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Archive for February, 2012

Medicare Online Enrollment System Upgraded

Tuesday, February 21st, 2012

The Centers for Medicare & Medicaid Services (CMS) has upgraded the Medicare Provider Enrollment, Chain and Ownership System (PECOS) in an effort to make the system easier and faster to use. In addition, providers can now see whether their Medicare administrative contractor (MAC) has asked them to revalidate their data, and digitally sign and certify their application. Health care providers and suppliers that enrolled in Medicare beforeMarch 25, 2011must revalidate their enrollment by March 2015, but only after their Medicare administrative contractor notifies them to do so. The Affordable Care Act (ACA) established three levels of enrollment screening for providers and suppliers based on their risk of fraud, waste and abuse.

Access the PECOS enrollment at https://pecos.cms.hhs.gov/pecos/login.do

EHB Benefits FAQs Issued

Tuesday, February 21st, 2012

The Centers for Medicare & Medicaid Services (CMS) has issued Frequently Asked Questions (FAQ) on the agency’s intended approach to defining essential health benefits (EHB) for individual and small group health insurance plans under the Affordable Care Act (ACA). The FAQs are intended to provide additional guidance to states and others working to establish health insurance exchanges.CMSalso plans to release future guidance on Medicaid benchmarks and essential health benefits.

The CMSFAQ can be viewed at http://cciio.cms.gov/resources/files/Files2/02172012/ehb-faq-508.pdf

Medicare Physician Payment Cuts Delayed

Monday, February 20th, 2012

On February 17, Congress voted to delay a 27.4% cut to Medicare physician payments through December. To offset the cost of the delay, legislation would reduce reimbursement for Medicare bad debt to 65% from 70% for inpatient acute care hospitals in fiscal year 2013, and from 100% to 65% for critical access hospitals over three years. It would also expand the therapy cap and exceptions process to include services provided in hospital outpatient departments, and would reduce Medicaid Disproportionate Share Hospital (DSH) payments.

To read more about this legislation, please visit: http://thomas.loc.gov/home/thomas.php

HHS Announces Intent to Delay ICD-10 Compliance Date

Thursday, February 16th, 2012

As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services (HHS) Secretary Kathleen G. Sebelius announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).  The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule.

More information is available at http://www.hhs.gov/news/press/2012pres/02/20120216a.html

Proposed Rule Issued Implementing Overpayment Provision

Wednesday, February 15th, 2012

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule implementing an Affordable Care Act (ACA) requirement that health care providers and suppliers report and return self-identified overpayments by the later of 60 days after the date the overpayment was identified, or the date any corresponding cost report is due, if applicable. Retention of the overpayment beyond the deadline may result in False Claims Act liability. Examples of overpayments could include errors and non-reimbursable expenditures in cost reports, Medicare payments for non-covered services, payments in excess of the allowable amount for a covered service, duplicate payments, and receipt of Medicare payments when another payer had primary responsibility.

The proposed rule was published in the Federal Register and is available at http://www.gpo.gov/fdsys/pkg/FR-2012-02-16/pdf/2012-3642.pdf.

Final Rule on Benefit and Coverage Summaries Released

Thursday, February 9th, 2012

The departments of Health and Human Services (HHS), Treasury and Labor, along with the Internal Revenue Service (IRS), released a final rule detailing the new standards regarding the way in which health insurance plans must explain their coverage and benefits in marketing materials. This was a requirement of the Affordable Care Act (ACA). According to HHS, The rule and accompanying guidance are intended to provide consumers with clear, consistent and comparable summary information. Under the rule, health plans must provide a brief “Summary of Benefits and Coverage” and a uniform glossary of commonly used insurance terms before the purchase of health insurance and at the time of renewal. The rule’s requirements, which apply to all health plans, will take effect September 23, a six-month delay from the proposed effective date of March 23.

The final rule can be accessed at http://www.ofr.gov/(X(1)S(cqkh2tfp2zcqjhd0tggapmw2))/OFRUpload/OFRData/2012-03228_PI.pdf.

PAC-PRD Report Sent to Congress

Wednesday, February 8th, 2012

The Centers for Medicare & Medicaid Services (CMS) has sent to Congress a report on key findings from the Post Acute Care Payment Reform Demonstration (PAC-PRD), as required by the Deficit Reduction Act (DRA). The report describes the development and testing of the Continuity Assessments Record and Evaluation (CARE) which was mandated by the legislation, and reviews findings related to predicting patient-specific resource intensity across four post-acute care settings – long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health agencies. The demonstration involved 140 general acute hospitals and post-acute providers in 11 markets.

The report is available at http://www.cms.gov/Reports/Downloads/Flood_PACPRD_RTC_CMS_Report_Jan_2012.pdf.

Website for Clinical Trials Information Launched

Monday, February 6th, 2012

The National Institutes of Health (NIH) has launched a website to encourage participation in clinical research trials. The site contains information for patients and health care providers, including links to the agency’s registry of clinical trials, a database of clinical studies at the NIH campus in Bethesda, MD, and an NIH-funded registry of research volunteers.

The website is http://www.nih.gov/health/clinicaltrials/.

RAC Prepayment Review Demonstration to Launch

Monday, February 6th, 2012

The Centers for Medicare & Medicaid Services (CMS) plans to launch its Recovery Audit Prepayment Review Demonstration on or around June 1. the demonstration will allow Recovery Audit Contractors (RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules. The RACs will conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments. These reviews will focus on seven states with high populations of fraud- and error-prone providers (FL, CA, MI, TX, NY, LA, IL) and four states with high claims volumes of short inpatient hospital stays (PA, OH, NC, MO) for a total of 11 states. This demonstration will also help lower the error rate by preventing improper payments rather than the traditional “pay and chase” methods of looking for improper payments after they occur.

For more information visit www.cms.gov/CERT/02_Demonstrations.asp

HHS Reports on Progress Reducing Regulatory Burdens

Wednesday, February 1st, 2012

The Department of Health and Human Services (HHS) has issued a progress report on its efforts to reduce regulatory burdens. The major changes include a proposed rule revising the Medicare Conditions of Participation (CoP) for hospitals, final rules implementing a new credentialing/privileging process for physicians who provide telemedicine services, and removing the new physician signature requirement for clinical laboratory tests. According to the report, HHS plans to release four proposed rules easing regulatory burdens.

The progress report can be viewed at http://www.hhs.gov/open/execorders/13563/index.html.