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Archive for April, 2012

Final Rule Published on ACA Program Integrity Provisions

Wednesday, April 25th, 2012

The Centers for Medicare & Medicaid Services (CMS) has published a final rule implementing three Medicare and Medicaid program integrity provisions of the Patient Protection and Affordable Care Act (ACA) which finalizes an interim final rule issued in May 2010. It specifies that only a physician or other eligible health professional enrolled in Medicare with an approved status (or who has validly opted out of Medicare) may certify or order certain services, including durable medical equipment, home health and Part B laboratory and imaging services. The regulations require that Medicare contractors deny claims from a provider or supplier for these services if these requirements are not met. The rule also requires Medicare providers and suppliers to maintain documentation for seven years from the date of service and to provide it to CMS upon request. The rule also defines existing Medicare and Medicaid requirements that fee-for-service providers include their National Provider Identifier (NPI) on Medicare enrollment applications and on Medicare and Medicaid claims.

The final rule can be accessed at this link.

Spending Data Added to Hospital Compare Website

Friday, April 20th, 2012

The Centers for Medicare & Medicaid Services (CMS) has added data from the new Medicare spending per beneficiary measure to the Hospital Compare website. The “Spending per Hospital Patient with Medicare” is a measure that shows whether Medicare spends more, less or about the same as the national average per episode of care for patients treated at a specific hospital. The measure includes any Medicare Part A and Part B payments for services provided to a patient three days prior to a hospital stay, during the hospital stay and 30 days after discharge from the hospital.

The Hospital Compare website address is http://hospitalcompare.hhs.gov/.

DMEPOS Competitive Bidding Recompete Announced

Tuesday, April 17th, 2012

The Centers for Medicare & Medicaid Services (CMS) has announced plans to recompete the Medicare durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) Competitive Bidding Program contracts in nine areas of the country. The Round One recompete will apply to the same nine regions as the first round – Charlotte, Cincinnati, Cleveland, Dallas, Kansas City, Miami, Orlando, Pittsburgh and Riverside, CA – and include additional products.

For more information, go to this link.

ICD-10 Implementation Delay Proposed

Saturday, April 14th, 2012

The Department of Health and Human Services (HHS) has proposed a one-year delay in the deadline for implementing the International Classification of Diseases, 10th Edition (ICD-10) for administrative health care transactions. The new October 1, 2014 compliance date would apply to both diagnosis and procedure (ICD-10-CM and ICD-10-PCS) codes. The proposed rule, which was published April 14, also includes several changes under the Health Insurance Portability and Accountability Act (ACA).

The proposed rule can be viewed at http://www.gpo.gov/fdsys/pkg/FR-2012-04-17/pdf/2012-8718.pdf

Hospital Outpatient Quality Measure Temporarily Suspended

Thursday, April 12th, 2012

The Centers for Medicare & Medicaid Services (CMS) has temporarily suspended use of outpatient quality measure OP-19. This quality measure is used to assess the percentage of emergency department patients who receive a transition record on discharge from the ED. The suspension is effective retroactive to January because of potential concerns with the measure specifications.

The CMSnotification can be found at this link.

Medicare ACOs Announced

Wednesday, April 11th, 2012

The Centers for Medicare & Medicaid Services (CMS) has announced the first 27 accountable care organizations (ACOs) to participate in the voluntary Medicare Shared Saving Program (MSSP). The selected organizations will be responsible for improving care for nearly 375,000 beneficiaries in 18 states through better coordination among providers.CMSalso announced that five ACOs began participating in the program’s Advance PaymentACOModel, which provides advance payment of expected shared savings to rural and physician-based ACOs that would benefit from additional start-up resources.

The ACOparticipation information is available in a Press Release at http://www.cms.gov/apps/media/press_releases.asp.

MedPAC Discusses EHR Program and Recommends Medicare Benefit Redesign

Thursday, April 5th, 2012

The Medicare Payment Advisory Commission (MedPAC) recently discussed the Medicare electronic health record (EHR) incentive program, and several commissioners expressed concern about the small number of hospitals and eligible professionals who have successfully attested to “meaningful use” of EHRs to date. Commissioners also expressed interest in monitoring the program going forward to see whether EHR implementation facilitates system efficiencies and cost savings. In addition, the commission unanimously voted to recommend that Congress direct the Health and Human Services (HHS) secretary to develop and implement a new Medicare Fee-For-Service benefit design to replace the current design. Commissioners expressed displeasure with the current benefit design and a desire for a more robust benefit package that is focused more on value. The proposed benefit design would include: an out-of-pocket maximum, deductible(s) for Parts A and B, and copayments (instead of coinsurance) that may vary by type of service and provider. TheHHSsecretary would be able to alter or eliminate cost-sharing, including the out-of-pocket maximum, based on evidence of the value of services. The proposal would not change the benefit aggregate cost sharing liability, and would include an additional charge on supplemental insurance.

More information is available at http://www.medpac.gov/.

Choosing Wisely® Campaign Launched

Wednesday, April 4th, 2012

Nine physician specialty societies have identified 45 tests or procedures that may be overused or unnecessary for certain patients based on the evidence, and encouraged physicians and patients to choose their use wisely. The Choosing Wisely® campaign is an initiative of the American Board of Internal Medicine (ABIM) Foundation. Current participants in the campaign include the American Academy of Allergy, Asthma & Immunology; American Academy of Family Physicians; American College of Cardiology; American College of Physicians; American College of Radiology; American Gastroenterological Association; American Society of Clinical Oncology; American Society of Nephrology; and American Society of Nuclear Cardiology.

For each society’s list of “Five Things Physicians and Patients Should Question,” visit http://choosingwisely.org.

2010 PQRS and eRx Incentive Payments Report Published

Monday, April 2nd, 2012

In a recent report from the Centers for Medicare & Medicaid Services (CMS), the Physician Quality Reporting System (PQRS) and eRx Incentive Program paid a combined total of $662 million in Medicare payment incentives in 2010, a 72% increase from 2009. About 26% of physicians and other eligible professionals participated in the quality reporting program, of which 72% were eligible for incentives. Roughly 19% of physicians and eligible professionals participated in the eRx program, of which 63% were eligible for incentives. Both programs allow participants to earn incentive payments for reporting data on quality measures for covered professional services furnished to Medicare beneficiaries. Under the eRx program, eligible professionals report data on the electronic quality measure regarding their use of a qualified electronic prescribing system.

The report can be accessed at http://www.cms.gov/apps/media/press/factsheet.asp.