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Archive for October, 2011

2012 Medicare Premiums and Deductibles Announced

Friday, October 28th, 2011

The Centers for Medicare & Medicaid Services (CMS) has announced the Medicare premiums and deductibles for beneficiaries in 2012. For Medicare Part A, which pays for inpatient hospital, skilled nursing facility, hospice and some home health care services, the deductible paid by the beneficiary when admitted as a hospital inpatient will be $1,156. This deductible is the cost for up to 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries must pay an additional $289 per day for days 61 through 90, and $578 per day for hospital stays beyond the 90th day in a benefit period.

The standard monthly premium for Medicare Part B will be $99.90, a $15.50 decrease from the 2011 premium. However, most Part B beneficiaries were “held harmless” in 2011 and paid $96.40 per month. The 2012 premium represents a $3.50 increase for them.

For more on the 2012 premiums and deductibles, go to http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4140&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&

Final ACO Rule Released

Thursday, October 20th, 2011

The Centers for Medicare & Medicaid Services (CMS) has released a final rule¬†governing the creation of Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program. The rule makes several major changes that will make the program more attractive and operationally viable. The rule allows all participants to share in first-dollar savings and eliminates down-side risk for low-risk ACOs participating in the track one option. CMS also stated that it will not withhold any portion of an ACO’s earned bonus and eliminated indirect medical education payments from spending estimates. In addition, CMS reduced the number of quality measures to be reported to 33 from 65 and did not finalize any meaningful use requirements for the ACO program.

The final rule is at http://www.ofr.gov/OFRUpload/OFRData/2011-27461_PI.pdf.

CMS Proposes Two Sets of Regulatory Reforms and Finalizes Another

Wednesday, October 19th, 2011

On October 18, the Centers for Medicare & Medicaid Services (CMS) proposed two sets of regulatory reforms and finalized a third. All of the reforms are designed to improve transparency and help providers operate more efficiently by reducing their regulatory burden. One set proposes updates to the Medicare Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs). The second set, the Medicare Regulatory Reform Rule, addresses regulatory requirements for a broader range of health care providers and suppliers who are regulated under Medicare and Medicaid. CMS also finalized a third rule reducing the regulatory burden for ambulatory surgical centers (ASCs). This rule became effective on October 18.

According to CMS estimates, annual savings to hospitals from the proposed revisions to the CoP could exceed $900 million in its first year, the Medicare Regulatory Reform rule could save up to $200 million in the first year, and the final rule for ASCs could generate and extra $50 million saving per year.

The display copy of the proposed rules is available at http://www.ofr.gov/(X(1)S(0ifbimlizkdoryd51vavts04))/OFRUpload/OFRData/2011-27175_PI.pdf.

The final rule for ASCs can be accessed at http://www.ofr.gov/(X(1)S(0ifbimlizkdoryd51vavts04))/OFRUpload/OFRData/2011-27171_PI.pdf.

Study Shows HF Hospitalizations Decline

Tuesday, October 18th, 2011

According to a study published in the Journal of the American Medical Association, hospitalizations for heart failure declined 29.5% among Medicare patients between 1998 and 2008.  The study estimates that if the 2008 Medicare fee-for-service population of 27.3 million had an HF hospitalization rate similar to that of 1998, an additional 229,000 HF hospitalizations would have been expected that did not occur.

The study can be viewed at http://jama.ama-assn.org/content/306/15/1669.short.

MedPAC Recommends Repeal of SGR

Friday, October 14th, 2011

The Medicare Payment Advisory Commission (MedPAC) has recommended Congress repeal the Sustainable Growth Rate (SGR) formula used to calculate the Medicare Physician Fee Schedule (MPFS) and replace it with a 10-year path of legislated MPFS updates. The updates would freeze current payment levels for primary care and reduce annual payments for all other MPFS services by 5.9% for three years followed by a freeze. MedPAC stated that it was not suggesting that Congress fully offset the cost of repealing the SGR formula, and did not recommend any offsets to payments outside the MPFS. MedPAC also recommended Congress direct the Secretary of Health and Human Services (HHS) to collect data to more accurately estimate the work and practice expense components of the SGR and reduce relative value units for overpriced resources in a budget-neutral manner.

For further details, visit http://www.medpac.gov/documents/10142011_MedPAC_SGR_letter.pdf

FDA and CMS Launch Parallel Review Pilot

Monday, October 10th, 2011

The Food and Drug Administration (FDA) and the Centers for Medicare & Medicaid Services (CMS) have voluntary launched a “parallel review” pilot program for concurrent review of new medical devices for FDA approval and Medicare coverage. The new program will focus on innovative technologies that can benefit from the efficiencies of parallel review and accept up to five submissions per year.

Information about the program can be accessed here.

IOM Recommends Guidelines for Essential Benefits Package

Friday, October 7th, 2011

An Institute of Medicine (IOM) report is recommending criteria and methods to guide the Department of Health and Human Services (HHS) in developing a package of essential benefits for qualified health plans under the Affordable Care Act (ACA). The ACA requires HHS to define the minimum package of benefits that certain health plans must cover, including those participating in health insurance exchanges. The report recommends that the cost of the average premium for the initial package not exceed the national average premium for the typical small employer plan. The report stated that HHS will need to gauge potential services and products against a set of criteria, including medical effectiveness, safety and relative value compared with alternative options. In addition, HHS will need to evaluate whether the package as a whole protects the most vulnerable individuals, promotes services that have proved effective, and addresses the medical concerns of greatest importance to the public.

The report is available at http://www.nap.edu/catalog.php?record_id=13234.

Report to Congress on RAC Program Issued

Thursday, October 6th, 2011

In fiscal year 2010, Recovery Audit Contractors (RAC) have identified and corrected $75 million in Medicare overpayments and $16.9 million in underpayments, according to the Centers for Medicare & Medicaid Services (CMS) first annual report to Congress on the RAC program. The report identifies overpayments and underpayments by state and RAC region, the most common coding errors by region, and actions being taken to prevent improper payments. The report also scores the four RACs for their overall accuracy; however, it does not explain how the scores were derived. In addition, it provides an update on CMS efforts to expand recovery auditing to Medicaid and Medicare Parts C and D, as required by the Affordable Care Act (ACA).

The annual report can be found by going to http://www.cms.gov/Recovery-Audit-Program/Downloads/FY2010ReportCongress.pdf