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Archive for December, 2014

Proposed Rule Issued to Help Consumers Compare Health Insurance Benefits

Monday, December 22nd, 2014

On December 22, the Departments of Health and Human Services, Labor, and the Treasury issued proposed rules to help people who are shopping for health insurance coverage better understand their options. The proposed rules would add features making the Summary of Benefits and Coverage (SBC) more user-friendly, and a new coverage example would better illustrate the cost of services for more consumers. The proposed rules would also significantly streamline and shorten the SBC by removing information that is not required by statute and has been identified through consumer testing to be less relevant for consumers purchasing health insurance.

The revised SBC would also assist employers in comparing plan options to find the best coverage for their businesses and employees, and the rules would clarify and streamline the requirements health insurers and group health plans must follow.

If finalized, the new requirements would be implemented for plan years on or after September 1, 2015.

For more information on the proposed rules, visit: http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/SBC-Proposed-Rule-Fact-Sheet-122214.pdf

New Quality Measures Added to Physician and Hospital Compare Websites

Thursday, December 18th, 2014

The Centers for Medicare & Medicaid Services (CMS) has added new quality data to the Physician Compare website. Additionally, CMS has updated quality measures on the Hospital Compare website and released data on new measures. CMS posted the publicly reported 2013 PQRS Group Practice Reporting Option (GPRO) measures for 139 group practices, 214 Shared Savings Program Accountable Care Organizations (ACOs), and 23 Pioneer ACOs. The specific measures being reported are:

  • Controlling blood sugar levels in patients with diabetes
  • Controlling blood pressure in patients with diabetes
  • Prescribing aspirin to patients with diabetes and heart disease
  • Prescribing medicine to improve the pumping action of the heart in patients who have both heart disease and certain other conditions

The Hospital Compare measures being reported for the first time are:

  • Patient experience of care
  • Timely and effective care
  • Readmission, complications and deaths
  • Payment and value of care
  • PPS-exempt Cancer Hospital Quality Reporting Program

For more information on Physician Compare, visit http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/physician-compare-initiative/

For information on Hospital Compare, please visit: http://www.medicare.gov/hospitalcompare/search.html

MedPAC Considers 2015 Updates

Thursday, December 18th, 2014

The Medicare Payment Advisory Commission (MedPAC) is considering a package of draft recommendations to Congress that would affect the inpatient, outpatient and long-term care hospital (LTCH) prospective payment systems (PPS). The recommendations would increase payment rates for the hospital inpatient and outpatient PPSs by 3.25% in 2015, reduce or eliminate payment differences between hospital outpatient departments and physician offices for selected procedures, and reimburse LTCHs at the same rates as acute care hospitals for certain patients. The commission also considered a draft recommendation that would freeze Medicare payments to physicians in 2015 and in place of the sustainable growth rate formula (SGR). The commission also is considering establishing a prospective per-beneficiary payment to replace the Primary Care Incentive Payment Program after it expires at the end of 2015.

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

CMS Releases Video Detailing ICD-10

Tuesday, December 16th, 2014

The Centers for Medicare & Medicaid Services (CMS) has released a video detailing the characteristics and unique features of the ICD-10-CM coding system. The video discusses the ICD-10-CM coding structure and explains how to assign diagnosis codes using ICD-10. In addition, the video highlights free resources that coders can use as they prepare for the transition to ICD-10.

The video can be viewed at https://www.youtube.com/watch?v=s86pXhhOG7c&list=UUhHTRPxz8awulGaTMh3SAkA

State Innovation Models Initiative Recipients Announced

Tuesday, December 16th, 2014

On December 15, the Centers for Medicare and Medicaid Services (CMS) announced the recipients of 11 Model Test and 21 Model Design awards under the second round of the State Innovation Models initiative. In round two, the State Innovation Models initiative is providing more than $665 million over the next four years to support state-led, multi-payer health care payment and service delivery models that will improve health system performance, increase quality of care, and decrease costs for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries, and for all residents of participating states. The States will engage a broad group of stakeholders including health care providers and systems, long-term service and support providers, commercial payers, state hospital and medical associations, tribal communities, and consumer advocacy organizations. Transformation efforts supported by this initiative must improve health, improve care, and lower costs for Medicare, Medicaid, and CHIP beneficiaries.

More information on the State Innovation Models initiative can be found at: innovation.cms.gov/initiatives/State-Innovations.

Proposed Rule on MSSP Issued

Monday, December 8th, 2014

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that addresses changes to the Medicare Shared Savings Program (MSSP). The proposed rule also contains provisions relating to Medicare payments to providers of services and suppliers participating in Accountable Care Organizations (ACOs) under the MSSP. In addition, the agency proposes changing the methodology for assigning beneficiaries to ACOs, creating a third track for MSSP participation, and providing additional data to the ACOs.

The proposed rule is available for viewing at: https://www.federalregister.gov/articles/2014/12/08

Annual List of Potential Medicare Quality Measures Released

Monday, December 1st, 2014

The Measure Applications Partnership (MAP), which reviews Medicare quality and performance measures before formal rulemaking, has published a list of 202 measures under consideration for use in hospital and other Medicare public reporting and payment programs. Draft recommendations will be published in January, with final recommendations made to the Department of Health and Human Services (HHS) by February 1.

The list is at http://www.qualityforum.org/MUC.aspx