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Archive for July, 2013

IOM Issues Report on Crisis Planning

Wednesday, July 31st, 2013

The Institute of Medicine (IOM) has issued a report along with a toolkit to assist emergency response planners develop indicators and triggers for activating crisis standards of care when insufficient resources are available to provide the normal level of care to all patients in a disaster or public health emergency. The report builds on two previous IOM reports on crisis standards of care (CSC). According to the authors, the report focuses on indicators and triggers that guide transitions along the continuum of care, from conventional standards of care to contingency surge response and standards of care to crisis surge response and standards of care, and back to conventional standards of care.

The report and the toolkit can be accessed at http://www.iom.edu/Reports/2013/Crisis-Standards-of-Care-A-Toolkit-for-Indicators-and-Triggers.aspx

Providers Can Rate Performance of their MAC

Monday, July 29th, 2013

Medicare providers now have the opportunity to rate the performance of their Medicare Administrative Contractor (MAC) using the MAC Satisfaction Indicator which was recently launched by the Centers for Medicare & Medicaid Services as a way to measure provider satisfaction. Each year, CMS will draw a random sample of health care providers from the registry to complete the survey tool, which will be used to improve the level of claims administration service offered by the MACs.

Registration is available at http://www.cms.gov/Medicare/Medicare-Contracting/MSI/

OPEN PAYMENTS Mobile Apps Announced

Wednesday, July 17th, 2013

The Centers for Medicare & Medicaid Services (CMS) has introduced two free mobile device applications (apps) to help physicians and health care industry users to track their payments and other financial transfers the industry will report under the OPEN PAYMENTS program.  Created by a provision of the Affordable Care Act (ACA), OPEN PAYMENTS creates greater public transparency about the financial transactions between doctors, teaching hospitals, drug and device manufacturers, and other health care businesses.

CMS has made these apps available to facilitate accurate reporting of required information, which will be available to the public and will be published annually on the OPEN PAYMENTS website. To support the OPEN PAYMENTS program, CMS designed the mobile applications (one each for physicians and health care industry users), merging this proven and efficient format with real-time 24-hour tracking technology.  In August 2013, pharmaceutical and device manufacturers, along with group purchasing organizations (GPOs), will collect and prepare to report payments and other transfers of value made to physicians and teaching hospitals, as well as certain ownership and investment interests.

For more information, please visit www.go.cms.gov/openpayments

Marketplace Navigators Final Rule Published

Friday, July 12th, 2013

The Centers for Medicare & Medicaid Services (CMS) has published a final rule outlining the standards for Navigators, the in-person assisters in Federally-facilitated and State Partnership Marketplaces. State-based Marketplaces have the option of using this guidance or developing their own. The rule identifies training, conflict of interest standards, and standards for serving people with limited English proficiency and people with disabilities.

Navigators and similar in-person assisters will provide unbiased information to consumers about health insurance, the new Health Insurance Marketplaces, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.

The final rule can be viewed at http://www.ofr.gov/OFRUpload/OFRData/2013-17125_PI.pdf.

2014 Medicare Physician Fee Schedule Proposed Rule Published

Monday, July 8th, 2013

On July 8, 2013, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (MPFS) on or after January 1, 2014.  The proposed rule also proposes changes to several of the quality reporting initiatives that are associated with PFS payments, including the Physician Quality Reporting System (PQRS), as well as changes to the Physician Compare tool.  Finally, the proposed rule includes proposals for implementing the value-based payment modifier (Value Modifier) required by the Affordable Care Act (ACA) that would affect payment rates to certain groups based on the quality and cost of care they furnish to beneficiaries enrolled in the traditional Medicare fee-for-service program.

CMS will accept comments until September 6 and the final rule is expected to be released by November 1, 2013.

The proposed rule can be accessed at:


2014 HOPPS and ASC Proposed Rules Issued

Monday, July 8th, 2013

On July 8, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) beginning January 1, 2014.  CMS proposes to update the OPPS market basket by 1.8 percent for CY 2014.   The proposed hospital market basket increase published in the Fiscal Year (FY) 2014 Inpatient Prospective Payment System (IPPS)/Long-Term Care Hospital Prospective Payment System (LTCH PPS) proposed rule is 2.5 percent.  The Medicare statute requires a productivity adjustment reduction of 0.4 percentage points and a 0.3 percentage point reduction to the CY 2014 OPPS market basket. Total calendar year (CY) 2014 OPPS payments are projected to increase by $4.37 billion or 9.5 percent, and CY 2014 Medicare payments to ASCs are projected to increase by approximately $133 million or 3.51 percent as compared to CY 2013.

The CY 2014 Outpatient Prospective Payment System (OPPS)/ASC rule proposes to expand the categories of related items and services packaged into a single payment for a primary service under the OPPS, in order to make the OPPS more of a prospective payment system.  The proposed rule would further expand the categories of packaged items and services by adding seven additional categories of supporting services. In addition to packaging these seven categories, CMS is proposing to create 29 comprehensive ambulatory payment categories (APCs) to replace 29 existing device-dependent APCs.

ASC payments are annually updated for inflation by the percentage increase in the consumer price index for all urban consumers (CPI-U).  For CY 2014, the CPI-U update is projected to be 1.4 percent.  The multifactor productivity (MFP) adjustment is projected to be 0.5 percent, resulting in an MFP-adjusted CPI-U update of 0.9 percent for CY 2014.  In addition, CMS is proposing that certain ancillary or adjunctive services that would be packaged under the OPPS for CY 2014 also would be packaged under the ASC payment system for CY 2014.  Payments to ASCs that fail to meet ASC Quality Reporting Program requirements would be reduced by two percent.

CMS will accept comments until September 6 and the final rule is expected to be released by November 1, 2013.

The proposed rule can be accessed at:


ESRD PPS Proposed Rule Released

Tuesday, July 2nd, 2013

The Centers for Medicare & Medicaid Services (CMS) has released the 2014 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) proposed rule. Based on the proposed rule, hospital-based facilities would see a 9.3% payment cut. However, the overall reduction will be 9.4% because of a 2.9% ESRD bundled market basket update minus a 12% drug utilization adjustment, 0.4% productivity adjustment and a wage index budget-neutrality adjustment as required by law. The 2014 ESRD PPS would then have a base rate of $216.95. The rule also addresses issues related to coverage and payment of durable medical equipment, prosthetics, orthotics, and supplies.

The proposed rule was published in the July 8 Federal Register with comments accepted until August 30 and can be viewed at https://www.federalregister.gov/articles/2013/07/08