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Archive for March, 2013

Proposed Rule Released Regarding Part B Inpatient Billing

Thursday, March 21st, 2013

The Centers for Medicare & Medicaid Services (CMS) has published a proposed rule that would allow additional Part B payment when a Medicare Part A claim is denied because the beneficiary should have been treated as an outpatient, rather than being admitted to the hospital as an inpatient.  The rule proposes that if the beneficiary is enrolled in Part B, Medicare would pay for all reasonable and necessary Part B hospital inpatient services when a Part A inpatient admission is denied as not reasonable and necessary. Currently, payment is only for a limited list of Part B inpatient services currently allowed in these circumstances.

The proposed rule can be viewed at https://www.federalregister.gov/articles/2013/03/18/2013-06163/medicare-program-part-b-inpatient-billing-in-hospitals

MedPAC Publishes Report to Congress

Monday, March 18th, 2013

The Medicare Payment Advisory Commission (MedPAC) has published its March report to Congress. Their recommendations are a 1% increase in hospital inpatient and outpatient prospective payment system payments.  For inpatient services, MedPAC recommended the difference between the 2014 statutory update and a 1% increase to offset the costs of changes in hospitals’ documentation and coding. The commission also recommended no marketbasket update for inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities or home health providers in 2014. The report also recommends the elimination of the update to ambulatory surgical center payment in 2014 and requiring them to submit cost data.

The report can be viewed at http://www.medpac.gov/documents/Mar13_EntireReport.pdf.

CMS Releases Sequester Information

Monday, March 11th, 2013

The Budget Control Act of 2011 requires mandatory across-the-board reductions in Federal spending, also known as sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, 2013. As a result of this, Medicare Fee for Service (FFS) claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by 2 percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.

The claims payment adjustment shall be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments. Though beneficiary payments for deductibles and coinsurance are not subject to the 2 percent payment reduction, Medicare’s payment to beneficiaries for unassigned claims is subject to the 2 percent reduction.

More information can be found going to  http://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2013-03-08-standalone.pdf

More States Move to Establish Health Insurance Marketplaces

Thursday, March 7th, 2013

On March 7, Health and Human Services (HHS) Secretary Kathleen Sebelius announced that more states are moving forward to implement the health care law and establishing Health Insurance Marketplaces. HHS conditionally approved Iowa, Michigan, New Hampshire, and West Virginia to operate State Partnership Marketplaces, which will be ready for open enrollment in October 2013.

Twenty-four states and the District of Columbia have been conditionally approved to partially or fully run their Marketplace. In addition, several other states have suggested their own approaches to contributing toward plan management in their Marketplace in 2014. HHS will continue to provide all states with the flexibility, resources, and time needed to support the establishment of the new health insurance marketplace.

For more information on the new health insurance Marketplace, visit:

ICD-10 Timelines Posted

Wednesday, March 6th, 2013

The Centers for Medicare & Medicaid Services has posted timelines to assist providers’ and payers’ transition to the new ICD-10-CM coding system. All entities covered  by the Health Insurance Portability and Accountability Act (HIPPA) must transition to the ICD-10 coding system by October 1, 2014.

The timelines can be accessed by going to http://www.cms.gov/Medicare/Coding/ICD10/ICD-10ImplementationTimelines.html

Health IT Advisory Committee Appointments Named

Monday, March 4th, 2013

Health and Human Services (HHS) Secretary Kathleen Sebelius has named new and continuing members to both the Health Information Technology (HIT) Policy and HIT Standards Committees. The committees provide a direct means for health information technology stakeholders and the public to provide input to HHS. The new members are: Jeremy Delinsky, chief technology officer at Athenahealth; Keith Figlioli, senior vice president of health care informatics at Premier Inc.; Lisa Gallagher, senior director of privacy and security at HIMSS; Anne LeMaistre, M.D., chief medical information officer at Seton Healthcare Family, Ascension Health; Kim Nolen, medical outcomes specialist at Pfizer Inc.; Eric Rose, M.D., director of clinical terminology at Intelligent Medical Objects; Andrew Wiesenthal, M.D., director of health care practice at Deloitte Consulting; and Taha Kass-Hout, M.D., director of the division of informatics solutions and operations at the Centers for Disease Control and Prevention.

For more information, see the HHS news release at: http://www.hhs.gov/news/press/2013pres/03/20130301a.html.

HHS Issues Notice of Benefit and Payment Parameters

Monday, March 4th, 2013

The Department of  Health and Human Services (HHS) issued a  Notice of Benefit and Payment Parameters in a final rule on March 1. The notice expands the standards set forth in earlier rules and provides further information on the permanent risk adjustment, transitional reinsurance and temporary risk corridors programs, advance payments of the premium tax credit, cost-sharing reductions, medical loss ratio, and the Small Business Health Options Program (SHOP).

To stabilize premiums as new consumer protection begin in the individual and small group market in 2014, the Affordable Care Act (ACA) creates three programs – risk adjustment, reinsurance, and risk corridors. These programs will work with the premium tax credits, cost-sharing reductions, medical loss ratio program and new market reforms, including the guaranteed availability protections and prohibition of the use of a variety of factors to help ensure affordable health insurance. Key policies include: a risk adjustment program that will assist health insurance plans in providing coverage to individuals with higher risk populations; reducing the incentives for health insurance issuers to avoid enrolling people with pre-existing conditions; stabilizing premiums in the individual market for health insurance; protecting health insurance issuers against uncertainty in setting premium rates; helping working Americans afford health insurance in the Marketplaces; finalizing a number of provisions to SHOP; and amending the Medical Loss Ratio (MLR) program.

HHS  also issued an interim final rule with comment  in which HHS is adjusting the risk corridors calculation to align with the single risk pool  provision of the ACA and is allowing Qualified Health Plan issuers to use an optional simplified methodology for calculating the amounts of cost-sharing reductions provided during a transition period.

The Notice of Benefit and Payment Parameters for 2014, the Payment Notice Amendment interim Final rule with comment, and the SHOP proposal can be viewed at https://www.federalregister.gov/public-inspection.