1.800.456.4350 info@prgweb.com

Archive for August, 2014

HHS Senior Counselor Named

Wednesday, August 13th, 2014

Health and Human Services (HHS) Secretary Sylvia Burwell has named Kevin Thurm as a senior counselor in the department. Thurm served as deputy secretary under former HHS Secretary Donna Shalala and has held various leadership positions at Citigroup since 2001. As a senior counselor reporting to Burwell, he will work with senior staff on strategic initiatives, policy challenges, and engagement with external partners.

The press release can be found at http://www.hhs.gov/news/press/2014pres/08/20140813a.html

Limited Restart of RAC Reviews Announced

Wednesday, August 6th, 2014

The Centers for Medicare & Medicaid Services has announced that they will allow current Recovery Audit Contractors (RACs) to restart a limited number of claim reviews. CMS stated that most reviews will be done on an automated basis. However, a limited number will be complex reviews on certain claims, including spinal fusions, outpatient therapy services, durable medical equipment, prosthetics, orthotics and supplies, and cosmetic procedures. RACs will not review claims to determine whether the care was delivered in the appropriate setting during the restart.

For more information, go to http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Recent_Updates.html

Medicare Releases 2015 IPPS and LTCH Final PPS Rule

Monday, August 4th, 2014

On August 4, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating the fiscal year (FY 2015) Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals (LTCH). CMS announced that the payment rate update to general acute care hospitals will be 1.4% in FY 2015. The rate update for long-term care hospitals will be 0.9%. The difference in the updating is accounted for by different statutory and regulatory provisions that apply to each system.

Some key provisions included in the 2015 Inpatient Prospective Payment System (IPPS) final rule are:

  • For FY 2015, CMS is increasing the applicable percentage reduction to the Hospital Value-Based Purchasing (VBP) Program adjusting to 1.5% of the base operating MS-DRG payment amounts to all participating hospitals. CMS estimates that the total amount available for the value-based incentive payment will be approximately $1.4 billion.
  • Hospital Readmissions Reduction Program will see a maximum reduction increase from 2 to 3 percent. For FY 2015, CMS will assess hospitals’ readmissions measures endorsed by the National Quality Forum. CMS estimates that hospital readmissions for Medicare declined by a total of 150,000 from January 2012 through December 2013.
  • CMS is implementing the Affordable Care Act’s (ACA) Hospital Acquired Condition (HAC) Reduction Program. Beginning in FY 2015, hospitals scoring in the top quartile for the rate of HACs will have their Medicare inpatient payments reduced by one percent. This new program builds on the progress in this area achieved through the existing HAC program, which is currently saving $30 million annually.
  • CMS is revising the labor market areas used for the wage index based on the most recent Office of Management and Budget (OMB) Core-Based Statistical Area delineations that are based on 2010 Census data. In order to mitigate potential negative payment impacts, CMS is adopting a one-year transitional during FY 2015 that would be based on a 50/50 blend of the former wage index and the new wage index. The new wage index will take effect in full in FY 2016.

The display copy can be found by going to https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-18545.pdf