Medical Industry Reimbursement News

On February 17, Congress voted to delay a 27.4% cut to Medicare physician payments through December. To offset the cost of the delay, legislation would reduce reimbursement for Medicare bad debt to 65% from 70% for inpatient acute care hospitals in fiscal year 2013, and from 100% to 65% for critical access hospitals over three years. It would also expand the therapy cap and exceptions process to include services provided in hospital outpatient departments, and would reduce Medicaid Disproportionate Share Hospital (DSH) payments.

To read more about this legislation, please visit: http://thomas.loc.gov/home/thomas.php

As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services (HHS) Secretary Kathleen G. Sebelius announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10^th Edition diagnosis and procedure codes (ICD-10).  The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule.

More information is available at http://www.hhs.gov/news/press/2012pres/02/20120216a.html

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule implementing an Affordable Care Act (ACA) requirement that health care providers and suppliers report and return self-identified overpayments by the later of 60 days after the date the overpayment was identified, or the date any corresponding cost report is due, if applicable. Retention of the overpayment beyond the deadline may result in False Claims Act liability. Examples of overpayments could include errors and non-reimbursable expenditures in cost reports, Medicare payments for non-covered services, payments in excess of the allowable amount for a covered service, duplicate payments, and receipt of Medicare payments when another payer had primary responsibility.

The proposed rule was published in the Federal Register and is available at http://www.gpo.gov/fdsys/pkg/FR-2012-02-16/pdf/2012-3642.pdf.

The departments of Health and Human Services (HHS), Treasury and Labor, along with the Internal Revenue Service (IRS), released a final rule detailing the new standards regarding the way in which health insurance plans must explain their coverage and benefits in marketing materials. This was a requirement of the Affordable Care Act (ACA). According to HHS, The rule and accompanying guidance are intended to provide consumers with clear, consistent and comparable summary information. Under the rule, health plans must provide a brief “Summary of Benefits and Coverage” and a uniform glossary of commonly used insurance terms before the purchase of health insurance and at the time of renewal. The rule’s requirements, which apply to all health plans, will take effect September 23, a six-month delay from the proposed effective date of March 23.

The final rule can be accessed at http://www.ofr.gov/(X(1)S(cqkh2tfp2zcqjhd0tggapmw2))/OFRUpload/OFRData/2012-03228_PI.pdf.

The Centers for Medicare & Medicaid Services (CMS) has sent to Congress a report on key findings from the Post Acute Care Payment Reform Demonstration (PAC-PRD), as required by the Deficit Reduction Act (DRA). The report describes the development and testing of the Continuity Assessments Record and Evaluation (CARE) which was mandated by the legislation, and reviews findings related to predicting patient-specific resource intensity across four post-acute care settings – long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health agencies. The demonstration involved 140 general acute hospitals and post-acute providers in 11 markets.

The report is available at http://www.cms.gov/Reports/Downloads/Flood_PACPRD_RTC_CMS_Report_Jan_2012.pdf.

The National Institutes of Health (NIH) has launched a website to encourage participation in clinical research trials. The site contains information for patients and health care providers, including links to the agency’s registry of clinical trials, a database of clinical studies at the NIH campus in Bethesda, MD, and an NIH-funded registry of research volunteers.

The website is http://www.nih.gov/health/clinicaltrials/.

The Centers for Medicare & Medicaid Services (CMS) plans to launch its Recovery Audit Prepayment Review Demonstration on or around June 1. the demonstration will allow Recovery Audit Contractors (RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules. The RACs will conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments. These reviews will focus on seven states with high populations of fraud- and error-prone providers (FL, CA, MI, TX, NY, LA, IL) and four states with high claims volumes of short inpatient hospital stays (PA, OH, NC, MO) for a total of 11 states. This demonstration will also help lower the error rate by preventing improper payments rather than the traditional “pay and chase” methods of looking for improper payments after they occur.

For more information visit www.cms.gov/CERT/02_Demonstrations.asp

The Department of Health and Human Services (HHS) has issued a progress report on its efforts to reduce regulatory burdens. The major changes include a proposed rule revising the Medicare Conditions of Participation (CoP) for hospitals, final rules implementing a new credentialing/privileging process for physicians who provide telemedicine services, and removing the new physician signature requirement for clinical laboratory tests. According to the report, HHS plans to release four proposed rules easing regulatory burdens.

The progress report can be viewed at http://www.hhs.gov/open/execorders/13563/index.html.

The Centers for Medicare & Medicaid Services (CMS) has published a notice in the Federal Register stating that it will not propose changes to the current Emergency Medical Treatment and Labor Act (EMTALA) regulations. While the agency said that a hospital has satisfied its EMTALA obligation when it admits an individual “in good faith in order to stabilize the [emergency medical condition],” it is providing an additional 60 days to comment on the applicability of EMTALA to hospitals with specialized capabilities.

The notice can be found by going to http://www.gpo.gov/fdsys/pkg/FR-2012-02-02/pdf/2012-2287.pdf.

A new online toolkit will serve as a pilot program for providing health information technology (HIT) resources to rural health care providers. The toolkit, developed by the Rural Assistance Center (RAC) and the National Rural Health Resource Center (The Center) is designed to help rural providers find resources for HIT, electronic health records (EHR), meaningful use and related topics. Funding for the toolkit is provided by the federal Office of Rural Health Policy (ORHP).

For more information, see the news release at http://www.raconline.org/collaborate/pr_hittoolkit.php.