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Archive for January, 2016

Proposed Rule Would Allow Qualified Entities to Share/Sell Claims Data Analyses

Friday, January 29th, 2016

On January 29, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would allow organizations approved as qualified entities to confidentially share or sell analyses of Medicare and private claims data to health care providers, employers, and others to support improved care. The Qualified Entry Program allows qualified organizations to access patient-protected Medicare data to publicly report on provider and supplier performance across multiple payers. CMS has approved 13 qualified entities to date. The rule was published in the February 2 Federal Register.

The rule can be found at https://www.gpo.gov/fdsys/pkg/FR-2016-02-02/pdf/2016-01790.pdf

Proposed Rule on Improvements to Shared Savings Program Released

Thursday, January 28th, 2016

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule to update the methodology used to measure the performance of Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program. Key proposals include:

  • Recognizing that health cost trends vary in communities across the country by using regional, rather than national, spending growth trends when establishing and updating an ACO’s rebased benchmark.
  • Adjusting an ACO’s rebased benchmark when it enters a second or subsequent agreement period by a percentage (increased over time) of the difference between Fee-For-Service spending in the ACO’s regional service area and the ACO’s historical spending, which will provide a greater incentive for continued ACO participation and improvement.
  • Giving ACOs time to prepare for benchmarks that incorporate regional expenditures by using a phased-in approach to implementation.

Other changes would include:

  • Adding a participation option to facilitate an ACO’s transition to performance-based risk arrangements by allowing eligible ACOs to elect a fourth year under their existing first agreement, and defer by one year entering a second agreement period under a performance-based risk track.
  • Streamlining the methodology for adjusting an ACO’s benchmark when its composition changes.
  • Clarifying the timeline and other criteria for reopening determinations of ACO shared savings and shared losses for good cause, fraud, or similar fault.

The proposed rule is available at https://www.federalregister.gov/articles/2016/02/03/2016-01748/medicare-program-medicare-shared-savings-program-accountable-care-organizations-revised-benchmark

FAQ on ‘PO’ Modifier Published

Tuesday, January 26th, 2016

The Centers for Medicare & Medicaid Services (CMS) has released answers to Frequently Asked Questions (FAQs) regarding the Healthcare Common Procedure Coding System (HCPCS) “PO” modifier. Effective January 1st, hospitals that operate off-campus provider-based outpatient departments must include the modifier “PO” with the billing code for each item and service furnished in those departments. The modifier does not apply to items or services paid under other Medicare payment systems, or to services physically provided at a remote location of the main hospital, according to the CMS FAQ.

The FAQ can be found at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/PO-Modifier-FAQ-1-19-2016.pdf

Guide to Preventing Readmissions Among Diverse Medicare Patients Issued

Tuesday, January 26th, 2016

The Centers for Medicare & Medicaid Services’ (CMS) Office of Minority Health has issued a guide to help hospitals prevent readmissions among racially and ethnically diverse Medicare beneficiaries. The guide reviews key readmissions issues and strategies for reducing readmissions, and offers high-level recommendations to prevent avoidable readmissions in diverse populations. CMS developed the guide in collaboration with the Disparities Solutions Center at Massachusetts General Hospital and the National Opinion Research Center at the University of Chicago as part of the agency’s plan to reduce health disparities in Medicare.

The guide can be found at https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/OMH_Readmissions_Guide.pdf

Post-acute Recommendations Finalized by MedPAC

Sunday, January 17th, 2016

The Medicare Payment Advisory Commission (MedPAC) has finalized its recommendations to provide no updates in fiscal year 2017 for Medicare payments to home health (HH) agencies, skilled nursing facilities (SNF), inpatient rehabilitation facilities or long-term care hospitals. The commission has also recommended rebasing the HH payment system over a two-year period starting in 2018, and eliminating therapy as a factor in setting HH payments. In addition, it has recommended that the Department of Health and Human Services (HHS) reform the SNF prospective payment system and report to Congress in 2019 on the impacts of those reforms and need for further payment system changes. The recommendations will be presented to Congress in March.

The commission also provided an update on its research on a unified payment system for post-acute care, which was legislatively mandated and will be presented to Congress in June. MedPAC and HHS would develop the new payment approach to replace the current prospective payment systems for post-acute care, with this work slated for presentation to Congress in 2022. Services would be paid for based on patients’ clinical characteristics, rather than care setting.

For more information, visit www.medpac.gov


Additional Outpatient POS Code Created

Saturday, January 16th, 2016

Effective January 1, 2016, there will be two possible place of service codes (POS) to choose from for outpatient hospital settings: new POS code 19 and revised POS code 22. POS 19 is defined as a portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation to services to sick or injured persons who do not require hospitalization or institutionalization. POS 22 is defined as a portion of a hospital’s main campus hospital provider based department which provides diagnostic therapeutic (both surgical and nonsurgical), and rehabilitation to services to sick or injured persons who do not require hospitalization or institutionalization

Reporting outpatient hospital POS code 19 or 22 is a minimum requirement to trigger the facility payment amount under the Medicare Physician Fee Schedule (MPFS) when services are provided to a registered outpatient.

The MLNMatters Article can be found at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9231.pdf

New Medicare ACO participants Announced

Monday, January 11th, 2016

The Centers for Medicare & Medicaid Services (CMS) has announced 121 new Medicare Accountable Care Organization (ACO) participants, which include 21 that will begin participating this year in a new Next Generation ACO model. The new model includes a prospectively set benchmark which allows beneficiaries to choose to be aligned to the ACO and tests beneficiary incentives for seeking care at participating providers. Also, 39 ACOs will join two existing participants in the ACO Investment Model (AIM), which builds on the Advance Payment ACO model to encourage ACOs to form in rural and underserved areas. The AIM model is expected to provide $83 million in upfront and ongoing investments to participants, which are repaid from the ACO’s shared savings.

The news release can be found at http://www.hhs.gov/about/news/2016/01/11/new-hospitals-and-health-care-providers-join-successful-cutting-edge-federal-initiative.html

Update to the CY 2016 MPFS Data Base Issued

Friday, January 8th, 2016

On January 8, the Centers for Medicare & Medicaid Services (CMS) has issued a Change Request (CR) 9495 that amends the payment files that were issued to the contractors based on the CY 2016 Medicare Physician Fee Schedule (MPFS) Final Rule. The Agency amended these payment files in order to correct technical errors to the MPFS update files, and to include corrections described in the CY 2016 MPFS Final Rule Correction Notice.

For more information, go to https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3438CP.pdf