On November 30, 2011, the United States Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that eligible providers that satisfy the Medicare and Medicaid EHR Incentives Program Stage 1 Meaningful Use criteria in 2011 may wait until 2014 to comply with CMS‘s Stage 2 criteria.
The Centers for Medicare and Medicaid Services (CMS) just released the final inpatient prospective payment system (IPPS) rule for Fiscal Year (FY) 2012. While covering reimbursements for approximately 3,400 acute care hospitals, the final rule also updates reimbursement policies for more than 400 long-term care hospitals (LTCHs).
According to CMS, total Medicare operating payments to acute care hospitals for inpatient services will increase by 1.1 percent ($1.13 billion) for FY 2012, compared with FY 2011. Medicare reimbursements to LTCHs during the same period are projected to increase by 2.5 percent ($126 million).
The final IPPS rule also contains provisions designed to strengthen the relationship between reimbursements and quality of care. For example, it expands quality measures that must be reported under the Hospital Inpatient Quality Reporting Program by focusing on prevention of healthcare-related infections and readmissions.
Also, the final rule sets forth initial readmissions measures that will be included in a forthcoming Hospital Readmissions Reduction Program, as mandated by the Patient Protection and Affordable Care Act (PPACA). The program will apply to rates of readmissions for heart failure, acute myocardial infarction (heart attack) and pneumonia. CMS indicated that it plans to continue the implementation of this program in future rulemaking. The program itself is set to begin in FY 2013.
The final IPPS rule takes effect on October 1, will be published in the Federal Register on August 18.
However, you can download a copy of the rule now. [PDF, 4.09MB, 1492 pgs]
CMS announced a series of calls on specific Medicare program vulnerabilities identified in HHS Office of Inspector General (OIG) reports. Some of the issues being addressed on the calls correspond to some recently posted RAC Approved Issues. Since CMS has included specific emails for sending in questions before the sessions, provider may wish to compose and send off questions about these issues. The issues listed by CMS are vague enough as to allow for quite a broad range of questions, particularly for the Day Two topics. Find a complete PDF of topics, dates and times below. Continue reading
CMS has published a revised Medicare Physician’s Guide.
From the Preface:
This publication has been developed for Medicare Fee-For-Service (FFS) providers and suppliers. It provides the following information about the Medicare Program:
• Introduction to the Medicare Program;
• Becoming a Medicare provider or supplier;
• Medicare reimbursement;
• Medicare services;
• Protecting the Medicare Trust Fund;
• Medicare overpayments and FFS appeals; and
• Provider outreach and education.
On July 29, 2011, the Centers for Medicare and Medicaid Services (CMS) published the final rule for skilled nursing facility Medicare reimbursement in fiscal year 2012. Among other things, the rule imposes an approximate 11% cut in Medicare reimbursement rates for all skilled nursing facilities.
CMS first introduced the cut in an April 28, 2011 proposed rule to recapture extra funds that were unintentionally reimbursed for therapy services under RUG- IV, the classification system implemented earlier this year. Finalizing most provisions in the proposed rule, the final rule included a recalibration adjustment of 12.6%, which, coupled with the 1.7% market basket update, resulted in a net update of -11.1% (equivalent to $3.87 billion) in payment for fiscal year 2012. Importantly, the impact on each facility will vary depending on its case-mix and geographic location.
CMS will host a national provider call on the rule on August 23, 2011, from 1:30 P.M. to 3:00 P.M. (EST). Registration is open until 1:30 P.M., August 22, 2011, or when space has been filled. Subject matter experts will discuss new MDS 3.0 policies, including allocation of group therapy and a question and answer session will follow the presentations.
[Original article by Seyfarth Shaw LLP]
CMS is hosting “accelerated development learning sessions” (ADLS) to educate executives about ways to build successful accountable care organizations (ACOs).
Comment regarding the proposed policy statement detailing accountable care organizations’ (ACOs) participation in the Medicare Shared Savings Program (MSSP)
The Federal Trade Commission (FTC) and Department of Justice (DOJ) issued a joint statement regarding how the agencies will enforce the U.S. antitrust laws with respect to new Accountable Care Organizations (ACOs).
Five-year Test Showed Improved Innovation and Care, But Few C0st Savings
The results from the five year “Group Practice Demonstation” project, which incentivized ten leading health systems if they could reduce costs by “treating older patients more efficiently while providing high-quality care,” were reported June 1 in the Washington Post. Reports issued by CMS and the GAO also offer disappointing conclusions for the project. Continue reading
Links to the CMS ICD-10 Website
If you missed the AAPC-CMS ICD-10 Code-a-thon held on April 26, 2011, or if you just want a closer look at all the materials from the presentation, they are now available on the CMS website in the Latest News section. Continue reading