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Archive for June, 2012

ETF Regulations Expanded

Thursday, June 28th, 2012

Existing regulations require that at the time of enrollment, enrollment change request or revalidation, providers and suppliers that expect to receive payment from Medicare for services provided must also agree to receive Medicare payments through electronic funds transfer (EFT).  The Affordable Care Act (ACA) further expands this regulation by mandating federal payments to providers and suppliers only be made by electronic means.  As part of the Centers for Medicare & Medicaid Services (CMS) revalidation efforts, all suppliers and providers who are not currently receiving EFT payments are required to submit the CMS-588 EFT form with their Provider Enrollment Revalidation application, or at the time any change is being made to the provider enrollment record by the provider or supplier or their delegated official.

For more information, go to http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1126.pdf

2013 ICD-10-PCS Files Posted

Thursday, June 28th, 2012

The 2013 ICD-10-PCS files have been posted on the 2013 ICD-10-PCS and GEMs webpage. This includes the 2013 Index and Tabular files, guidelines, code titles, addendum to reference manual, and slides. The 2013 ICD-10-PCS files contain information on the new procedure coding system that is being developed as a replacement for ICD-9-CM, Volume 3.  The 2013 General Equivalent Mappings (GEMs), Reimbursement Mappings and Reference Manual will be posted at a later date.

The webpage can be found by going to http://www.cms.gov/medicare/coding/ICD10/2013-icd-10-pcs-gems.html

MedPAC Submitted June Report to Congress

Friday, June 15th, 2012

The Medicare Payment Advisory Commission (MedPAC) submitted its June report to Congress, which includes recommendations for reforming Medicare’s benefit design and improving care for beneficiaries enrolled in both Medicare and Medicaid. The proposed Medicare 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. With respect to dual-eligible beneficiaries, MedPAC raises concerns about a Center for Medicare and Medicaid Innovation (CMMI) demonstration project. The project will test financial models for states to better align financing and integrate primary, acute, behavioral health and long-term care services for dual Medicare and Medicaid enrollees, including whether the initiative is in effect a program change rather than a demonstration.

The report also includes two congressionally mandated reports concerning Medicare rural areas and home infusion therapy. Required by the Affordable Care Act (ACA), the rural report evaluates health care access, quality, payment adequacy and special payments. Rather than specific recommendations, the report includes a set of principles to guide expectations and policies with respect to these rural issues.

The report can be viewed at http://www.medpac.gov/documents/Jun12_EntireReport.pdf,

CMMI Accepting New Applicants for Advance Payment ACO Model

Tuesday, June 12th, 2012

Beginning August 1, the Center for Medicare & Medicaid Innovation (CMMI) announced that it will begin accepting new applicants for its Advance Payment Accountable Care Organization (ACO) model. The program provides upfront and monthly payments of expected shared savings to rural and physician-based ACOs seeking to participate in the Medicare Shared Savings Program (MSSP). These additional start-up resources help smaller ACOs establish the necessary infrastructure for the Shared Savings Program.

For more information, see the CMMI announcement at http://innovations.cms.gov/.

Report Issued on Use of ACA Medicare Preventive Benefit

Monday, June 11th, 2012

According to the Centers for Medicare & Medicaid Services (CMS), about 14.3 million people in original Medicare received an annual wellness visit or other preventive service at no cost to them in the first five months of 2012. That includes 1.1 million people who received an annual wellness visit. Medicare last year began offering annual wellness visits, cancer screenings and other recommended preventive services with no co-payment or deductible, as required by the Patient Protection and Affordable Care Act (ACA). In 2011, 32.5 million enrollees took advantage of the benefit.

A report can be viewed at http://downloads.cms.gov/files/preventionreport.pdf.

CMS Announces Data and Information Initiative

Tuesday, June 5th, 2012

On June 5, the Centers for Medicare & Medicaid Services (CMS) announced a new data and information initiative that will be a key tool in the agency’s evolution from a fee-for-service based payer to a value-based purchaser of care.

The data and information initiative will be administered through a new Office of Information Products and Data Analytics (OIPDA) that will oversee CMS’s comprehensive portfolio of data and information. Under OIPDA, the development, management, use and dissemination of data and information resources will become one of CMS’s core functions. Ensuring the privacy and security of personal health information remains a top priority as OIPDA improves access to, and use of, CMS data and information resources. With timely, relevant data, CMS and its partners will be better able to define and reward high quality, low cost care.

This effort also enhances data analytics and management strategies that are being widely promoted through programs by the White House Office of Science and Technology Policy.

More information on CMS’s initiative is available at http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ResearchGenInfo/OIPDA.html.

Supervision Requirement for Certain Outpatient Services Changed

Tuesday, June 5th, 2012

Effective July 1, the Centers for Medicare & Medicaid Services (CMS) has finalized its decision to change the supervision requirement for 27 hospital outpatient therapeutic services from direct supervision to general supervision. Under general supervision, the service is performed under the overall direction and control of a physician or non-physician practitioner but their presence is not required. The services deal with psychotherapy, bladder catheterization, immunization administration, and smoking and tobacco cessation counseling.

The decision can be viewed at http://www.cms.gov/Regulations-and-Guidance/Guidance/FACA/Downloads/PrelimSupervisionDecisions.pdf