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Archive for September, 2011

CMS Releases 2012 ICD-10-PCS GEMs Files

Friday, September 30th, 2011

The Centers for Medicare & Medicaid Services (CMS) has posted the 2012 ICD-10 Procedure Coding System (PCS) General Equivalence Mappings (GEMs) files to the CMS website. These files are available on the 2012 ICD-10-PCS and GEMs webpage at http://www.cms.gov/ICD10/11b15_2012_ICD10PCS.asp. To access the files, scroll to the bottom of the page to the “Downloads” section.

MedPAC Proposes SGR Fix

Tuesday, September 20th, 2011

The Medicare Payment Advisory Commission (MedPAC) is proposing to fix the Sustainable Growth Rate (SGR), which is used to determine physician payments, by sharing the cost of repealing the SGR among physicians, providers and beneficiaries. In the draft of the proposal, MedPAC stated that its SGR repeal would cost about $200 billion. To pay for its repeal plan, MedPAC suggests instituting a 10-year payment rate freeze for primary care physicians and three years of reduced payments at 5.9 percent each for specialists followed by a seven-year payment freeze. To offset the cost of its draft SGR recommendation, MedPAC recommends a hospital inpatient prospective payment system update of 1% in FY 2012 and no updates for inpatient rehabilitation facilities, long-term care hospitals and home health services. It also recommends reimbursing evaluation and management visits in hospital outpatient departments at physician fee schedule rates, rebasing the home health prospective payment system in 2013 and raising the compliance threshold for inpatient rehabilitation facilities to 75%.

The draft options can be viewed at http://www.medpac.gov/transcripts/Draft%20Offset%20List%20for%20Public.pdf.

ICD-10 Guidance for Medicare Providers Released

Thursday, September 15th, 2011

The Centers for Medicare & Medicaid Services (CMS) has released guidance to assist health care providers in implementing the ICD-10 coding system for Medicare fee-for-service claims. The Medicare Learning Network (MLN) article includes new information specifying how providers should process claims that span the ICD-10 implementation date, for which ICD-9 and ICD-10 codes may both be applicable. Providers must use the ICD-10 coding system to report diagnoses and procedures on health care claims beginning October 1, 2013.

The MedLearn article is available at http://www.cms.gov/MLNMattersArticles/downloads/MM7492.pdf.

Enroll America Launched

Wednesday, September 14th, 2011

Enroll America, an organization created to assist uninsured people to enroll in health coverage available through the Patient Protection and Affordable Care Act (ACA), has officially been launched. The organization is a collaborative organization, working with partners that span the gamut of health coverage stakeholders-health insurers, hospitals, doctors, pharmaceutical companies, employers, consumer groups, faith-based organizations, civic organizations, and philanthropies. The mission of Enroll American is to promote better ways to streamline the enrollment process and launch a massive public information campaign in 2013 and 2014 to ensure Americans know about the new coverage.

For more information about Enroll American, visit http://www.enrollamerica.org/.

Million Hearts Campaign Launched

Tuesday, September 13th, 2011

On September 13, the Department of Health and Human Services (HHS) announced a public-private initiative to prevent one million heart attacks and strokes over the next five years. The initiative, known as the Million Hearts campaign, is focused on two goals – empowering American to make health choices and improving care for people who do need treatment by encouraging a targeted focus on the “ABCS” – Aspirin therapy, Blood pressure control, Cholesterol control, and Smoking cessation. HHS will target more than $200 million in new and refocused investments to achieve the goals of Million Hearts.

More information can be viewed at http://millionhearts.hhs.gov/docs/Million_Hearts_Press_Release.pdf.

Contractor Provider Satisfaction Survey Results Published

Wednesday, September 7th, 2011

According to the results of the Centers for Medicare & Medicaid Services’ (CMS) Medicare Contractor Provider Satisfaction Survey, 72% of health care providers were satisfied or very satisfied with their Medicare contractors. The annual survey measures satisfaction with contractors in the areas of provider enrollment and inquiries, education, audit and reimbursement, claims processing, appeals and medical review. Satisfaction was highest for home health agencies and hospices and lowest among federally qualified health centers and end-stage renal disease (ESRD) providers. The survey was sent to about 30,000 randomly selected Medicare providers.

For more on the survey, visit www.cms.gov/MCPSS.

Guidance Announced on Patient Visitation Rights

Wednesday, September 7th, 2011

The Department of Health and Human Services (HHS) has announced new guidance to support enforcement of rules that protect hospital patients’ right to choose their own visitors during a hospital stay. These rules, finalized by the Centers for Medicare & Medicaid Services (CMS) last November, apply to all hospitals that participate in Medicare and Medicaid. The guidance also supports enforcement of the right of patients to designate the person of their choice, including a same-sex partner, to make medical decisions on their behalf should they become incapacitated.

The press release can be viewed here.

Palliative Care Certification Program Launched

Friday, September 2nd, 2011

The Joint Commission has launched a certification programĀ for hospital inpatient palliative care programs. Participants in the program must have a formal palliative care program that follows evidence-based practices or guidelines and uses data for performance improvement. Standards for the program are based on the National Consensus Project’s clinical practice guidelines for palliative care and the National Quality Forum’s framework for palliative and hospice care quality.

For more information, visit http://www.capc.org/palliative-care-professional-development/Licensing/joint-commission/tjc-guide-2011.pdf.