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Archive for January, 2012

No Proposed Changes to EMTALA

Tuesday, January 31st, 2012

The Centers for Medicare & Medicaid Services (CMS) has published a notice in the Federal Register stating that it will not propose changes to the current Emergency Medical Treatment and Labor Act (EMTALA) regulations. While the agency said that a hospital has satisfied its EMTALA obligation when it admits an individual “in good faith in order to stabilize the [emergency medical condition],” it is providing an additional 60 days to comment on the applicability of EMTALA to hospitals with specialized capabilities.

The notice can be found by going to http://www.gpo.gov/fdsys/pkg/FR-2012-02-02/pdf/2012-2287.pdf.

New Health IT Resource Targets Rural Health Providers

Friday, January 27th, 2012

A new online toolkit will serve as a pilot program for providing health information technology (HIT) resources to rural health care providers. The toolkit, developed by the Rural Assistance Center (RAC) and the National Rural Health Resource Center (The Center) is designed to help rural providers find resources for HIT, electronic health records (EHR), meaningful use and related topics. Funding for the toolkit is provided by the federal Office of Rural Health Policy (ORHP).

For more information, see the news release at http://www.raconline.org/collaborate/pr_hittoolkit.php.

EHR Incentive Program Appeals Guidance Published

Tuesday, January 24th, 2012

The Centers for Medicare & Medicaid Services (CMS) has issued guidance creating a process and requirements for appealing eligibility, meaningful use and incentive payment determinations under the Medicare electronic health record (EHR) incentive program.

Guidance information is available at http://www.cms.gov/QualityMeasures/05_EHRIncentiveProgramAppeals.asp#TopOfPage.

PCORI Issues Draft National Priorities

Monday, January 23rd, 2012

The Patient Centered Outcomes Research Institute (PCORI) has issued its Draft National Priorities for Research and Research Agenda, Version 1, which presents five prioritized research areas. These focus on information that patients and caregivers need in order to make important healthcare decisions. The priorities and agenda will guide PCORI’s first primary research funding announcement, and PCORI will work closely and continuously with all stakeholders to refine the agenda and to identify specific areas and questions where PCORI’s research can have the greatest impact.

PCORI seeks stakeholder input on the draft document. Comments should be submitted through the online portal by March 15, 2012.

To learn more or to submit comments, please visit: http://www.pcori.org/provide-input/priorities-agenda/

MLN Newsletter Identifies Payment Issues

Friday, January 20th, 2012

A recent Medicare Learning Network (MLN) newsletter, published by the Centers for Medicare & Medicaid Services’ (CMS), discusses payment issues identified by Recovery Audit Contractors (RAC) that impact inpatient hospitals and ambulance providers. The MLN newsletter highlights major findings by Medicare claims processing contractors, recovery auditors, the Office of Inspector General (OIG) and others to help fee-for-service providers avoid billing errors and improper activities.

Providers can access previous newsletters online and subscribe to other MLN educational product and articles at http://www.cms.gov/MLNProducts/downloads/MedQtrlyCompNL_Archive.pdf.

CBO Issues Report on Medicare Demonstrations

Thursday, January 19th, 2012

According to a report issued by the Congressional Budget Office (CBO), most of the Medicare demonstration projects, which were developed to enhance health care quality and improve efficiency, have not reduced Medicare spending. The report reviews outcomes from six disease management/care coordination demonstrations and four value-based payment demonstrations. The CBO states that the disease management/care coordination demonstrations, comprised of 34 programs operated by disease management companies, have had little or no effect on hospital admissions or regular Medicare spending. Only one value-based payment demonstration that has shown significant savings was is the Medicare Participating Heart Bypass Center.

For further details, go to http://www.cbo.gov/doc.cfm?index=12663

Health Spending Grows Only 3.9%

Wednesday, January 18th, 2012

According to a report from the Centers for Medicare & Medicaid Services (CMS), U.S. spending on health care grew 3.9% in 2010 to $2.6 trillion, slightly surpassing the record low of 3.8% growth in 2009.  Spending for hospital care increased 4.9% in 2010, down from 6.4% in 2009, and is the fourth consecutive year of relatively slow growth. Private health insurance spending for hospital services, the largest share of spending for hospital care, grew 2.2% in 2010, down from 4.8% in 2009. This is the smallest increase since 1996. Medicare spending for hospital care grew 4.6% in 2010, down from 5.3% in 2009, while Medicaid spending grew 11.2% in 2010, up from 10.4% in 2009.

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

MedPAC Recommends ASC and Post-Acute Payment Updates

Thursday, January 12th, 2012

The Medicare Payment Advisory Commission (MedPAC) has recommended that Congress provide a 0.5% update for ambulatory surgical centers (ASCs) in calendar year 2013 and to require them to submit cost data and direct the Health and Human Services secretary to implement a value-based purchasing program for ASCs no later than 2016. MedPAC also recommended long-term care hospitals, skilled nursing facilities (SNF) and inpatient rehabilitation facilities receive a 0% market-basket update for fiscal year 2013. The commission also recommended a 1.0% update for the end-stage renal disease (ESRD) prospective payment system (PPS), and a 0.5% update for hospice providers. The commission further recommended revising and rebasing the SNF PPS, and reducing payments to SNFs with relatively high readmission rates.

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

MedPAC Recommends 1.0% Update

Thursday, January 12th, 2012

The Medicare Payment Advisory Commission (MedPAC) has recommended that Congress provide an update of 1.0% for inpatient and outpatient hospital payments for fiscal year 2013. In addition, it recommended equalizing Medicare payment rates for non-emergency evaluation and management (E/M) services between hospital outpatient departments and physician office settings by reducing hospital outpatient department payments for E/M clinic visits by more than 70%. The commission also stated that the E/M payment changes should be phased in over three years, during which reductions for certain hospitals with a disproportionate share percentage of 0.25 or higher would be limited to 2.0% of overall Medicare payments.

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

FAQ Issued on Medicaid RAC Program

Thursday, January 12th, 2012

The Centers for Medicare & Medicaid Services (CMS) published answers to frequently asked questions (FAQ) regarding the Medicaid Recovery Audit Contractor (RAC) program. In its FAQ, CMS discussed operational guidance to states and general information about the Medicaid RAC program. CMS anticipates sharing certain information about each state’s Medicaid RAC through its Medicaid RACs-At-A-Glance website.

The FAQ can be accessed at http://www.cms.gov/MedicaidIntegrityProgram/downloads/Scanned_document_29-12-2011_13-20-42.pdf.