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Archive for July, 2011

IRF PPS Final Rule Released

Friday, July 29th, 2011

The Centers for Medicare & Medicaid Services released a final rule updating the inpatient rehabilitation facility prospective payment system (IRF PPS) for fiscal year (FY) 2012. The rule includes a market-basket update of 2.9%, a 1.0% cut mandated by the Affordable Care Act (ACA) and other provisions, for a net update of 2.2%. The rule also implements an IRF quality reporting system. Under the new system, IRFs will be required to submit data on two quality measures: catheter-associated urinary tract infections and new or worsening pressure ulcers. Beginning in FY 2014, IRFs that do not submit these data will face a 2% payment reduction.

The final rule can be viewed at http://www.ofr.gov/OFRUpload/OFRData/2011-19516_PI.pdf.

SNF PPS Final Rule Published

Friday, July 29th, 2011

The Centers for Medicare & Medicaid Services (CMS) published a final rule updating the skilled nursing facility prospective payment system (SNF PPS) for fiscal year (FY) 2012. The rule implements a 12.6% cut associated with recalibrating the case-mix levels of the SNF PPS to adjust for greater than expected use of high-paying payment units added to the SNF PPS in October 2010. The rule has a net reduction of $3.87 billion (11.1%) which takes into account the recalibration, a 2.7% market-basket increase and a negative 1.0% productive adjustment required by the Affordable Care Act (ACA). In addition, the regulation includes a number of more specific therapy reporting rules intended to more accurately link therapy and payment levels. With regard to group therapy, payment will now be allocated based on the number of patients in the group, with group size being limited to four patients. The final rule takes effect on October 1.

The final rule is available at http://www.ofr.gov/OFRUpload/OFRData/2011-19544_PI.pdf

AHRQ Report States Heart Disease is Most Costly Medical Condition

Monday, July 25th, 2011

According to a new report by the Agency for Healthcare Research and Quality (AHRQ), heart disease was the most costly adult medical condition in 2008, accounting for about $90.4 billion in health care spending. Cancer was the second most costly condition, accounting for about $71.4 billion in spending and the highest expenditure per person. Among women, spending for mental and trauma-related disorders ranked third and fourth, followed by osteoarthritis, asthma, hypertension, diabetes, back problems and hyperlipidemia (high cholesterol and other lipid levels). Among men, spending for trauma-related disorders and osteoarthritis ranked third and fourth, followed by mental disorders, diabetes, hypertension, hyperlipidemia, asthma and back problems. The findings are based on data from the 2008 Medical Panel Expenditure Survey, sponsored by AHRQ and the Centers for Disease Control and Prevention.

The report can be found by going to http://www.meps.ahrq.gov/mepsweb/data_files/publications/st331/stat331.pdf

Proposal to Cover Depression Screening Released

Friday, July 22nd, 2011

The Centers for Medicare & Medicaid Services (CMS) has released a proposal to cover annual screening for depression for Medicare beneficiaries. Under the proposal, screening would be in primary care settings that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment and follow-up. CMS stated that the evidence is adequate to conclude that screening for depression in adults is reasonable and necessary for the prevention or early detection of illness or disability. CMS will accept public comments on the proposed coverage determination and then issue a final decision memorandum.

The proposed decision memo is available at https://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?&NcaName=Screening%20for%20Depression%20in%20Adults&bc=ACAAAAAAIAAA&NCAId=251&

Accreditation Required Beginning January 1 for ADI Billing

Tuesday, July 19th, 2011

Beginning January 1, 2012, providers and suppliers who furnish the technical component (TC) of advanced diagnostic imaging (ADI) services will need to be accredited in order to bill Medicare for those services under the physician fee schedule. Those not accredited by that deadline will not be able to bill Medicare until they become accredited. Advanced diagnostic imaging (ADI) procedures include diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET).

For more information about ADI Accreditation, including details of the accreditation process and the organizations approved by CMS to grant accreditation, please visit this link.

An MLN Special Edition Article (SE1122), “Important Reminders about Advanced Diagnostic Imaging (ADI) Accreditation Requirements”, has also been published and is available at http://www.CMS.gov/MLNMattersArticles/Downloads/SE1122.pdf.

New FAQs Posted to the EHR Website

Friday, July 15th, 2011

CMS has posted the latest information about the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Fifteen new FAQs on meaningful use, payment information for eligible hospitals, eligibility, and additional information for eligible hospitals have been added to the CMS website.

More information is available at http://www.cms.gov/EHRIncentivePrograms/

CDC Issues Infection Prevention Guide

Thursday, July 14th, 2011

The Centers for Disease Control and Prevention (CDC) has issued an infection prevention guide and checklist for outpatient care settings. Based on existing CDC guidelines for hospitals and other health care facilities, the tools can help endoscopy clinics, surgery centers, primary care offices and other outpatient care providers assess their adherence to recommended infection prevention practices.

For more information, visit www.cdc.gov.

New POS Codes Section on CMS Website

Wednesday, July 13th, 2011

The Centers for Medicare & Medicaid Services has created a new section for Place of Service (POS) codes on their website. This section is located under the “Coding” category on the Medicare tab of the CMS website at http://www.cms.gov/place-of-service-codes. The POS section was formerly located on the Medicaid website.

Funding Available for Hospitals

Monday, July 11th, 2011

The U.S. Department of Health and Human Services (HHS) has announced that up to $500 million in Partnership for Patients funding will be available to help hospitals, healthcare provider organizations and others improve care and stop millions of preventable injuries and complications related to healthcare acquired conditions and unnecessary readmissions. 

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

MRI Coverage Expanded for Patients with FDA-Approved Pacemakers

Thursday, July 7th, 2011

The Centers for Medicare & Medicaid Services (CMS) has expanded Medicare coverage of Magnetic Resonance Imaging (MRI) for beneficiaries with implanted pacemakers when used according to FDA-approved labeling in an MRI environment.  A final National Coverage Determination (NCD) posted provides access to the MRI environment for patients with FDA-approved pacemakers.

The final decision memorandum is available on the CMS website at https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?&NcaName=Magnetic%20Resonance%20Imaging%20(MRI)%20(3rd%20Recon)&bc=ACAAAAAAIAAA&NCAId=252&.