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Archive for November, 2011

CMS Announces Competitive Bidding Program Operational Details

Wednesday, November 30th, 2011

The Centers for Medicare & Medicaid Services (CMS) has announced operational details for the next stage in the DME Competitive Bidding program. In addition, CMS launched a comprehensive education program to help guide suppliers through the competitive bidding process.

Additional information on the competitive bidding program is available at: http://www.cms.hhs.gov/DMEPOSCompetitiveBid/01_overview.asp#TopOfPage


Stage 2 of ‘Meaningful Use’ to be Delayed

Wednesday, November 30th, 2011

The Department of Health and Human Services (HHS) intends to delay untilOctober 1, 2013the proposed start of Stage 2 meaningful use requirements for hospitals under the Medicare electronic health record (EHR) incentive program. Stage 2 was scheduled to begin onOctober 1, 2012. Incentive payments for those hospitals and physicians that qualify under Stage 1 will continue and hospitals can continue to build out additional capacity beyond Stage 1.

For more, visit www.hhs.gov/news/press/2011pres/11/20111130a.html

Tavenner Nominated as CMS Administrator

Wednesday, November 23rd, 2011

President Obama has nominated Centers for Medicare & Medicaid Services (CMS) Principal Deputy Administrator Marilyn Tavenner to succeed Donald Berwick, M.D. who stepped down on December 2, as CMS administrator. Ms. Tavenner will serve as administrator on an acting basis during the confirmation process.

Before coming to CMS, Ms. Tavenner served as secretary ofVirginia’s Health and Human Services department where she oversaw 2 agencies that employed 18,000 people. Her career also included 25 years working for the for-profit Hospital Corporation ofAmericawhere she started as a staff nurse and became president of outpatient services.

More information is available at http://www.whitehouse.gov/the-press-office/2011/11/23/president-obama-announces-more-key-administration-posts.

Payment Demonstrations Announced

Tuesday, November 15th, 2011

Beginning on January 1, 2012, the Centers for Medicare & Medicaid Services (CMS) will conduct three demonstration projects that focus on reducing improper payments. They are:

  • The Recovery Audit Prepayment Review which will allow Medicare Recovery Auditors (RACs) to review claims before they are paid to insure that the provider complied with all Medicare payment rules.
  • Part A to Part B Rebilling Demonstration will allow hospitals to rebill for 90% of the Part B payment when a Medicare contractor denies a Part A inpatient short stay claim as not reasonable and necessary due to the hospital billing for the wrong setting
  • Prior Authorization for Certain Medical Equipment Demonstration which will require Prior Authorization for certain medical equipment for all Medicare beneficiaries who reside in seven states with high populations of fraud and error-prone providers.

The CMS press release can be found by going to this link.

Supreme Court to Review ACA Case

Monday, November 14th, 2011

On November 14, it was announced that the U.S. Supreme Court agreed to review a case brought by Florida and 25 other states challenging the Affordable Care Act (ACA). The Supreme Court will review the individual mandate and its severability, as well as the ACA’s Medicaid expansion and whether the Anti-Injunction Act bars federal lawsuits against the individual mandate before the provision takes effect.

For more information, visit http://www.supremecourt.gov/

Cardiovascular Disease Prevention Services Coverage Announced

Wednesday, November 9th, 2011

The Centers for Medicare & Medicaid Services (CMS) has announced that Medicare is adding coverage for a number of preventive services to reduce cardiovascular disease.  Under the coverage decision, CMS will cover one face-to-face visit each year to allow patients and their care providers to determine the best way to help prevent cardiovascular disease. The visit must be furnished by primary care practitioners, such as a beneficiary’s family practice physician, internal medicine physician, or nurse practitioner, in settings such as physicians’ offices.  During these visits, providers may screen for hypertension and promote healthy diet as part of an overall initiative to reduce the burden of cardiovascular disease in the United States.

To read the new policy, visit the CMS website at: http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=248

Comments Requested on CED Guidance Policy

Monday, November 7th, 2011

On November 7, the Centers for Medicare & Medicaid Services (CMS) issued a public solicitation for comments on the Medicare program’s coverage with evidence development (CED) guidance policy. Comments are due by January 6, 2012. In CMS’s most recent solicitation for comments, CMS describes CED as a mechanism through which we provide conditional payment for items and services while generating clinical data to demonstrate their impact on health outcomes.

For further details on the public solicitation, go to this link.

Final 2012 MPFS Rule Released

Wednesday, November 2nd, 2011

On November 1, the Centers for Medicare & Medicaid Services (CMS) released the final rule updating Medicare payment policies and rates for physicians. The Medicare Physician Fee Schedule (MPFS) final rule with comment period implements the Sustainable Growth Rate (SGR) provisions that were adopted in the Balanced Budget Act of 1997. Based on the SGR formula, Medicare payment rates to providers paid under the MPFS will be reduced by 27.4% for services in 2012.

In addition, CMS is expanding the potentially misvalued code initiative. CMS will focus on the codes billed by physicians in each specialty that result in the highest Medicare expenditures under the MPFS to determine whether these codes are overvalued. In the past, CMS targeted specific codes for review that may have affected a few procedural specialties, such as cardiology and radiology, but had not reviewed the highest expenditure codes across all specialties.

The rule also implements a multiple procedure payment reduction to the professional component of advanced imaging services. The reduction will be 25% for CY 2012 rather than the 50% reduction that was proposed. CMS also is moving forward its three-day policy window payment provisions, which will pay physicians services at the lower facility rate if they are delivered in a physician office wholly owned and operated by a hospital and provided within three days of a hospital admission.

 CMS is also making changes in how it adjusts payment for geographic variation in practice expense. In addition, the final rule implements the third year of a 4-year transition to new practice expense relative value units.

 The final rule was published in the November 28, 2011 Federal Register and will be implemented on January 1, 2011. CMS will accept comments on certain aspects of the final rule until January 3, 2011.

For more information, visit this link.

CMS Publishes HOPPS/ASC Final Rules

Wednesday, November 2nd, 2011

On November 1, the Centers for Medicare & Medicaid Services (CMS) published the final rules updating Medicare payment policies and rates for hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) for calendar year 2012. The final rule will increase payment rates under the hospital outpatient prospective payment System (HOPPS) by 1.9%. This increase is based on the projected hospital inpatient market basket percentage increase of 3.0% for inpatient services paid under the Hospital Inpatient Prospective Payment System (HIPPS) minus the multifactor productivity adjustment of 1.0 percentage points and minus a 0.1% point adjustment. The final rule increases payment rates to ASCs by 1.6%. 

In addition, the final rule will expand the measures reported under the Hospital Outpatient Quality Reporting Program, will create a new quality reporting program for ASCs and will strengthen the Hospital Value-based Purchasing program that will affect payment to hospitals for inpatient stays beginning October 1, 2012.

Other provisions in the final rule will:

  • Pay for the acquisition and pharmacy overhead costs of separately payable drugs and biologicals, other than new drugs and biologicals that have pass-through status, at the average sales price (ASP) plus 4%.
  • Pay for partial hospitalization (PHP) services in hospital based PHPs and community mental heath centers (CMHCs) based on the unique cost-structures of each type of program.
  • Establish a quality reporting program for ASCs and adopt five quality control measures.

The CY 2012 OPPS/ASC final rule with comment period will be published in the November 30, 2011 Federal Register. Comments on designated provisions are due by January 3, 2012.

The press release can be found at http://www.cms.gov/apps/media/press/release.asp?Counter=4144&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&sr

HH PPS Final Rule Published

Wednesday, November 2nd, 2011

Medicare payments to home health agencies will decrease by about 2.31% in calendar year 2012 under the final rule updating Medicare home health prospective payment system (HH PPS) rates. The net decrease includes a 2.4% market basket update, a 1.0% cut mandated by the Affordable Care Act (ACA), a wage index update, and a 3.79% coding offset to adjust for changes in case mix. The 2012 coding offset is the first of two installments that total 5.06%. The rule will allow hospital and post-acute care physicians to satisfy the home health requirement for a face-to-face encounter by informing the certifying physician of their encounters with the patient.

The finale rule can be found at http://www.ofr.gov/OFRUpload/OFRData/2011-28416_PI.pdf