and coding and not just overpayments made in FYs 2008 and 2009. MedPAC also recommends a 1.0% update for outpatient hospital and physician payments, and a 0.5% update for ambulatory surgery centers. The report further recommends Congress provide no payment update in FY 2012 for inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities or home health providers.

The report can be viewed at http://www.medpac.gov/documents/Mar11_EntireReport.pdf

Proposed Consumer Disclosure Notices Published

Monday, March 7th, 2011

On March 7th, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule regarding consumer disclosure notices that health insurers would use to report proposed rate increases of 10% or more.  The Department of Health and Human Services (HHS) published a proposed rule last December establishing a process for reviewing “unreasonable” health insurance rate increases in the individual and small group markets. For rate increases on or after July 1, 2011, an increase of 10% or more in the preceding 12-month period would trigger a rate review under the rule.

The proposed rule can be viewed at http://edocket.access.gpo.gov/2010/pdf/2010-32143.pdf.

CMS Announces Improvements to PECOS

Sunday, March 6th, 2011

The Centers for Medicare & Medicaid Services (CMS) has enhanced the Provider Enrollment, Chain and Ownership System (PECOS), which health care providers use to electronically enroll in Medicare and update their enrollment information. CMS said the changes include an improved submission process and new module for checking the status of an enrollment application. CMS fact sheets on PECOS are available for physicians and non-physician practitioners, provider and supplier organizations, and DMEPOS suppliers.

More information regarding the PECOS system is available at https://pecos.cms.hhs.gov/pecos/login.do.

IOM Committee Releases Geographic Variation Datasets

Wednesday, March 2nd, 2011

The Institute of Medicine (IOM) committee studying geographic variation in health care spending has released four datasets which will be used for the development of Medicare payment recommendations. The Centers for Medicare & Medicaid Services (CMS) created the datasets at the committee’s request The datasets include health care utilization measures and total, standardized and risk-adjusted spending for certain major kinds of Medicare services at the state and Hospital Referral Region levels. They also include data on 30-day inpatient readmissions and emergency department visits; and certain quality measures from the Hospital Compare database and Agency for Healthcare Research and Quality’s (AHRQ) Prevention Quality Indicators and Patient Safety Indicators.

For more information, go to this link.

RAC Record Request Limit Raised

Wednesday, March 2nd, 2011

The Centers for Medicare & Medicaid Services (CMS) has increased the number of medical records that Recovery Audit Contractors (RAC) can request in a 45-day period from hospitals with more than $100 million in annual Medicare payments. Under the revised policy, RACs can request up to 500 records per period from these hospitals, an increase from 300 records. To determine the $100-million threshold, CMS counts hospitals’ diagnosis-related group payments minus additional payments for outliers, Disproportionate Share Hospitals (DSH), and direct and indirect graduate medical education (IME).

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