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Archive for January, 2014

Final Rule Allows Patients Access to Lab Reports

Friday, January 31st, 2014

The Department of Health and Human Services (HHS) has issued a final rule allowing laboratories to give patients or their designated representative direct access to completed test reports. While patients can continue to get access to their laboratory test reports from their doctors, the rule amends the Clinical Laboratory Improvement Amendments (CLIA) and Health Insurance Portability and Accountability Act Privacy (HIPAA) Rule to provide patients a new way to obtain their test reports directly from the laboratory.

The final rule is available at http://www.gpo.gov/fdsys/pkg/FR-2014-02-06/pdf/2014-02280.pdf.

Two-midnight Partial Enforcement Delay Extended

Friday, January 31st, 2014

The Centers for Medicare & Medicaid Services (CMS) has extended the partial enforcement delay of the two-midnight policy for inpatient admission and medical review criteria for six months. According to CMS, recovery auditors and other Medicare review contractors will not conduct post-payment patient status reviews of inpatient hospital claims with dates of admission on or after October 1, 2013 through September 30, 2014. However, Medicare Administrative Contractors (MAC) will continue to conduct pre-payment “probe and educate” audits on select claims.

More information is available at http://cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/InpatientHospitalReviews.html.

Medicare ACO Savings and Bundled Payment Participants Announced

Thursday, January 30th, 2014

The Centers for Medicare & Medicaid Services (CMS) has announced that Medicare accountable care organizations (ACOs) have generated more than $380 million in savings in the first year of the Shared Savings and Pioneer ACO programs. In addition, CMS announced that 232 additional acute-care hospitals, skilled nursing homes, physician group practices, long-term care hospitals, and home health agencies have entered agreements to participate in the Bundled Payments for Care Improvement initiative. The Medicare demonstration project includes four models of care that bundle payments for multiple services received during an episode of inpatient and/or post-acute care.

A press release is available at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2014-Press-releases-items/2014-01-30.html.

Eisenberg Quality Award Winners Announced

Thursday, January 23rd, 2014

The National Quality Forum and Joint Commission have announced the 2013 John M. Eisenberg Patient Safety and Quality Award winners. The awards for innovation at the national level will go the Minnesota Hospital Association, Institute for Clinical Systems Improvement and Stratis Health for their partnership to reduce avoidable readmissions. The Hospital Association of Southern California, Hospital Association of San Diego & Imperial Counties, Hospital Council of Northern & Central California, Anthem Blue Cross, and National Health Foundation will receive an award for their quality improvement initiative. The award for innovation at a local level will go to Vidant Health in Greenville, SC., and the individual achievement award will go to Gail Warden, president emeritus of Henry Ford Health System in Detroit.

For more information, visit this link.


CMS Clarifies Use of Service Vendors

Thursday, January 23rd, 2014

The Centers for Medicare & Medicaid Services (CMS) has clarified that hospitals can continue to use service vendors to assist them in making Medicaid presumptive eligibility (PE) determinations under the Affordable Care Act (ACA). In their clarification, CMS states that hospitals can rely on third-party contractors to help staff their in-hospital PE operations by staffing welcome desks, meeting with consumers, and helping them fill out PE applications as long as the hospital takes responsibility for the PE determinations that result.

CMS issued the clarifications in a series of FAQs on hospital PE. The FAQ can be viewed at http://www.medicaid.gov/State-Resource-Center/FAQ-Medicaid-and-CHIP-Affordable-Care-Act-Implementation/Downloads/FAQs-by-Topic-Hospital-PE-01-23-14.pdf.

The clarification is available at http://content.govdelivery.com/attachments/USCMS/2014/01/24/file_attachments/265156/CIB-01-24-2014.pdf.

MedPAC Announces 2015 Recommendations

Monday, January 13th, 2014

The Medicare Payment Advisory Commission (MedPAC) has approved a final recommendation to Congress that increases Medicare payment rates in 2015 for the hospital inpatient and outpatient prospective payment systems by 3.25%. They also note that their recommendation is 5.25% if the sequester continues in 2015. The Commission has also recommended that Congress reduce or eliminate differences in payment between hospital outpatient departments and physician offices for certain  procedures, and that long-term care hospitals be reimbursed at the same rates as general acute-care hospitals for patients who are not chronically critically ill, which is defined as an intensive care unit stay of at least eight days.

For more information, visit http://medpac.gov/

CMS and Maryland Announce New Initiative

Friday, January 10th, 2014

On January 10, the Centers for Medicare & Medicaid Services (CMS) and the state of Maryland jointly announced a new initiative to modernize Maryland’s unique all-payer rate-setting system for hospital services.

Maryland operates the nation’s only all-payer hospital rate regulation system. This system is made possible, in part, by a 36 year old Medicare waiver that exempts Maryland from the Inpatient Prospective Payment System (IPPS) and the Outpatient Prospective Payment System (OPPS), and allows Maryland to set rates for these services. Under the waiver, all third party purchasers pay the same rate. The State of Maryland and CMS believe that the new model test will provide an opportunity for Maryland to reform its delivery system to align with the goals of delivering better health, better care, and lower cost.

For further details, the press release can be found at: http://www.cms.gov/Newsroom/Newsroom-Center.html

OIG Report Released on Fraud Associated with EHRs

Wednesday, January 8th, 2014

According to a report released by the Department of Health and Human Services’ Office of Inspector General (OIG), the Centers for Medicare & Medicaid Services (CMS) should provide best practices and guidance to its contractors for detecting potential fraud associated with electronic health records (EHR). In addition, CMS should direct its contractors to use EHR audit logs when reviewing medical records.

The report can be found by going to http://oig.hhs.gov/oei/reports/oei-01-11-00571.asp

Discussion Paper and Proposed Financial Model Released by IOM

Monday, January 6th, 2014

The Institute of Medicine (IOM) released a discussion paper and proposed financial model to help hospitals and other health care providers assess the costs and benefits of implementing electronic health records (EHR). The proposed standard model is intended to help providers conduct inter-organizational comparisons, identify best-in-class implementation approaches, and prioritize process redesign endeavors.

For further details, visit http://www.iom.edu/Global/Perspectives/2014/ReturnOnInformation.aspx

123 New Medicare ACOs Named

Friday, January 3rd, 2014

Physicians, hospitals and other health care providers have formed 123 new accountable care organizations have been named to participate in the Affordable Care Act’s Medicare Shared Savings Program (MSSP) beginning this January 1. MSSP participants work to provide high-quality coordinated care to Medicare fee-for-service beneficiaries while reducing the rate of growth in health care spending. To date, more than 360 organizations have formed Medicare ACOs serving more than 5.3 million beneficiaries.

For a list of the 123 new ACOs, visit http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/2014-ACO-Contacts-Directory.pdf.