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Archive for April, 2015

Five Facts About ICD-10

Thursday, April 30th, 2015

To help dispel some of the myths surrounding ICD-10, CMS recently talked with providers to identify common misperceptions about the transition. These five facts address some of the common questions and concerns CMS has heard about ICD-10:

• The ICD-10 transition date is October 1, 2015. The government, payers, and large providers alike have made a substantial investment in ICD-10. This cost will rise if the transition is delayed, and further ICD-10 delays will lead to an unnecessary rise in health care costs. Get ready now for ICD-10.

• Providers will not have to use 68,000 codes. Most practices do not use all 13,000 diagnosis codes available in ICD-9, nor will they be required to use the 68,000 codes that ICD-10 offers.

• Providers will use a similar process to look up ICD-10 codes that they use with ICD-9. Increasing the number of diagnosis codes does not necessarily make ICD-10 harder to use. As with ICD-9, an alphabetic index and electronic tools are available to help with code selection.

• Outpatient and office procedure codes are not changing. The transition to ICD-10 for diagnosis coding and inpatient procedure coding does not affect the use of Current Procedural Terminology (CPT) for outpatient and office coding. Providers will continue to use CPT.

• All Medicare Fee-For-Service providers have the opportunity to conduct testing with CMS before the ICD-10 transition. Providers can conduct acknowledgement testing at any time with their Medicare Administrative Contractor (MAC). Testing will ensure that providers are able to submit claims with ICD-10 codes. During a special acknowledgement testing week to be held in June 2015, providers will have access to real-time help desk support.

For more information, visit http://www.palmettogba.com/palmetto/icd.nsf/vMasterDID/9VVEPF1676

Participation Rises in PQRS and Electronic Prescribing Incentive Programs

Thursday, April 23rd, 2015

The Centers for Medicare & Medicaid Services (CMS) has released the 2013 Physician Quality Reporting System (PQRS) and Electronic Prescribing (e-prescribing) Incentive Program Experience Report, which provides data and trends on participation, incentive eligibility, incentive payments, and payment adjustments since the beginning of the programs.

The 2013 report found that there was an increase in participation from eligible professionals, as well as an increase in reporting clinical quality information for both PQRS and the e-prescribing Incentive Program. This reflects both increased use of electronic prescribing as well as increased tracking and reporting of important quality information. The report also indicates progress in CMS’s efforts to improve quality measurements and to build a national electronic health information infrastructure.

For more information, go to http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/AnalysisAndPayment.html.

$120 Million Awarded by PCORI

Wednesday, April 22nd, 2015

The Patient-Centered Outcomes Research Institute (PCORI) has awarded about $59 million for five pragmatic clinical studies to compare the clinical effectiveness of certain treatments in typical care settings. The studies will compare proton beam versus photon radiation therapy to treat breast cancer; lifestyle interventions alone versus interventions along with diabetes medication to reduce weight and metabolic problems in youth taking certain antipsychotic medications for bipolar disorders; biological versus conventional drug treatment for Crohn’s disease in children; nerve blocking regional versus general anesthesia for older adults undergoing surgery for hip fracture; and exercise coaching versus usual care for older adults with low-impact fractures from falls. The institute also awarded about $62 million for 29 studies that will compare options for improving outcomes for conditions such as opioid addiction, arthritis, stroke, Parkinson’s disease, leukemia and chronic kidney disease.

For more information, visit http://www.pcori.org/content/pcori-board-approves-120-million-new-patient-centered-research-projects

FY 2016 Proposed Inpatient and LTCH Rule Released

Friday, April 17th, 2015

On April 17, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update fiscal year (FY) 2016 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-term Care Hospital (LTCH) Prospective Payment System (PPS).  The rule would increase rates by 1.1% in FY 2016.  This reflects the projected hospital market-basket update of 2.7%, adjusted by -0.6 % for multi-factor productivity and -0.2 % in accordance with the Affordable Care Act. In addition, the rate is further decreased by a proposed 0.8 % for a documentation and coding recoupment required by the American Taxpayer Relief Act of 2012.

The proposed rule also includes ACA-mandated Medicare Disproportionate Share Hospital (DSH) reductions. The reduction would reduce overall Medicare DSH payments by $1.3 billion in FY 2016 compared to FY 2015. The rule also proposes that a number of clinical quality measures be submitted electronically for the FY 2018 Inpatient Quality Reporting Program. CMS is also proposing changes to the Hospital-Acquired Conditions Program, the Hospital Readmissions Reduction Program, and the Value-Based Purchasing Program. The proposed rule will be published in the April 30 Federal Register and comments will be accepted through June 16.

The proposed rule can be found at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-09245.pdf

MACRA Legislation Signed into Law

Thursday, April 16th, 2015

On April 16, 2015, President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) into law. Under MACRA, the sustainable growth rate (SGR) physician payment methodology is replaced with 0.5% annual payment increases for doctors for the next five years while Medicare transitions to a physician payment system focused on quality, value, and accountability. Under the new physician payment methodology, Medicare payments will rise by 0.5% each year between 2015 and 2019. Base payments will then be held steady from 2020 to 2025, but doctors will become eligible for additional payments under the Merit-based Incentive Payment System (MIPS). The MIPS intention is to reward physicians and certain other medical professionals based on a number of factors related to quality of care. These factors include implementation of care models that emphasize quality over volume and meaningful use of electronic health records. Under MIPS, doctors, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists will receive annual payment increases or decreases based on their performance. Beginning in 2026, physicians will receive a 0.75% annual increase if they participate in an alternative payment model or a 0.25% annual increase if they do not.

In addition, MACRA will extend the Children’s Health Insurance Program (CHIP) for two more years, as well as extending funding for community health centers, ambulance add-on payments, home health rural add-on payments, and the therapy cap exceptions process

MACRA also contains the following of measures:

  • Limiting base payment increases for post-acute providers, such as long-term care and inpatient rehabilitation hospitals, skilled nursing facilities, and home health and hospice organizations, to 1% in 2018.
  • Delaying by one year scheduled reductions in Medicaid “disproportionate share hospital” payments to hospitals that care for large numbers of people who are uninsured or covered by Medicaid. These reductions will occur between 2018 and 2025, instead of between 2017 and 2024.
  • Strengthening certain aspects of anti-fraud oversight under Medicare
  • Prohibiting the Secretary of HHS from implementing the final rule requiring the transition of all 10-day and 90-day global surgical packages to 0-day global periods.
  • Amending the Protecting Access to Medicare Act of 2014 to extend the moratorium on the two midnight rule through September 2015.

The legislation can be found at https://www.congress.gov/bill/114th-congress/house-bill/2

Strategy to Address Blocking of Electronic Health Information Released

Monday, April 13th, 2015

According to a report released by the Office of the National Coordinator (ONC) for Health Information Technology, there is information blocking occurring which is interfering with the exchange of electronic health information. The report states that most of the complaints are directed at health IT developers; however, health care providers have also been accused. The report details steps the agency is taking to address information blocking, including efforts to strengthen in-the-field surveillance of health IT certified by ONC, constrain standards and implementation specifications, and promote greater transparency in certified health IT products and services, among other actions.

The report can be found at http://www.healthit.gov/sites/default/files/reports/info_blocking_040915.pdf

Proposed Rule Modifying EHR Reporting Period Released

Wednesday, April 8th, 2015

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that would modify the reporting period for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program in 2015 to a 90-day period aligned with the calendar year and provide additional flexibilities, including reducing the share of patients that must use the patient portal. In addition, the rule would remove some measures that have reached widespread adoption. The shortened reporting period that is proposed would provide hospitals additional time to transition to Stage 2 and would increase the likelihood they will meet CMS’s timetable.

The proposed rule can be found at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-08514.pdf