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Archive for March, 2012

IOM Recommends More Integration

Wednesday, March 28th, 2012

According to a report released by the Institute of Medicine (IOM), the traditional separation between primary health care providers and public health professionals is impeding greater success in meeting their shared goal of promoting the overall health of the population. The report recommends that the federal Centers for Disease Control and Prevention and the Health Resources and Services Administration foster integration between primary care and public health through funding, policies and other means. Based on a review of published papers and case studies in specific cities, the study committee found that successful integration of primary care and public health requires community engagement to define and tackle local population health needs, leadership that bridges disciplines and jurisdictions and provides support and accountability, shared data and analyses, and sustained focus by partners.

The report is available at http://www.iom.edu/Reports/2012/Primary-Care-and-Public-Health.aspx

CMS Delays Innovation Grants Award Date

Monday, March 26th, 2012

The Centers for Medicare & Medicaid Services (CMS) has delayed the award date for the Health Care Innovation Challenge to allow more time to review the roughly 3,000 applications it received. The initiative will award up to $1 billion in grants over three years to projects that identify and test promising new payment and care delivery models for Medicare, Medicaid and the Children’s Health Insurance Program.

The information for the Innovation Center is available at http://www.innovation.cms.gov/initiatives/Innovation-Challenge/index.html.

Enforcement of New HIPAA Transaction Standards Delayed

Friday, March 16th, 2012

The Centers for Medicare & Medicaid Services (CMS) has delayed the enforcement of the new Version 5010 and D.0 transaction standards for electronic health care claims through June 30. The new standards took effect January 1 for health care providers and others covered by the Health Insurance Portability and Accountability Act (HIPAA).CMS’ Office of E-Health Standards and Services said that remaining issues warrant an extension of enforcement discretion to ensure that all entities can complete the transition. At the present time, the Medicare fee-for-service program is reporting successful receipt and processing of more than 70% of Part A claims and 90% of Part B claims in the Version 5010 format.

The announcement can be viewed at http://www.cms.gov/ICD10/Downloads/EnforcementDiscretionAnnouncement.pdf.

RACs to Increase Medical Record Requests

Friday, March 16th, 2012

The Centers for Medicare & Medicaid Services (CMS) has significantly increased the number of medical records that Recovery Audit Contractors (RAC) may request from hospitals and other institutional providers. The new annual limit for most providers is 2% of all claims submitted in the prior calendar year, divided by 8. RACs may not request more than 400 medical records in a 45-day period, which is up from 300. In addition, the 45-day cap has been increased to 600 for some hospitals with more than $100 million in Medicare Severity-Diagnosis Related Group payments. When responding to aRACrequest for medical records, skilled nursing facilities must provide documentation for all claims associated with the full SNF episode of care, from admission to discharge.

For more on the new annual limits, see the CMSnotice at http://www.cms.gov/Recovery-Audit-Program/Downloads/Providers_ADRLimit_Update-03-12.pdf.

Final Rule Published on Implementing Health Insurance Exchanges

Monday, March 12th, 2012

The Department of Health and Human Services (HHS) has released a final rule implementing health insurance exchanges for individuals and small businesses under the Affordable Care Act (ACA). The ACA requires states to establish exchanges to facilitate the purchase of qualified health plans in the individual and small group markets beginning in 2014. The rule establishes the required framework for a state health insurance exchange, including exchange structure. It also includes standards for health plan participation, determining an individual’s eligibility to enroll in exchange health plans and insurance affordability programs, enrollment, and the Small Business Health Options Program.

The rule can be viewed at https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-06125.pdf and will be published in the Federal Register on March 27, 2012.

Hospital VBP Program FAQs Published

Thursday, March 8th, 2012

The Centers for Medicare & Medicaid Services (CMS) has compiled frequently asked questions (FAQ) from hospitals and hospital stakeholders about the first year of the Hospital Value-Based Purchasing (VBP) Program, scheduled to begin for discharges on or afterOctober 1, 2012.

The Centers for Medicare & Medicaid Services (CMS) has compiled frequently asked questions (FAQ) from hospitals and hospital stakeholders about the first year of the Hospital Value-Based Purchasing (VBP) Program, scheduled to begin for discharges on or afterOctober 1, 2012.

The questions cover the following topics:

  • The program’s background
  • Hospital eligibility
  • Incentive payments
  • Performance periods
  • Performance assessment
  • Performance measures
  • Calculating performance scores
  • Translating scores into payments
  • Public reporting
  • Appeals

For further information, visit the CMS Hospital Value-Based Purchasing web page.

Medicare Redesigns Claims and Benefits Statement

Wednesday, March 7th, 2012

The Centers for Medicare & Medicaid Services (CMS) has announced the redesign of the statement that informs Medicare beneficiaries about their claims for Medicare services and benefits. The redesigned statement, known as the Medicare Summary Notice (MSN), will be available online and, starting in 2013, mailed out quarterly to beneficiaries.CMSwill take additional actions this year to make information about benefits, providers and claims more accessible and easier to understand for seniors and people with disabilities who have Medicare. ThisMSNredesign reflects more than 18 months of research and feedback from beneficiaries to provide enhanced customer service and respond to suggestions and input.

To see a side-by-side comparison of the former and redesigned MSNs, please visit: http://www.cms.gov/apps/files/msn_changes.pdf

Proposed Rule updating EHR Certification Criteria Published

Wednesday, March 7th, 2012

The Department of Health and Human Services’ Office of the National Coordinator (ONC) for Health Information Technology published a proposed rule updating certification requirements for electronic health record (EHR) technology effective in 2014. In the proposed rule, hospitals and eligible professionals will only be required to own certified EHR technology for the objectives they use to demonstrate meaningful use under the Medicare or Medicaid EHR incentive program. The proposed rule was published in the March 7 Federal Register with comments accepted for 60 days.

The proposed rule is available in the Federal Register. http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/2012-4443.pdf

Accreditation for Advanced Diagnostic Imaging Notice Issued

Friday, March 2nd, 2012

The Centers for Medicare & Medicaid Services (CMS) issued a notice in the Federal Register inviting independent accreditation organizations to apply to becomeCMS-designated accreditation organizations for accrediting suppliers furnishing the technical component (TC) of advanced diagnostic imaging (ADI) services.  The notice also includes the application guidelines for approval of organizations wishing to accredit these suppliers.  The solicitation is limited to accrediting organizations that have not previously applied to participate in the advanced diagnostic imaging supplier accreditation program.  Applications will be accepted throughMay 1, 2012.

The Federal Register Notice can be accessed at https://www.federalregister.gov/articles/2012/03/02/2012-5013/medicare-program-solicitation-of-independent-accrediting-organizations-to-participate-in-the.