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Archive for May, 2014

GAO Makes MedPAC Appointments and Designates Vice Chair

Thursday, May 29th, 2014

The Government Accountability Office (GAO) has named three new members to the Medicare Payment Advisory Commission (MedPAC) and reappointed two members. The new members, whose terms will expire in April 2017, are Warner Thomas, president and CEO of Ochsner Health System in New Orleans, Francis “Jay” Crosson, M.D., a group vice president for the American Medical Association, and Kathy Buto, an expert in U.S. and international health policy. As the president and CEO of Ochsner Health System, Thomas oversees the Ochsner Medical Center in New Orleans, the Ochsner Clinic group practice, rurally-based and sub-acute care hospitals, skilled nursing and rehabilitation facilities, and hospices. The reappointed members are Willis Gradison, Jr., formerly a Scholar in Residence in the Health Sector Management Program at Duke University’s Fuqua School of Business, and William Hall, M.D., director of the Center for Healthy Aging at the University of Rochester School of Medicine. Jon Christianson, professor in the Division of Health Policy and Management at the University of Minnesota School of Public Health, was named vice chair of the commission.

For more details, visit http://www.gao.gov/press/medpac_appointments_vice_chair2014may29.htm

Medicare Prior-authorization Process Proposed

Friday, May 23rd, 2014

The Centers for Medicare & Medicaid Services (CMS) has proposed creating a Medicare prior-authorization process for durable medical equipment (DME), prosthetics, orthotics and supplies that are frequently subject to unnecessary utilization. The prior-authorization process would not create new clinical documentation requirements; however, it would ensure that existing documentation, coverage and coding requirements would be met before items would be furnished to beneficiaries and claims submitted for payment. The proposed rule would also expand Medicare’s prior-authorization demonstration for power mobility devices from seven states to 19, and establish similar demonstrations for certain non-urgent ambulance transport and hyperbaric oxygen therapy.

The proposed rule is available at https://www.federalregister.gov/articles/2014/05/28/2014-12245/medicare-program-prior-authorization-process-for-certain-durable-medical-equipment-prosthetics

ICD-10 and ICD-9-CM Code Sets Unchanged for 2015

Thursday, May 22nd, 2014

The partial freeze on updates to the ICD-10 and ICD-9-CM diagnosis and procedure codes will continue until October 1, 2015, the Centers for Medicare & Medicaid Services (CMS) announced. Regular updates to ICD-10 will begin on October 1, 2016, one year after the new planned implementation date, the agency said. CMS expects to release an interim final rule soon specifying a new ICD-10 compliance date of October 1, 2015. The 2015 ICD-9-CM, ICD-10-CM and ICD-10-PCS files contain no updates to the codes, CMS said. The agency expects to release the 2015 General Equivalence Mappings this summer.

More information is available at http://www.cms.gov/Medicare/Coding/ICD10/Downloads/Partial_Code_Freeze.pdf

Proposed Rule Issued Allowing Meaningful Use Flexibility

Tuesday, May 20th, 2014

The Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (HIT) have released a proposed rule that would allow hospitals and eligible professionals multiple pathways to meet meaningful use in 2014, including using the 2011 Edition Certified Electronic Health Record Technology (CEHRT) to meet the meaningful use requirements in place for 2013. CMS stated that, beginning in 2015, all eligible hospitals and professionals would be required to use the 2014 Edition CEHRT to report meaningful use. The rule also proposes beginning stage 3 meaningful use in fiscal year 2017.

The proposed rule can be viewed at https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-11944.pdf

Two-midnight Guidance Updated by CMS

Tuesday, May 13th, 2014

The Centers for Medicare & Medicaid Services (CMS) has updated its two-midnight guidance to reflect changes required by the Protecting Access to Medicare Act of 2014. CMS indicates that medical review activities under the Medicare Administrative Contractor Probe & Educate process will be extended through March 31, 2015. In addition, CMS said it will prohibit recovery auditors from conducting inpatient hospital patient status reviews on claims with dates of admission between October 1, 2013 and March 31, 2015.

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


ED Data Tool Released by NCHS

Monday, May 12th, 2014

The National Center for Health Statistics (NCHS) recently released a free online tool for searching emergency department (ED) data from its annual National Hospital Ambulatory Medical Care Survey. According to NCHS, the tool allows users to generate and store statistical analyses customized to their specific requirements. The tool currently contains data from the emergency department component of the 2005-2010 surveys, with more datasets planned for the future.

The online tool is available at http://www.cdc.gov/nchs/doqs/

CMS Issues Final Rule Reforming Medicare Regulations

Wednesday, May 7th, 2014

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule reforming Medicare regulations identified as unnecessary or excessively burdensome to hospitals and other health care providers. CMS estimates that the reforms will save providers about $660 million a year. The rule revises a proposal that each hospital have its own medical staff, even in multi-hospital systems. The rule also reduces the burden on small critical access hospitals, rural health clinics and federally qualified health centers by eliminating the requirement that a physician be held to a prescriptive on-site schedule.

The final rule is available at https://www.federalregister.gov/articles/2014/05/12/2014-10687/medicare-and-medicaid-programs-regulatory-provisions-to-promote-program-efficiency-transparency-and

FY 2015 Hospice Proposal Rule Published

Friday, May 2nd, 2014

The Centers for Medicare & Medicaid Services (CMS) has published a proposed rule for hospice payments for fiscal year (FY) 2015. The rule proposes to increase payments by 1.3%, or $230 million, compared to FY 2014. The rule also proposes to continue the phase out of the wage index budget neutrality adjustment factor as part of the seven-year phase out initiated in the FY 2010 final rule. The rule also provides an update on hospice payment reform analyses; seeks comments on “terminal illness” and “related conditions” definitions; and proposes coordination and appeals processes related to Part D payment for drugs for beneficiaries in a hospice. CMS also proposes several updates to the Hospice Quality Reporting Program, and most notably outlines requirements for the Hospice Consumer Assessment of Health Providers and Systems (CAHPS) patient experience survey. Hospice providers are required to begin collecting and reporting Hospice CAHPS data in 2015. In addition, CMS provides guidance on determining hospice eligibility and clarifies how hospices are to report diagnoses on claims. Comments on the proposed rule will be accepted through July 1.

The hospice rule can be viewed at https://www.federalregister.gov/articles/2014/05/08/2014-10505/medicare-program-fy-2015-hospice-wage-index-and-payment-rate-update-hospice-quality-reporting

Proposed FY 2015 IPF Rule Issued

Thursday, May 1st, 2014

The Centers for Medicare & Medicaid Services (CMS) has issued its inpatient psychiatric facility (IPF) proposed rule for fiscal year (FY) 2015. The rule would increase IPF rates by 2.1%. The proposed rule includes an initial market-basket update of 2.7% for those hospitals that submit data on quality measures. Hospitals not submitting data would receive a 0.7% update. The rule also proposes a productivity cut of 0.4% and an additional market-basket cut of 0.3%. In addition, the rule proposes new quality measures and reporting requirements under the IPF quality reporting program.

The psychiatric rule is available at https://www.federalregister.gov/articles/2014/05/06/2014-10306/medicare-program-inpatient-psychiatric-facilities-prospective-payment-system-update-for-fiscal-year

FY 2015 IRF and SNF Proposed Rules Released

Thursday, May 1st, 2014

The Centers for Medicare & Medicaid Services (CMS) has released the FY 2015 proposed rules updating Medicare payments for the inpatient rehabilitation facility (IRF) and the skilled nursing facility (SNF) prospective payment system (PPS). The IRF PPS proposed rule would implement a net increase of 2.2%, or $160 million, in FY 2015 compared to FY 2014. It also proposes modifications to requirements for therapy reporting, coding for the “60% Rule”, and the IRF quality reporting program. The SNF PPS proposed rule would increase aggregate payments by 2.0% in FY 2015. The SNF rule also proposes to revise how providers will report changes of therapy and clarifies requirements related to civil monetary penalties.

The inpatient rehabilitation facility proposed rule is available at http://www.ofr.gov/OFRUpload/OFRData/2014-10321_PI.pdf

The skilled nursing facility proposed rule is available at http://www.ofr.gov/OFRUpload/OFRData/2014-10319_PI.pdf