Medical Industry Reimbursement News

The Centers for Medicare & Medicaid Services (CMS) has announced plans to recompete the Medicare durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) Competitive Bidding Program contracts in nine areas of the country. The Round One recompete will apply to the same nine regions as the first round – Charlotte, Cincinnati, Cleveland, Dallas, Kansas City, Miami, Orlando, Pittsburgh and Riverside, CA – and include additional products.

For more information, go to this link.

The Department of Health and Human Services (HHS) has proposed a one-year delay in the deadline for implementing the International Classification of Diseases, 10th Edition (ICD-10) for administrative health care transactions. The new October 1, 2014 compliance date would apply to both diagnosis and procedure (ICD-10-CM and ICD-10-PCS) codes. The proposed rule, which was published April 14, also includes several changes under the Health Insurance Portability and Accountability Act (ACA).

The proposed rule can be viewed at http://www.gpo.gov/fdsys/pkg/FR-2012-04-17/pdf/2012-8718.pdf

The Centers for Medicare & Medicaid Services (CMS) has temporarily suspended use of outpatient quality measure OP-19. This quality measure is used to assess the percentage of emergency department patients who receive a transition record on discharge from the ED. The suspension is effective retroactive to January because of potential concerns with the measure specifications.

The CMSnotification can be found at this link.

The Centers for Medicare & Medicaid Services (CMS) has announced the first 27 accountable care organizations (ACOs) to participate in the voluntary Medicare Shared Saving Program (MSSP). The selected organizations will be responsible for improving care for nearly 375,000 beneficiaries in 18 states through better coordination among providers.CMSalso announced that five ACOs began participating in the program’s Advance PaymentACOModel, which provides advance payment of expected shared savings to rural and physician-based ACOs that would benefit from additional start-up resources.

The ACOparticipation information is available in a Press Release at http://www.cms.gov/apps/media/press_releases.asp.

The Medicare Payment Advisory Commission (MedPAC) recently discussed the Medicare electronic health record (EHR) incentive program, and several commissioners expressed concern about the small number of hospitals and eligible professionals who have successfully attested to “meaningful use” of EHRs to date. Commissioners also expressed interest in monitoring the program going forward to see whether EHR implementation facilitates system efficiencies and cost savings. In addition, the commission unanimously voted to recommend that Congress direct the Health and Human Services (HHS) secretary to develop and implement a new Medicare Fee-For-Service benefit design to replace the current design. Commissioners expressed displeasure with the current benefit design and a desire for a more robust benefit package that is focused more on value. The proposed benefit design would include: an out-of-pocket maximum, deductible(s) for Parts A and B, and copayments (instead of coinsurance) that may vary by type of service and provider. TheHHSsecretary would be able to alter or eliminate cost-sharing, including the out-of-pocket maximum, based on evidence of the value of services. The proposal would not change the benefit aggregate cost sharing liability, and would include an additional charge on supplemental insurance.

More information is available at http://www.medpac.gov/.

Nine physician specialty societies have identified 45 tests or procedures that may be overused or unnecessary for certain patients based on the evidence, and encouraged physicians and patients to choose their use wisely. The Choosing Wisely® campaign is an initiative of the American Board of Internal Medicine (ABIM) Foundation. Current participants in the campaign include the American Academy of Allergy, Asthma & Immunology; American Academy of Family Physicians; American College of Cardiology; American College of Physicians; American College of Radiology; American Gastroenterological Association; American Society of Clinical Oncology; American Society of Nephrology; and American Society of Nuclear Cardiology.

For each society’s list of “Five Things Physicians and Patients Should Question,” visit http://choosingwisely.org.

In a recent report from the Centers for Medicare & Medicaid Services (CMS), the Physician Quality Reporting System (PQRS) and eRx Incentive Program paid a combined total of $662 million in Medicare payment incentives in 2010, a 72% increase from 2009. About 26% of physicians and other eligible professionals participated in the quality reporting program, of which 72% were eligible for incentives. Roughly 19% of physicians and eligible professionals participated in the eRx program, of which 63% were eligible for incentives. Both programs allow participants to earn incentive payments for reporting data on quality measures for covered professional services furnished to Medicare beneficiaries. Under the eRx program, eligible professionals report data on the electronic quality measure regarding their use of a qualified electronic prescribing system.

The report can be accessed at http://www.cms.gov/apps/media/press/factsheet.asp.

According to a report released by the Institute of Medicine (IOM), the traditional separation between primary health care providers and public health professionals is impeding greater success in meeting their shared goal of promoting the overall health of the population. The report recommends that the federal Centers for Disease Control and Prevention and the Health Resources and Services Administration foster integration between primary care and public health through funding, policies and other means. Based on a review of published papers and case studies in specific cities, the study committee found that successful integration of primary care and public health requires community engagement to define and tackle local population health needs, leadership that bridges disciplines and jurisdictions and provides support and accountability, shared data and analyses, and sustained focus by partners.

The report is available at http://www.iom.edu/Reports/2012/Primary-Care-and-Public-Health.aspx

The Centers for Medicare & Medicaid Services (CMS) has delayed the award date for the Health Care Innovation Challenge to allow more time to review the roughly 3,000 applications it received. The initiative will award up to $1 billion in grants over three years to projects that identify and test promising new payment and care delivery models for Medicare, Medicaid and the Children’s Health Insurance Program.

The information for the Innovation Center is available at http://www.innovation.cms.gov/initiatives/Innovation-Challenge/index.html.

The Centers for Medicare & Medicaid Services (CMS) has delayed the enforcement of the new Version 5010 and D.0 transaction standards for electronic health care claims through June 30. The new standards took effect January 1 for health care providers and others covered by the Health Insurance Portability and Accountability Act (HIPAA).CMS’ Office of E-Health Standards and Services said that remaining issues warrant an extension of enforcement discretion to ensure that all entities can complete the transition. At the present time, the Medicare fee-for-service program is reporting successful receipt and processing of more than 70% of Part A claims and 90% of Part B claims in the Version 5010 format.

The announcement can be viewed at http://www.cms.gov/ICD10/Downloads/EnforcementDiscretionAnnouncement.pdf.