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Archive for October, 2013

2014 Medicare Premiums and Deductibles Announced

Monday, October 28th, 2013

The Centers for Medicare & Medicaid Services (CMS) announced the 2014 Medicare premiums and deductibles for beneficiaries. Under Medicare Part A, which pays for inpatient hospital, skilled nursing facility, hospice and some home health care services, the deductible paid by the beneficiary when admitted as a hospital inpatient will be $1,216. This deductible represents the cost for up to 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries will be responsible for daily payments for hospital stays that exceed 60 days in a benefit period.

The standard monthly Medicare Part B premium rate for enrollees will remain at $104.90, but is adjusted upward for higher income beneficiaries.

The press release can be found at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-10-28.html

Program Integrity Rules Finalized

Friday, October 25th, 2013

The Centers for Medicare & Medicaid Services (CMS) has issued a rule which finalizes certain program integrity standards for health insurance exchanges, state-operated premium stabilization programs, and advance payment of the Affordable Care Act’s (ACA) premium tax credit and cost-sharing reductions. The rule also finalizes standards permitting qualified health plans (QHP) to use an alternate methodology to calculate the value of cost-sharing reductions. In addition, the rule establishes a vendor approval process for a survey to compare enrollee satisfaction among comparable health plans offered on the exchanges.

For further information, go to http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/pi-final-10-24-2013.html

ESRD Rule Finalized

Tuesday, October 22nd, 2013

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare policies and payment rates for 2014 for dialysis facilities paid under the End Stage Renal Disease (ESRD) Prospective Payment System (PPS). CMS received extensive public comment on the proposed rule issued in July. CMS carefully reviewed the comments and has decided to implement a three- to four-year transition for the drug utilization adjustment to the base rate mandated by Congress as part of the American Taxpayer Relief Act. Overall payments for 2014 will see a zero percent change.

The rule also finalized a 50 percent increase to the home dialysis training add-on payment adjustment that is made for both peritoneal dialysis and home hemodialysis training treatments.

The final rule will also strengthen the ESRD Quality Incentive Program (QIP), which creates incentives for dialysis facilities to improve the quality of care and patient outcomes for beneficiaries diagnosed with ESRD. For the ESRD QIP Payment Year (PY) 2016 program (which will rely on measures of dialysis facility performance during 2014), CMS is finalizing 11 measures addressing infections, anemia management, dialysis adequacy, vascular access, mineral metabolism management, and patient experience of care. CMS is also finalizing the method by which performance scores will be calculated by weighting clinical measures at 75 percent of the total performance score and weighting the reporting measures at 25 percent. The ESRD QIP will reduce payments to ESRD facilities that do not meet or exceed certain performance standards.

Additionally, the final rule includes several provisions related to Medicare policies on durable medical equipment (DME). CMS is a finalizing clarification of the 3-year minimum lifetime requirement for DME and the distinction between routinely purchased and capped rental DME. The rule also finalizes the implementation of budget-neutral fee schedules for splints and casts, and intraocular lenses inserted in a physician’s office as well as a few technical amendments and corrections to existing regulations related to payment for durable medical equipment, prosthetics, and orthotics items and services.

For more information about the final rule, please go to: http://www.ofr.gov/OFRUpload/OFRData/2013-28451_PI.pdf

Less than Half of Eligible Hospitals Awarded EHR Payments

Monday, October 21st, 2013

According to a report released by the Government Accountability Office (GAO), only 48% of eligible hospitals were awarded Medicare incentive payments for meaningful use (MU) of electronic health records (EHR) for 2012. This represents 2,291 hospitals, up from 777 in 2011.Urban areas hospitals were 1.2 times more likely to have been awarded a payment compared to those in rural areas.

The report is available at http://www.gao.gov/products/GAO-14-21R.

Medicare Redeterminations Increase 33%

Thursday, October 3rd, 2013

According to a report published by the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG), the number of first-level appeals of Medicare Part A claims, known as redeterminations, increased by 33% between 2008 and 2012. However, the proportion of redeterminations favorable to appellants declined for both inpatient and outpatient services with the largest decline among inpatient redeterminations related to Recovery Audit Contractors (RAC). Favorable RAC-related inpatient redeterminations fell to 11% in 2012 from 83% in 2009. As part of the report, the OIG has recommended that the Centers for Medicare & Medicaid Services (CMS) use the Medicare Appeals System (MAS) to monitor the timeliness of redetermination processing, to develop a strategy to monitor the quality, accuracy and completeness of the data entered into MAS, and to continue to foster information sharing among Medicare contractors.

The report can be viewed at https://oig.hhs.gov/oei/reports/oei-01-12-00150.asp.

FAQs on 2 Midnight Admission and Medical Review Criteria Policy Issued

Tuesday, October 1st, 2013

The Centers for Medicare & Medicaid Services (CMS) has issued new guidance in the form of several frequently asked questions (FAQs) on the 2 midnight inpatient admission and review criteria. The agency reiterated that Medicare Administrative Contractors (MAC) and Recovery Audit Contractors (RAC) are not to review claims spanning more than two midnights after admission for a determination of whether the inpatient hospital admission was appropriate. CMS has also announced that, for a period of 90 days, it will not permit RACs to review inpatient admissions of one midnight or less that begin on or after October 1, 2013. In addition, the agency stated that MACs and RACs will not review any claims from critical access hospitals during this period. However, CMS will allow the MACs to review small samples of inpatient hospital claims with admission dates of October 1 through December 31, 2013, that span less than two midnights to determine whether the inpatient hospital admission was appropriate. If the MAC determines that the admissions were appropriate, it will cease further reviews for that hospital from October 1 through December 31, 2013, unless there are significant changes in billing patterns for admissions.

The FAQ is available at http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medical-Review/Downloads/2MidnightInpatientAdmissionGuidanceandPatientStatusReviewsforA-.pdf

Medicare DSH Rule Released

Tuesday, October 1st, 2013

The Centers for Medicare & Medicaid Services (CMS) has released an interim final rule regarding the process the agency will use in determining uncompensated care payments to hospitals eligible for the Disproportionate Share Hospital (DSH) payment adjustment in FY 2014.  CMS will accept comments on the interim final rule through November 29.

The DSH files can be viewed at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/dsh.html