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Archive for June, 2011

National Roll-Out of New Antifraud Technology Announced

Friday, June 17th, 2011

Beginning July 1, the Centers for Medicare & Medicaid Services (CMS) will begin using predictive modeling technology to fight Medicare fraud on a national basis. Similar to technology used by credit card companies, predictive modeling helps identify potentially fraudulent Medicare claims on a nationwide basis, and helps stop fraudulent claims before they are paid.  This initiative builds on the new anti-fraud tools and resources provided by the Affordable Care Act (ACA) that are helping move CMS beyond its former “pay & chase” recovery operations to an approach that focuses on preventing fraud and abuse before payment is made. 

The press release can be accessed at http://www.cms.gov/apps/media/press_releases.asp.

Impact on Physician Payment Examined by CBO

Thursday, June 16th, 2011

According to a new report published by the Congressional Budget Office (CBO), Medicare physician payment rates will fall by 29.4% in January without congressional action. Last year, Congress passed legislation delaying a 25% Medicare payment cut for physicians until 2012. The new estimate is the cumulative result of congressional action to override planned reductions in the physician fee schedule each year since 2003. The report also examines the budgetary impact of alternative policies for adjusting the sustainable growth rate (SGR) formula used to calculate the annual payment update for physicians.

The report can be found by visiting http://www.cbo.gov/ftpdocs/122xx/doc12240/SGR_Menu_2011.pdf

MedPAC Issues Report to Congress

Wednesday, June 15th, 2011

The Medicare Payment Advisory Commission (MedPAC) released its annual June report to Congress. This report examines the interplay between the program and specific aspects of the broader health care system such as federally qualified health centers (FQHCs) and treatment of dual eligibles. The report also assesses the current Medicare payment systems, including the sustainable growth rate (SGR) system used to determine physician payments and Medicare’s traditional fee-for-service benefit package, and makes recommendations to improve payment accuracy for in-office ancillary services such as diagnostic imaging.

The entire report can be viewed at http://www.medpac.gov/documents/Jun11_EntireReport.pdf.

Updated List of Serious Events Approved by NQF

Tuesday, June 14th, 2011

The National Quality Forum (NQF) has approved an updated list of Serious Reportable Events (SREs). The four new SREs are: death or serious injury of a neonate associated with labor or delivery in a low-risk pregnancy; patient death or serious injury resulting from the irretrievable loss of an irreplaceable biological specimen; patient death or serious injury resulting from failure to follow up or communicate laboratory, pathology or radiology test results; and death or serious injury of a patient or staff member associated with the introduction of a metallic object into the MRI area. In addition to hospital care, the updated list applies to office-based practices, ambulatory surgery centers and skilled nursing facilities.

The list can be viewed here.

CMS Extends Deadlines for Pioneer ACO Program

Wednesday, June 8th, 2011

The Centers for Medicare & Medicaid Services (CMS) will extend the application deadline for the Pioneer Accountable Care Organization (ACO) Model program to August 19. The deadline for submitting a letter of intent will be extended to June 30.

For more on the program, under the Center for Medicare and Medicaid Innovation, visit http://innovations.cms.gov.

CMI Announces Demonstration Project

Monday, June 6th, 2011

In September, the Center for Medicare and Medicaid Innovation (CMI) will launch a three-year demonstration project that will pay up to 500 Federally Qualified Health Centers (FQHC) to coordinate care for Medicare patients. Certain FQHCs that have provided medical services to at least 200 Medicare beneficiaries in the previous 12-month period can apply through August 12 to participate in the project. Participating health centers will be paid a care management fee of $18 per quarter for each eligible beneficiary and receive technical assistance to pursue level 3 recognition as a patient-centered medical home from the National Committee for Quality Assurance (NCQA).

For more on the project, visit www.fqhcmedicalhome.com/demooverview.aspx.

Proposed Rule Outlines Options for Consumers, Employers

Friday, June 3rd, 2011

The Centers for Medicare & Medicaid Services (CMS) has published proposed rules that will enable consumers and employers to select higher-quality, lower-cost physicians, hospitals and other health care providers in their area. The new rules will allow organizations that meet certain qualifications access to patient-protected Medicare data to produce public reports on physicians, hospitals and other health care providers. These reports will combine private sector claims data with Medicare claims data to identify which hospitals and doctors provide the highest quality and most cost-effective care. This initiative is part of a broader effort by the Administration to improve care and lower costs.

The proposed rule is on display at the Office of the Federal Register at http://www.archives.gov/federal-register/public-inspection/index.html .

New MedPAC Members Named

Wednesday, June 1st, 2011

The Government Accountability Office (GAO) has named two new members to the Medicare Payment Advisory Commission (MedPAC). Willis Gradison Jr., a former member of Congress and scholar in residence at Duke University’s health sector management program, and William Hall, M.D., a geriatrician and professor of medicine at the University of Rochester, will serve three-year terms on the board.

The announcement can be found at http://www.gao.gov/about.new/hcac/medpac11.html

Proposed Rule Implementing Accounting of Disclosures Mandate Published

Wednesday, June 1st, 2011

The Department of Health and Human Services’ (HHS) Office for Civil Rights published a proposed rule implementing the Health Information Technology for Economic and Clinical Health (HITECH) Act mandate to provide patients with an accounting of disclosures of protected health information for treatment, payment and health care operations if the disclosures are though an electronic health record (EHR). The proposed rule imposes a significant new obligation that covered entities provide patients with information about who has accessed their electronic PHI in a “designated record set.”Comments on the proposed rule will be accepted through August 1.

The proposed rule can be viewed at http://www.gpo.gov/fdsys/pkg/FR-2011-05-31/pdf/2011-13297.pdf.

IOM Report Recommends Changes to Geographic Adjustments

Wednesday, June 1st, 2011

The Institute of Medicine (IOM) has released a report stating that the Centers for Medicare & Medicaid Services (CMS) should change the data sources and methods it uses to calculate geographic adjustments in order to increase the accuracy of Medicare fee-for-service payments. The report recommends moving to one source of wage and benefits data for the hospital wage index and geographic practice costs indices; changing to one set of payment areas and labor markets; using smoothing techniques based on commuting patterns to lessen wage differentials across geographic boundaries; and expanding the range of occupations included in the index calculations.  The committee will also issue a supplemental report further assessing geographic practice costs indices for physicians, and a final report will be issued in early 2012 evaluating the effects of both the hospital and physician adjustment factors on the distribution of the health care workforce, quality of care, population health and the ability to provide efficient, high-value care.

The report is available at http://www.iom.edu/Reports/2011/Geographic-Adjustment-in-Medicare-Payment-Phase-I-Improving-Accuracy.aspx.