MedWorm: Centers for Medicare and Medicaid Services (CMS)

Medicare Part D: A First Look at Part D Plan Offerings in 2013

Rural publications via the Rural Assistance Center — Mon, 17 Jun 2013 19:10:24 +0100

Examines the stand-alone Part D drug plan options available to Medicare beneficiaries in 2013. The first in a series of planned reports examining the private plan choices available to Medicare beneficiaries. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

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EHR Incentive Programs: Whats New for Stage 1 in 2013

Rural publications via the Rural Assistance Center — Mon, 17 Jun 2013 19:08:39 +0100

Describes the Stage 1 Electronic Health Record (EHR) Incentive Programs including meaningful use objectives, measures, and exclusions for eligible professionals, eligible hospitals, and critical access hospitals. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Medicare Dependent Hospital

Rural publications via the Rural Assistance Center — Mon, 17 Jun 2013 18:55:40 +0100

Provides information on Medicare Dependent Hospitals (MDH) including classification criteria, MDH payments and resources. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

2014 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter

Rural publications via the Rural Assistance Center — Mon, 17 Jun 2013 16:44:20 +0100

Provides information for health plans regarding how to implement CMS policies and procedures and comply with critical program requirements for the 2014 contract year. Includes detailed information on the Medicare Advantage (Part C) and prescription drug (Part D) programs. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

CMS Issues Health Insurance Exchange Proposed Rules

News stories via the Rural Assistance Center — Mon, 17 Jun 2013 06:00:00 +0100

HealthLeaders Media article reports that the Centers for Medicare and Medicaid Services has unveiled its proposed rules governing the operation of health insurance exchanges [PDF] which aim to facilitate and regulate the sale of private coverage to millions of people beginning Jan. 1, 2014, under the Patient Protection and Affordable Care Act. (Source: News stories via the Rural Assistance Center)

Hospital Reclassifications

Rural publications via the Rural Assistance Center — Thu, 13 Jun 2013 19:33:43 +0100

Fact sheet provides information about urban to rural reclassification, geographic reclassification, timelines for reclassification and Rural Referral Center (RRC) status. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

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Medicare to Pay for More FDG-PET Scans

MedPage Today Campaign '08 — Wed, 12 Jun 2013 18:37:04 +0100

WASHINGTON (MedPage Today) -- Up to three scans using 18F-fluorodeoxyglucose-enhanced positron emission tomography technology can be covered by Medicare for oncology treatment planning, the Centers for Medicare and Medicaid Services said. (Source: MedPage Today Campaign '08)

Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals

Rural publications via the Rural Assistance Center — Mon, 10 Jun 2013 16:36:57 +0100

Describes payment adjustments to be applied to Medicare eligible professionals who are not meaningful users of certified electronic health record (EHR) technology under the Medicare EHR Incentive Programs. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Crackdown on Medicare fraud grows nationwide

bizjournals.com Health Care:Biotechnology headlines — Fri, 07 Jun 2013 19:43:02 +0100

The number of health care fraud cases filed in the Middle District of Tennessee has increased over the past few years, and if recent data from the Centers for Medicare and Medicaid Services is any indication, we're not alone. New data released Thursday shows that over the past four years, the federal government has recovered $14.9 billion in health care fraud judgments, settlements and administrative impositions. In addition, CMS has revoked the ability of 14,663 providers and suppliers to bill… (Source: bizjournals.com Health Care:Biotechnology headlines)

Kentucky Doc Admits to Falsifying Patient DataKentucky Doc Admits to Falsifying Patient Data

Medscape Today Headlines — Fri, 07 Jun 2013 16:00:20 +0100

Dr Sandesh Rajaram Patil, who practiced at St Joseph's Hospital, admitted that he lied about the severity of coronary disease and submitted this false data to the Centers for Medicare and Medicaid Services to receive payment for the procedure. Heartwire (Source: Medscape Today Headlines)

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No Stopping Sequestration Cancer Cuts, Says CMSNo Stopping Sequestration Cancer Cuts, Says CMS

Medscape Today Headlines — Thu, 06 Jun 2013 20:45:48 +0100

Members of the US Congress wrote an appeal to the Centers for Medicare and Medicaid Services. They just received their answer. Medscape Medical News (Source: Medscape Today Headlines)

Register Now For National Provider Call on PQRS Reporting Presented by CMS on June 5

American Academy of Neurology — Sun, 02 Jun 2013 16:15:20 +0100

The Centers for Medicare and Medicaid Services (CMS) is holding a free National Provider Call, Getting Started with PQRS Reporting: Implications for the Value-based Payment Modifier, this Wednesday, June 5 at 1:30 p.m. Eastern Time. (Source: American Academy of Neurology)

Antipsychotics Continue to Have a Place in the Management of Difficult Behavior Problems in Patients With Dementia

Journal of the American Medical Directors Association — Sat, 01 Jun 2013 04:00:00 +0100

Prescribing antipsychotics for elderly patients with dementia has become controversial in recent years, and perhaps no clinical issue in history has inspired so much involvement from the federal government. In May of 2012, the Centers for Medicare and Medicaid Services (CMS) announced an initiative to reduce the use of antipsychotic medications in nursing homes by 15% by the end of the year. This is only the most recent governmental action seeking to improve the quality of care in nursing homes. The federal government has been vocal relative to antipsychotic prescribing in the elderly since 1987, when Congress passed the Nursing Home Reform Amendments, known as OBRA-87, a series of nursing home standards that sought to improve care and uphold patients' rights, including the right to be fre...

Public Health Surveillance in the Dialysis Setting: Opportunities and Challenges for Using Electronic Health Records

Seminars In Dialysis — Fri, 31 May 2013 04:00:00 +0100

Abstract The US Centers for Disease Control and Prevention has conducted public health surveillance for healthcare‐associated infections (HAIs) in dialysis facilities since the 1970s, evolving from facility‐level surveys to patient‐level surveillance systems. The Centers for Medicare and Medicaid Services (CMS) recently implemented incentives for all end‐stage renal disease (ESRD) facilities to monitor and report patient‐level quality indicators to the Centers for Disease Control and Prevention's (CDC's) National Healthcare Safety Network (NHSN) in accordance with the NHSN Dialysis Event Protocol. These CMS incentives have led to a rapid increase in dialysis facility NHSN enrollment during 2012. Ongoing challenges to HAI surveillance in this setting include variability in the sur...

Public Health Surveillance in the Dialysis Setting: Opportunities and Challenges for Using Electronic Health Records.

Seminars in Dialysis — Fri, 31 May 2013 04:00:00 +0100

Authors: Wise ME, Lovell C Abstract The US Centers for Disease Control and Prevention has conducted public health surveillance for healthcare-associated infections (HAIs) in dialysis facilities since the 1970s, evolving from facility-level surveys to patient-level surveillance systems. The Centers for Medicare and Medicaid Services (CMS) recently implemented incentives for all end-stage renal disease (ESRD) facilities to monitor and report patient-level quality indicators to the Centers for Disease Control and Prevention's (CDC's) National Healthcare Safety Network (NHSN) in accordance with the NHSN Dialysis Event Protocol. These CMS incentives have led to a rapid increase in dialysis facility NHSN enrollment during 2012. Ongoing challenges to HAI surveillance in this setting inclu...

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Clinical evaluation of suspected deep vein thrombosis guides the decision to anticoagulate prophylactically but does not impact the decision to perform after hours duplex venous scanning or increase its yield

Journal of Vascular Surgery — Wed, 29 May 2013 23:17:31 +0100

The combined CPT and American Medical Association/Specialty Society Relative Value Scale Update Committee (or RUC) Five-Year Review Identification Workgroup screened CPT codes billed together 75% or more of the time. From this assessment, the workgroup indicated that there was duplication of work among CPT code 37201 (Transcatheter therapy, infusion for thrombolysis other than coronary) and CPT code 75896 (Transcatheter therapy, infusion, any method [eg, thrombolysis other than coronary], radiological supervision and interpretation). Therefore, a set of four bundled CPT codes were created under the direction of radiology, cardiology, and vascular surgery. The societies recognized that these patients require a significant amount of evaluation and management work typically in the intensive c...

Medicare Plan Finder

Rural web sites and other tools via the Rural Assistance Center — Fri, 24 May 2013 15:57:37 +0100

Includes a searchable website, either by general or personal information, which locates Medicare cost estimates and coverage information for your area. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

2013 Physician Fee Schedule Overview

Rural web sites and other tools via the Rural Assistance Center — Fri, 24 May 2013 15:39:29 +0100

Presents an overview of the physician fee schedule as well as a searchable website. Includes updates on the final rule as well as resources to download. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Guide

Rural publications via the Rural Assistance Center — Thu, 23 May 2013 17:26:57 +0100

Describes the information FQHCs are required to submit for a Prospective Payment System (PPS), and it explains how RHCs should bill for certain preventive services under the Affordable Care Act. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

National Health Expenditure Projections: 2011-2021

Rural publications via the Rural Assistance Center — Wed, 22 May 2013 16:41:08 +0100

Presents an analysis of projected national health care expenditures (NHE) through 2021. Updated annually. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

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Basic Medicare Information for Providers and Suppliers

Rural publications via the Rural Assistance Center — Wed, 22 May 2013 16:10:10 +0100

Provides an introduction to the Medicare Program, becoming a Medicare provider or supplier, Medicare reimbursement and services, the Medicare Trust Fund, overpayments and appeals, and outreach and education. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Health reform and the Affordable Care Act: The importance of mental health treatment to achieving the triple aim

Journal of Psychosomatic Research — Wed, 22 May 2013 04:00:00 +0100

Health reform efforts in the United States, including development of the chronic care model , the primary care medical home , pay-for-performance initiatives , and federally-funded Medicare demonstration projects preceded the passage of the federal 2010 Accountable Care Act (ACA). In addition to expanding health care coverage to uninsured populations in many states, the ACA provides recommendations to the Centers for Medicare and Medicaid Services (CMS) to test new payment and delivery models such as the Patient Centered Medical Home (PCMH) or Health Home models and Accountable Care Organizations in an to attempt to improve quality and outcomes of health care. Although Medicare (federally-funded insurance covering Americans ≥65years of age and those with chronic disabilities) and Medicai...

Medicare and Medicaid Programs; Electronic Health Record Incentive ProgramStage 2 (Final Rule)

Rural publications via the Rural Assistance Center — Tue, 21 May 2013 21:47:13 +0100

Specifies the Stage 2 criteria that eligibleprofessionals (EPs), eligible hospitals,and critical access hospitals (CAHs)must meet in order to qualify forMedicare and/or Medicaid electronichealth record (EHR) incentive payments. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Medicare Shared Savings Program and Rural Providers Fact Sheet

Rural publications via the Rural Assistance Center — Tue, 21 May 2013 21:17:11 +0100

Provides an overview of Accountable Care Organizations (ACOs) for rural providers. Discusses rules to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Medicare Billing Information for Rural Providers and Suppliers

Rural publications via the Rural Assistance Center — Mon, 20 May 2013 21:20:07 +0100

Provides Medicare billing charts and information on where to submit claims for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Skilled Nursing Facilities, Home Health Agencies, Critical Access Hospitals, and Swing Bed services. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

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Medicare Disproportionate Share Hospital: Rural Health Fact Sheet Series

Rural publications via the Rural Assistance Center — Mon, 20 May 2013 20:53:21 +0100

Presents an overview of the Medicare Disproportionate Share Hospital adjustment provision and lists how a hospital can qualify to receive it. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Sole Community Hospital: Rural Health Fact Sheet Series

Rural publications via the Rural Assistance Center — Mon, 20 May 2013 20:27:56 +0100

Presents information on Sole Community Hospitals including classification payments and criteria, resources, and a list of regional office rural health coordinators. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Critical Access Hospital: Rural Health Fact Sheet Series

Rural publications via the Rural Assistance Center — Mon, 20 May 2013 20:24:33 +0100

Provides information about Critical Access Hospital providers, designations, and payments. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

National Health Statistics Report #66: Adoption and Use of Electronic Health Records and Mobile Technology by Home Health and Hospice Care Agencies

Rural publications via the Rural Assistance Center — Mon, 20 May 2013 16:31:51 +0100

Presents estimates on the adoption and use of electronic health records and mobile technology in hospice and home care agencies. Based on data from the 2007 National Home and Hospice Care Survey. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Confused By Health Care Marketplaces? Help Is Coming

Fri, 17 May 2013 19:41:57 +0100

WebMD Medical News By Bara Vaida Reviewed by Lisa Zamosky May 8, 2013 — Now that the federal government is building health insurance Marketplaces (also called Exchanges) in 34 states, the question is: Will customers come? The Centers for Medicare and Medicaid Services (CMS), the government division overseeing the roll out of the new Marketplaces, is getting ready. It recently announced that thousands of people will be hired to staff call centers tied to the Marketplaces. Beginning in June, 7,000 to 9,000 additional people will answer phones through CMS’s “1-800-Medicare” help line, 24 hours a day, 7 days a week. The staff will answer questions about how to apply and enroll in the new insurance plans that will be offered in the states where the federal government is...

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AAFP Statement: Marilyn Tavenner Brings Needed Expertise, Leadership to CMS

AAFP News Releases and Statements — Fri, 17 May 2013 05:00:00 +0100

“The American Academy of Family Physicians applauds the confirmation of Marilyn Tavenner as administrator of the Centers for Medicare and Medicaid Services. (Source: AAFP News Releases and Statements)

Marilyn Tavenner Confirmed as Medicaid and Medicare Chief

NYT Health — Thu, 16 May 2013 00:29:28 +0100

The vote was 91 to 7 for Marilyn B. Tavenner, acting leader of the Centers for Medicare and Medicaid Services since December 2011. (Source: NYT Health)

Tavenner Confirmed as Medicare Chief

MedPage Today Campaign '08 — Wed, 15 May 2013 23:45:44 +0100

WASHINGTON (MedPage Today) -- The Senate on Wednesday confirmed Marilyn Tavenner to head the Centers for Medicare and Medicaid Services, making her the first confirmed administrator of the agency in nearly 7 years. (Source: MedPage Today Campaign '08)

2014 ICD-10 PCS and GEMs

Rural web sites and other tools via the Rural Assistance Center — Tue, 14 May 2013 14:33:04 +0100

Contains information on the new procedure coding system, ICD-10-PCS, that is being developed as a replacement for ICD-9-CM, Volume 3. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

Harkin Withdraws Hold on Tavenner Nomination

MedPage Today Public Health — Wed, 08 May 2013 16:35:17 +0100

(MedPage Today) -- Sen. Tom Harkin Tuesday removed the hold he had placed on the nomination of Marilyn Tavenner to head the Centers for Medicare and Medicaid Services and said he would no longer stand in the way of a Senate vote. (Source: MedPage Today Public Health)

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CMS Proposes Updates to the Wage Index and Payment Rates for the Medicare Hospice Benefit (Fact Sheet)

Rural publications via the Rural Assistance Center — Wed, 01 May 2013 19:16:00 +0100

Describes the proposed rule that would update fiscal year 2014 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

New Rewards And Penalties For Hospitals Proposed By Medicare

Health News from Medical News Today — Sun, 28 Apr 2013 17:00:00 +0100

Hospitals that take part in CMS' Inpatient Quality Reporting Program will receive 0.8% in extra payments, while those not successfully participating would have payments reduced by 2%, the Centers for Medicare and Medicaid Services (CMS) proposed on Friday to the USA's 3,400 acute care hospitals. CMS says its proposed Inpatient Prospective Payment System (IPPS) rule would represent an increase in payments to hospitals of almost $27 million in 2014 (fiscal). CMS says that the extra money has factored in an increase for inflation as well as an 0... (Source: Health News from Medical News Today)

Some Musings on the Fate of Graduate Medical Education

Journal of Surgical Education — Sun, 28 Apr 2013 04:12:04 +0100

Graduate medical education (GME) in the United States is under siege. The status quo is not sustainable and the way it was in the past will not be the way it will be in the future. The purpose of the paper is not to relive the history of GME in the United States, but to assess the current status and propose an alternative solution which might affect not only the Center for Medicare and Medicaid Services (CMS) and the American Board of Medical Specialists, but also the Accrediting Council for Graduate Medical Education (ACGME) and the various boards that certify individual practitioners. (Source: Journal of Surgical Education)

D.C. Week: Clearance for CMS Head Held Up

MedPage Today Primary Care — Sat, 27 Apr 2013 16:00:00 +0100

WASHINGTON (MedPage Today) -- The acting head of the Centers for Medicare and Medicaid Services (CMS) had an up-and-down week in Washington, as her nomination for administrator hit a speed bump from one powerful senator. (Source: MedPage Today Primary Care)

Medicare Offers Pay Boost to Hospitals

MedPage Today Geriatrics — Sat, 27 Apr 2013 02:43:00 +0100

WASHINGTON (MedPage Today) -- The Centers for Medicare and Medicaid Services issued a proposed rule late Friday that would increase payments to the nation's 3,400 acute care hospitals by nearly $27 million. (Source: MedPage Today Geriatrics)

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Tavenner Gets OK from Senate Committee

MedPage Today Public Health — Tue, 23 Apr 2013 19:00:00 +0100

WASHINGTON (MedPage Today) -- With a Senate committee vote in her favor Tuesday morning, Marilyn Tavenner moved a step closer to becoming the first confirmed administrator that the Centers for Medicare and Medicaid Services has had in 7 years. (Source: MedPage Today Public Health)

Causes and Implications of Readmission After Abdominal Aortic Aneurysm Repair

Journal of Vascular Surgery — Tue, 23 Apr 2013 16:12:22 +0100

In this study, the authors described the frequency, causes, predictors, and consequences of 30-day readmission after AAA repair in a Medicare population. Elective AAA repairs over a 2-year period from the CMS chronic conditions warehouse, a 5% national sample of Medicare beneficiaries, were studied. There were 2481 patients who underwent AAA repair, comprising 1502 endovascular aneurysm repairs (EVAR) and 749 open aneurysm repairs. The 30-day readmission rates were equivalent for EVAR (13.3%) and open repair (12.8%). Wound complication was the most common reason for readmission after both procedures. The relative frequency of other causes differed (ie, bowel obstruction after open repair and graft complication after EVAR). A multivariate analysis showed preoperative comorbidities had a mod...

Centers for Medicare and Medicaid Services, Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register updates via the Rural Assistance Center — Fri, 19 Apr 2013 06:00:00 +0100

The Centers for Medicare & Medicaid Services is publishing several proposed collections for public comment on the following: 1) Medicaid Managed Care Regulations; 2) Consolidated Renal Operations in a Web Enabled Network Third-party Submission Authorization Form; 3) Implementation of the Medicare Prescription Drug Plan and Medicare Advantage Plan Disenrollment Reasons Survey; and 4) National Implementation of In-Center Hemodialysis CAHPS Survey. (Source: Federal Register updates via the Rural Assistance Center)

St. Joseph Medical Center seeks to recoup $25M lost over Medicare license

bizjournals.com Health Care:Biotechnology headlines — Mon, 15 Apr 2013 18:49:47 +0100

University of Maryland St. Joseph Medical Center hopes to recoup the $25 million the hospital lost due a delay in receiving a new Medicare license. The Towson hospital lost the money between mid-December and late February because it was unable to bill for Medicare services while it waited for a new federal agreement. The Centers for Medicare and Medicaid Services (CMS) issued the new license Feb. 21, months after it had expected, according to recent documents related to the University of Maryland… (Source: bizjournals.com Health Care:Biotechnology headlines)

CMS publishes guidance on meaningful use audits

AuntMinnie.com Headlines — Fri, 12 Apr 2013 07:00:00 +0100

The U.S. Centers for Medicare and Medicaid Services (CMS) has published guidance (more) (Source: AuntMinnie.com Headlines)

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Medicare and State Health Care Programs: Fraud and Abuse; Electronic Health Records Safe Harbor Under the Anti-Kickback Statute; Proposed Rule; Comment Request

Federal Register updates via the Rural Assistance Center — Wed, 10 Apr 2013 06:00:00 +0100

This proposed rule from the Centers for Medicare and Medicaid Services and the Department of Health and Human Services Office of the Inspector General would impact small rural hospitals, HRSAs FLEX and SHIP grantees, rural health centers, State Offices of Rural Health and others. The proposed rule makes the suggested edit to extend the Stark and anti-kickback exceptions for purchasing electronic health records from December 31, 2013 to December 31, 2016. The proposed changes would drop an e-prescribing requirement and amend language regarding the types of electronic health records that qualify for the waivers; helping rural providers manage the cost of implementing electronic health records. (Source: Federal Register updates via the Rural Assistance Center)

Virtual Colonoscopy Used Appropriately May Expand Screening To More Patients

Health News from Medical News Today — Tue, 09 Apr 2013 07:00:00 +0100

In 2009, the Centers for Medicare and Medicaid Services (CMS) halted reimbursement for so-called "virtual colonoscopy" for routine colon-cancer screening in asymptomatic patients, in part due to concerns over how this procedure, computed tomography colonography (CTC), was being used in the elderly population... (Source: Health News from Medical News Today)

Funding Cuts for Nerve Studies Will Hit Neurology Patients Hard

American Academy of Neurology — Mon, 08 Apr 2013 19:25:00 +0100

In an unexpected decision at the end of last year, the Centers for Medicare and Medicaid Services (CMS) announced that it would cut reimbursement payments to the doctors conducting nerve studies by anywhere from 30 percent to 70 percent. (Source: American Academy of Neurology)

The Center For Medicare And Medicaid Innovation's Blueprint For Rapid-Cycle Evaluation Of New Care And Payment Models [Web First]

Health Affairs — Mon, 08 Apr 2013 04:00:00 +0100

This article describes that approach—setting forth how the Rapid Cycle Evaluation Group aims to deliver frequent feedback to providers in support of continuous quality improvement, while rigorously evaluating the outcomes of each model tested. This article also describes the relationship between the group’s work and that of the Office of the Actuary at the Centers for Medicare and Medicaid Services, which plays a central role in the assessment of new models. (Source: Health Affairs)

AAFP Statement: AAFP Proposes New Primary Care-Specific Evaluation and Management Codes to Increase Payment for Primary Care Services

AAFP News Releases and Statements — Fri, 05 Apr 2013 05:00:00 +0100

“On March 27, the American Academy of Family Physicians issued a letter to the Centers for Medicare and Medicaid Services calling for the development of a new set of evaluation and management codes specifically for primary care physicians that would result in increased payment for the intensity and complexity of care and work provided by primary care physicians. The AAFP has asked CMS to consider creating the new codes for inclusion in the 2014 Medicare Physician Fee Schedule. (Source: AAFP News Releases and Statements)

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Reversal in Medicare Advantage rate proposal

WDSU.com - Health — Tue, 02 Apr 2013 14:26:17 +0100

The federal government has reversed a proposed cut that could have left millions who get their health insurance through the Medicare Advantage plan paying more for coverage. The Centers for Medicare and Medicaid Services (CMS) announced Monday the fin... (Source: WDSU.com - Health)

Don't Panic! The Sunshine Act Promotes Transparency in Payments

American Academy of Neurology — Mon, 01 Apr 2013 20:11:00 +0100

Neurologists should begin retaining your own records of items of value received from pharmaceutical companies and device manufacturers to ensure you are prepared to evaluate and challenge the accuracy of reports submitted by these entities to the Centers for Medicare and Medicaid Services (CMS). (Source: American Academy of Neurology)

Feds have questions about Louisiana public hospital deals

WDSU.com - Health — Mon, 01 Apr 2013 15:34:57 +0100

The federal Centers for Medicare and Medicaid Services have questions about Louisiana's plan to provide extra federal money to private hospitals that run state hospitals. (Source: WDSU.com - Health)

The Changing landscape of health care delivery and the Heart Rhythm community

Heart Rhythm — Mon, 01 Apr 2013 04:00:00 +0100

As the global economy remains sluggish, pressures to contain the escalating costs of health care delivery continue to increase worldwide. In Canada and Europe, physicians also are facing cuts in reimbursement for services similar to those already implemented or being considered by the Centers for Medicare and Medicaid Services (CMS) in the United States. Scientists around the world face stiff competition for limited and shrinking research dollars that may impede our ability to advance our mission of ending death and suffering due to heart rhythm disorders.Anne M. Gillis, MD, FHRS (Source: Heart Rhythm)

Association Between Surgical Care Improvement Program Venous Thromboembolism Measures and Postoperative Events

Journal of Vascular Surgery — Mon, 01 Apr 2013 04:00:00 +0100

This study sought to determine the rates of adherence to SCIP-VTE guidelines, to identify factors for nonadherence, and to analyze relationships between SCIP guideline adherence and VTE events in the context of other patient and procedure factors. This was a retrospective cohort study of data from the VA Surgical Quality Improvement Program from 2006 to 2009. There were 30,531 surgeries analyzed. Patient demographics, comorbidities, and surgical characteristics associated with VTE were summarized. VTE rates were compared by SCIP-VTE adherence. VTE was modeled by adherence to SCIP and adjusting for multiple associated factors using multivariable logistic regression. Of the 30,531 surgeries evaluated, 89.9% adhered to SCIP-VTE, and 1.4% experienced VTE. Obesity, smoking, functional status, w...

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Hospital value‐based purchasing

Journal of Hospital Medicine — Mon, 01 Apr 2013 04:00:00 +0100

We describe the structure of the Centers for Medicare and Medicaid Services' VBP program, with a focus on which hospitals are eligible to participate in the program, the specific outcomes measured and incentivized, how rewards and penalties are allocated, and how the program will be funded. In an effort to anticipate some of the issues that lie ahead, we then highlight a number of potential challenges to the success of VBP, and discuss how VBP will impact the delivery and reimbursement of inpatient care services. We conclude by examining how the VBP program is likely to evolve over time. Journal of Hospital Medicine 2013. © 2013 Society of Hospital Medicine (Source: Journal of Hospital Medicine)

Clarification of the intent of ventricular assist devices before patient consent

The Journal of Thoracic and Cardiovascular Surgery — Mon, 01 Apr 2013 04:00:00 +0100

Moazami and Feldman recently proposed a single indication for mechanical circulatory support (MCS). This indication, “end-stage heart failure refractory to medical therapy,” similar to the tripartite nomenclature (“destination therapy,” “bridge to transplant,” and “bridge to recovery”) by the Centers for Medicare and Medicaid Services (CMS), is clinically and ethically incomplete. In this article, we describe how the CMS tripartite nomenclature unintentionally increases the risk of ethical problems characterized by misalignments in expectations and goals among heart failure teams, patients, and surrogates, and thus increases the risk of an inadequate informed consent process for MCS. Similar to Moazami and Feldman, we assert that the current tripartite nomenclature is probl...

The new dining practice standards: speech-language pathologists' guide to their implementation.

Seminars in Speech and Language — Mon, 01 Apr 2013 04:00:00 +0100

Authors: Bowman C Abstract In 2010, the "Creating Home II National Symposium on Culture Change and the Food and Dining Requirements" cosponsored by Centers for Medicare and Medicaid services (CMS) and the Pioneer Network created a multidisciplinary task force for dining practice standards. In 2011, this task force crafted and finalized the New Dining Practice Standards. These standards have been agreed upon by 12 national clinical standard setting organizations and will be referred to by CMS as new standards of practice. The new standards include evidence-based research, as well as new thinking in advance of research and corroboration with federal requirements. Speech-language pathologists can guide care communities in implementing the new standards and lead a new era of honoring t...

Endovascular Abdominal Aortic Aneurysm Repair to Facilitate Access for Transcatheter Aortic Valve Implantation [CASE REPORTS]

The Annals of Thoracic Surgery — Sun, 31 Mar 2013 04:00:00 +0100

We report a case in which the limitation of severe iliac artery occlusive disease was overcome by placement of an abdominal aortic endovascular graft that subsequently allowed successful transfemoral access and transcatheter aortic valve implantation. (Source: The Annals of Thoracic Surgery)

CMS to Review Gender Change Surgery

MedPage Today Psychiatry — Sat, 30 Mar 2013 18:43:15 +0100

WASHINGTON (MedPage Today) -- The Centers for Medicare and Medicaid Services (CMS) said it would reconsider covering gender change surgery under Medicare for patients with gender identity disorder. (Source: MedPage Today Psychiatry)

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Medicaid Incentive Programs To Encourage Healthy Behavior Show Mixed Results To Date And Should Be Studied And Improved [Rewarding Healthy Behavior]

Health Affairs — Mon, 04 Mar 2013 05:00:00 +0100

In September 2011 the Centers for Medicare and Medicaid Services awarded $85 million in grants to ten states to test financial incentive programs to encourage healthy behavior among Medicaid enrollees with chronic diseases. There is little published evidence about the effectiveness of such incentives within the Medicaid program. We evaluated the available research from three earlier Medicaid incentive programs and found mixed results. On the one hand, in Florida only about half of the $41.3 million in available credits was "claimed" by enrollees between 2006 and 2011. On the other, Idaho’s incentive program was credited with improving the proportion of children who were up-to-date on well-child visits. Our findings suggest that Medicaid incentive programs should be des...

Hospice Enrollment Saves Money For Medicare And Improves Care Quality Across A Number Of Different Lengths-Of-Stay [The Care Span]

Health Affairs — Mon, 04 Mar 2013 05:00:00 +0100

Despite its demonstrated potential to both improve quality of care and lower costs, the Medicare hospice benefit has been seen as producing savings only for patients enrolled 53–105 days before death. Using data from the Health and Retirement Study, 2002–08, and individual Medicare claims, and overcoming limitations of previous work, we found $2,561 in savings to Medicare for each patient enrolled in hospice 53–105 days before death, compared to a matched, nonhospice control. Even higher savings were seen, however, with more common, shorter enrollment periods: $2,650, $5,040, and $6,430 per patient enrolled 1–7, 8–14, and 15–30 days prior to death, respectively. Within all periods examined, hospice patients also had significantly lower rates of hospital ...

Update on New Federal Regulations Affecting Clinical Pathology Laboratories: Stage 2 ‘Meaningful Use’ Rules Top the List

Dark Daily — Fri, 01 Mar 2013 11:00:52 +0100

Final Stage 2 rules give providers another year to meet Stage 1 ‘meaningful use’ criteria and shorten Stage 2 requirements from one-year to just 90 days Clinical laboratory managers and pathologists may be interested to know that, over the fall months, the U.S. Department of Health and Human Services (HHS) released three new rules that [...] (Source: Dark Daily)

17 Hawaii nursing homes get highest rating from U.S. News & World Report

bizjournals.com Health Care:Biotechnology headlines — Tue, 26 Feb 2013 23:51:45 +0100

About 35 percent of the 48 Hawaii nursing homes on U.S. News & World Report’s list of the best nursing homes received an overall score of five stars, based on data from the Centers for Medicare and Medicaid Services. Seventeen nursing homes in Hawaii earned the top score for their overall performance in health inspections, nurse staffing, and quality of medical care, according to U.S. News & World Report website. Three of the 48 were not rated. Of the 17 that received five stars, five were hospitals… (Source: bizjournals.com Health Care:Biotechnology headlines)

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Using Lean Six Sigma to Reduce Rehospitalizations from a Nursing Home: A Pilot Study

Journal of the American Medical Directors Association — Mon, 25 Feb 2013 18:34:39 +0100

Readmissions to the hospital, including those after admission to a nursing home, is a problem that the Centers for Medicare and Medicaid Services and other payors are attempting to reduce. Lean Six Sigma is a Performance Improvement process that can be applied to such a problem. (Source: Journal of the American Medical Directors Association)

New Study Sets The Record Straight On Medicare's Overhead Costs

Health News from Medical News Today — Fri, 22 Feb 2013 09:00:00 +0100

The traditional Medicare program allocates only 1 percent of total spending to overhead compared with 6 percent when the privatized portion of Medicare, known as Medicare Advantage, is included, according to a study in the June 2013 issue of the Journal of Health Politics, Policy and Law. The 1 percent figure includes all types of non-medical spending by the Centers for Medicare and Medicaid Services plus other federal agencies, such as the IRS, that support the Medicare program, and is based on data contained in the latest report of the Medicare trustees... (Source: Health News from Medical News Today)

Hawaii to get funding from Centers for Medicare and Medicaid Services

bizjournals.com Health Care:Pharmaceuticals headlines — Fri, 22 Feb 2013 04:59:29 +0100

Hawaii will receive a planning grant of $937,691 from the Centers for Medicare and Medicaid Services as part of the State Innovation Model program created by the federal Affordable Care Act. Hawaii is one of 25 states to share in nearly $300 million in awards that will help them “deliver high-quality health care, lower costs and improve their health system performance,” the U.S. Department of Health and Human Services said in a statement. Starting April 1, Hawaii will have six months to design… (Source: bizjournals.com Health Care:Pharmaceuticals headlines)

Maryland wins $2.4M federal grant for medical home program

bizjournals.com Health Care:Physician Practices headlines — Thu, 21 Feb 2013 19:51:34 +0100

Maryland will be getting nearly $2.4 million from the Centers for Medicare and Medicaid Services to put toward expanding its patient centered medical home program. The award is part of nearly $300 million in State Innovation Model Initiative grants, which are intended to fund state-wide programs aimed at reforming the health care delivery system, reducing costs and improving quality. State programs are expected to focus on Medicare Medicaid and the Children’s Health Insurance Program. The innovation… (Source: bizjournals.com Health Care:Physician Practices headlines)

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Affordable Care Act: A Stronger Medicare Program

Rural publications via the Rural Assistance Center — Tue, 19 Feb 2013 19:26:13 +0100

Details how millions of seniors and people with disabilities with Medicare continued to experience lower costs on prescription drugs and improved benefits because of the Affordable Care Act. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

The impact of Centers for Medicare and Medicaid Services high-risk criteria on outcome after carotid endarterectomy and carotid artery stenting in the SVS Vascular Registry

Journal of Vascular Surgery — Wed, 13 Feb 2013 05:00:00 +0100

Objective: The Centers for Medicare and Medicaid Services (CMS) require high-risk (HR) criteria for carotid artery stenting (CAS) reimbursement. The impact of these criteria on outcomes after carotid endarterectomy (CEA) and CAS remains uncertain. Additionally, if these HR criteria are associated with more adverse events after CAS, then existing comparative effectiveness analysis of CEA vs CAS may be biased. We sought to elucidate this using data from the SVS Vascular Registry.Methods: We analyzed 10,107 patients undergoing CEA (6370) and CAS (3737), stratified by CMS HR criteria. The primary endpoint was composite death, stroke, and myocardial infarction (MI) (major adverse cardiovascular event [MACE]) at 30 days. We compared baseline characteristics and outcomes using univariate and mul...

The New Old Age Blog: Debate Over Brain Scans and Alzheimer's

NYT Health — Tue, 12 Feb 2013 19:10:22 +0100

An expert panel convened by the Centers for Medicare and Medicaid Services concluded that data supporting use of PET scans to diagnose Alzheimer's was weak. (Source: NYT Health)

Hospital Outpatient Prospective Payment System: Payment System Fact Sheet Series

Rural publications via the Rural Assistance Center — Mon, 11 Feb 2013 20:31:09 +0100

Provides information about the Hospital Outpatient Prospective Payment System, ambulatory payment classifications, and how payment rates are set. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

ACOs unite to form national association

Healthcare IT News — Mon, 11 Feb 2013 15:24:39 +0100

Out of the 258 accountable care organizations (ACOs) recognized by the Centers for Medicare and Medicaid Services, 60 of them, across more than 15 states, have joined together to form the National Association of ACOs. read more (Source: Healthcare IT News)

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The National ICD Registry Report: Version 2.1 including leads and pediatrics for years 2010 and 2011

Heart Rhythm — Mon, 11 Feb 2013 05:00:00 +0100

The evolution of health care toward evidence-driven decision making has been facilitated by electronic data management and the development of large clinical databases. As previously described, the American College of Cardiology Foundation (www.acc.org), through its subsidiary the National Cardiovascular Data Registry (NCDR; www.accncdr.com), worked in collaboration with Heart Rhythm Society (HRSonline.org) to develop the National ICD Registry to meet a mandate by the Center for Medicare and Medicaid Services. The registry is a means of determining the degree to which the real-world implantable cardioverter-defibrillator (ICD) use correlates with the randomized trials that inform evidence-based guidelines and to understand the clinical characteristics, processes of care, and outcomes of pat...

Advocating at the Centers for Medicare and Medicaid Services

Journal of the American Dietetic Association — Mon, 11 Feb 2013 05:00:00 +0100

With the various changes in health care, the Academy has been proactive in ensuring that our members are recognized as the nutrition experts and receive adequate reimbursement so that they may provide the necessary services to combat chronic disease and improve the health of Americans. To meet these health care changes head on, the Academy has been meeting with various organizations, collaborating with partners, educating members of Congress, and forming workgroups to tackle specific nutrition policy issues. The Centers for Medicare and Medicaid Services (CMS) is of particular interest to the Academy because of its large impact on health care delivery and payment and, ultimately, the field of dietetics. (Source: Journal of the American Dietetic Association)

Obama Renominates Tavenner to Lead Medicare, Medicaid Agency

News stories via the Rural Assistance Center — Fri, 08 Feb 2013 06:00:00 +0100

The Hill, (DC) article reports that President Obama has renominated Marilyn Tavenner to lead the Centers for Medicare and Medicaid Services (CMS), the agency that oversees Medicare, Medicaid and most of the implementation of President Obama's signature healthcare law. (Source: News stories via the Rural Assistance Center)

AAFP Statement: American Academy of Family Physicians Welcomes Tavenner Nomination as CMS Administrator

AAFP News Releases and Statements — Fri, 08 Feb 2013 06:00:00 +0100

“President Obama has made an excellent choice in re-nominating Marilyn Tavenner as administrator of the Centers for Medicare and Medicaid Services. (Source: AAFP News Releases and Statements)

CMS Program Aims at Cutting ESRD Spending

MedPage Today Public Health — Wed, 06 Feb 2013 22:31:41 +0100

WASHINGTON (MedPage Today) -- Healthcare providers and suppliers will be able to test new payment and delivery models for end-stage renal disease under a program announced this week by the Centers for Medicare and Medicaid Services. (Source: MedPage Today Public Health)

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Aging With Heart Failure⁎ Physiological Assessments and Risk for Hospital Admission

Journal of the American College of Cardiology — Wed, 06 Feb 2013 16:00:04 +0100

Healthcare systems that treat patients with heart failure have the daunting task of improving outcomes or be faced with economic penalty. Specifically, the need for readmission to the hospital after inpatient care and appropriate application of consensus-recommended medical and device therapies for heart failure is monitored as a means to evaluate clinical performance. As a result, there is an increased focus on the risk for hospital admission in new clinical studies and prospective trials. Many trials are now designed with heart failure–related hospital admission as the primary outcome measure—a shift from mortality or disease progression. Certainly, heart failure–related hospital admissions have skyrocketed over the past 20 years despite major breakthroughs in disease-modifying the...

Wisconsin Receives Federal Approval for AIDS/HIV Medical Home Model of Care

Wisconsin DHFS Press Releases — Wed, 06 Feb 2013 16:00:00 +0100

The Department of Health Services and AIDS Resource Center of Wisconsin (ARCW) announced the U.S. Centers for Medicare and Medicaid Services (CMS) has given final approval for the Wisconsin Health Home for Individuals with AIDS/HIV. The action by CMS is the culmination of more than four years of work in securing approval for the specialized health care system. (Source: Wisconsin DHFS Press Releases)

CMS to create new records system

Healthcare IT News — Wed, 06 Feb 2013 15:14:14 +0100

The Centers for Medicare and Medicaid Services will develop a new records system that will facilitate quality reporting for long term hospital care, according to Wednesday's Federal Register. read more (Source: Healthcare IT News)

Aging With Heart Failure ⁎ ⁎ Physiological Assessments and Risk for Hospital Admission

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 04 Feb 2013 21:04:11 +0100

CMS Delayed Final Rule On Payments To Physicians Released

Health News from Medical News Today — Mon, 04 Feb 2013 08:00:00 +0100

The CMS (Centers for Medicare and Medicaid Services) announced a long-awaited rule which will raise public awareness of the financial relationships between medical device and pharmaceutical companies and doctors and teaching hospitals. Peter Budetti, MD, CMS deputy administrator for program integrity said that patients have the right to know whether their doctor has a financial relationship with the makers of medical devices or medications they may need. "Disclosure of these relationships allows patients to have more informed discussions with their doctors... (Source: Health News from Medical News Today)

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CMS Announces Sunshine Act Final Rule

Health News from Medical News Today — Mon, 04 Feb 2013 08:00:00 +0100

The CMS (Centers for Medicare and Medicaid Services) announced the long-awaited Sunshine Act final rule which will raise public awareness of the financial relationships between medical device and pharmaceutical companies and doctors and teaching hospitals. Peter Budetti, MD, CMS deputy administrator for program integrity said that patients have the right to know whether their doctor has a financial relationship with the makers of medical devices or medications they may need. "Disclosure of these relationships allows patients to have more informed discussions with their doctors... (Source: Health News from Medical News Today)

Centers for Medicare and Medicaid Services Will Stop Payment for Infected Cardiac Implantable Devices; Will Implantable Pain Therapy be Next?

Pain Practice — Mon, 04 Feb 2013 05:00:00 +0100

(Source: Pain Practice)

CMS Issues Sunshine Rule

MedPage Today Public Health — Fri, 01 Feb 2013 22:36:08 +0100

WASHINGTON (MedPage Today) -- The Centers for Medicare and Medicaid Services issued a long-awaited rule Friday finalizing the details for a database that will list payments made to physicians by pharmaceutical and device manufacturers. (Source: MedPage Today Public Health)

CMS committee not yet swayed on brain amyloid PET imaging

AuntMinnie.com Headlines — Thu, 31 Jan 2013 17:14:50 +0100

A U.S. Centers for Medicare and Medicaid Services (CMS) advisory committee (more) (Source: AuntMinnie.com Headlines)

CHIME warns quality reporting via EHR not ready for prime time

Healthcare IT News — Mon, 28 Jan 2013 18:48:01 +0100

The College of Healthcare Information Management Executives (CHIME) says hospitals are not ready for quality reporting via EHRs. In its comments to the Centers for Medicare and Medicaid Services, submitted Jan. read more (Source: Healthcare IT News)

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Nursing: Frequently in the Bull's-Eye for Noncompliance

Nurse Leader — Fri, 25 Jan 2013 18:08:48 +0100

This article addresses the reason for such extensive and frequent nursing involvement and provides strategies for preventing a noncompliance finding. (Source: Nurse Leader)

Bottom Line: CMS Actuary Closes Books

MedPage Today Public Health — Sat, 19 Jan 2013 18:00:00 +0100

BALTIMORE, Md. (MedPage Today) -- Rick Foster will retire on Feb. 1, leaving the post of chief actuary for the Centers for Medicare and Medicaid Services, a position he's held since February 1995. (Source: MedPage Today Public Health)

CAH Method II Physician Participation in the Medicare EHR Incentive Program: Fact Sheet

Rural publications via the Rural Assistance Center — Fri, 18 Jan 2013 19:17:47 +0100

Reports that physicians who assign their reimbursement and billing to a critical access hospital (CAH) under Method II (CAH IIs) are now eligible to participate in the Medicare Electronic Health Record (EHR) Incentive Program as eligible professionals (EPs). -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Electronic Health Record (EHR) Incentive Program FAQs

Rural publications via the Rural Assistance Center — Thu, 17 Jan 2013 19:35:05 +0100

Frequently asked questions (FAQs) regarding the Medicare and Medicaid EHR Incentive Programs that provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

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CMS has released proposed rules for health insurance exchanges

Healthcare IT News — Thu, 17 Jan 2013 14:35:25 +0100

The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule that outlines further details about the standards and systems for states’ health insurance exchanges, Medicaid and the Children’s Health Insurance Programs (CHIP) to work together to meet consumer health needs, improve quality and lower costs in 2014. read more (Source: Healthcare IT News)

Patient satisfaction associated with lower emergency department use but more hospitalisations and higher costs and mortality

Evidence-Based Medicine — Thu, 17 Jan 2013 05:00:00 +0100

Commentary on: Fenton JJ, Jerant AF, Bertakis KD, et al.. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med 2012;172:405–11. Context With the ascent of patient-centred medical homes and accountable care organisations in the USA, patient satisfaction is being seen as an outcome that should be elevated to a performance measure on par with the process of care. Health systems are encouraged to be patient-centred, and patients are encouraged to be consumers and choose providers on the basis of satisfaction (and other) metrics. It is expected that lower publicly reported satisfaction scores will motivate hospitals to improve care quality and patient satisfaction to retain the market share. The potential...

The rush to digitize patient records has not cut costs

ICMCC: The International Council on Medical and Care Compunetics — Tue, 15 Jan 2013 16:12:48 +0100

“There is good news on the health-care spending front. According to the federal Centers for Medicare and Medicaid Services, the nation’s health-care bill grew only 3.9 percent in 2011, the third straight year at that pace — which is about half the average annual rate between 2003 and 2007. Consequently, health care is no longer consuming [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

Feds lift threat against UC Davis over rogue researchers

bizjournals.com Health Care:Biotechnology headlines — Tue, 15 Jan 2013 01:42:54 +0100

The UC Davis Medical Center has ducked a knock-out punch from federal officials: the academic medical center is back in good graces with the agency that oversees Medicare. In November, Centers for Medicare and Medicaid Services threatened to terminate the hospital from participation in government health care programs after a neurosurgery research scandal posed questions about the hospital’s ability to render safe care. On Friday, medical center officials received a letter saying the threat was… (Source: bizjournals.com Health Care:Biotechnology headlines)

HealthEast is one of last to adopt new Medicare program

bizjournals.com Health Care:Biotechnology headlines — Mon, 14 Jan 2013 22:58:12 +0100

The Centers for Medicare and Medicaid Services (CMS) has selected Community Health Network — an organization formed by HealthEast Care System and Entira Family Clinics — to be part of its accountable care program. HealthEast is one of the last large Twin Cities-based health providers to participate in the accountable care program. Last year St. Paul-based HealthEast, Entira, and a group of independent specialists formed Community Health Network, an accountable care organization (ACO). St. Paul-based… (Source: bizjournals.com Health Care:Biotechnology headlines)

Are dermatology residents adequately prepared for the business of medicine?

Journal of the American Academy of Dermatology — Mon, 14 Jan 2013 15:39:31 +0100

To the Editor: Most physicians expend valuable time at the beginning of their careers learning the basics of practice management. Improper documentation and billing puts physicians, including residency programs, at risk for an audit from the Centers for Medicare and Medicaid Services, which could result in penalties, repayments, and potentially even jail time. The aim of this study was to assess current dermatology residents' knowledge, education, exposure, and comfort level regarding billing and coding while assessing how important they believe this aspect of medicine is in residency training. (Source: Journal of the American Academy of Dermatology)

The search for improved electrocardiographic diagnosis of acute coronary syndrome

Journal of Electrocardiology — Fri, 11 Jan 2013 05:00:00 +0100

The standard 12 lead electrocardiogram (ECG) is a critical tool for the categorization of acute coronary syndromes. ECG diagnosis of ST elevation myocardial infarction (STEMI) triggers emergent therapies for management of presumed coronary occlusion, while other ECG findings categorize patients to less invasive treatment algorithms. Unfortunately, the standard 12-lead ECG is limited in the accuracy of identification and classification of ACS presentations. False positive tests may result in further harmful testing and even unnecessary treatment, whereas false negative results may result in delay or withholding of treatment that limits loss of myocardium and possibly human life. There are devices that enhance the standard ECG's capabilities to diagnose ACS, and these so called signal analys...

CMS issues new meaningful use guidance

AuntMinnie.com Headlines — Thu, 10 Jan 2013 22:43:25 +0100

The U.S. Centers for Medicare and Medicaid Services (CMS) has provided new (more) (Source: AuntMinnie.com Headlines)

Reliability of Readmission Rates as a Hospital Quality Measure in Cardiac Surgery

Journal of Surgical Research — Thu, 10 Jan 2013 19:14:40 +0100

Reducing readmission after surgery has been targeted by the Center for Medicare and Medicaid Services as a potential focus for quality improvement initiatives. However, the reliability of using readmission rates as a measure of hospital quality is unknown. (Source: Journal of Surgical Research)

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ManTech completes ALTA Systems acquisition

bizjournals.com Health Care:Hospitals headlines — Wed, 09 Jan 2013 18:54:50 +0100

Fairfax-based ManTech International Corp. has completed its acquisition of government information technology contractor ALTA Systems Inc. for an undisclosed sum. The acquisition of Fairfax-based ALTA expands ManTech’s presence in the health care IT market. ATLA is among the contractors on a Centers for Medicare and Medicaid Services Enterprise System Development contract that runs through 2018. (Source: bizjournals.com Health Care:Hospitals headlines)

Medicare Participation Enrollment Deadline Extended to February 15

American Academy of Neurology — Mon, 07 Jan 2013 14:11:00 +0100

ICD-10 could put many small physician practices out of business, coalition contends

Modern Medicine — Mon, 07 Jan 2013 05:00:00 +0100

Nearly 40 national physician groups are calling on the Centers for Medicare and Medicaid Services to quash implementation plans of the ICD-10 system for outpatient diagnosis coding. (Source: Modern Medicine)

Medicare Participation Enrollment Deadline Extended to February 15

American Academy of Neurology — Sat, 05 Jan 2013 18:29:46 +0100

Due to the uncertainty surrounding physician payment, the Centers for Medicare and Medicaid Services (CMS) has extended their Annual Participation Enrollment Period until February 15, 2013. Any changes to participation status must be post-marked by February 15. Participation status changes made during the extension will be retroactive to January 1. (Source: American Academy of Neurology)

CMS Releases Guidance on Remote IONM Billing for 2013

American Academy of Neurology — Fri, 04 Jan 2013 15:39:00 +0100

The Centers for Medicare and Medicaid Services (CMS) recently posted guidance for billing Medicare for remote intraoperative neurophysiology monitoring in calendar year (CY) 2013. (Source: American Academy of Neurology)

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Parkland plans mock inspections to prepare for CMS review

bizjournals.com Health Care:Hospitals headlines — Wed, 02 Jan 2013 22:40:13 +0100

Parkland Health & Hospital System will prepare for a 2013 survey by the U.S. Centers for Medicare and Medicaid Services by conducting “mock surveys” in February and March, the hospital announced Wednesday. About 97 percent of corrections necessary for the hospital to pass the crucial inspection have been made or are on schedule for completion by their designated deadlines, hospital officials say. The focus now is shifting to ensuring that the changes in areas such as infection control and psychiatric… (Source: bizjournals.com Health Care:Hospitals headlines)

Including catheter-associated urinary tract infections in the 2008 CMS payment policy: a qualitative analysis.

Urologic Nursing — Tue, 01 Jan 2013 05:00:00 +0100

Authors: Palmer JA, Lee GM, Dutta-Linn MM, Wroe P, Hartmann CW Abstract The study presented in this article addresses the impact of the 2008 nonpayment policy of the Centers for Medicare and Medicaid Services (CMS) on catheter-associated urinary tract infections (CAUTIs) from the perspective of infection preventionists. With rich qualitative data, it sheds light on the day-to-day impact of this recent health policy on CAUTI prevention. PMID: 23556374 [PubMed - in process] (Source: Urologic Nursing)

Quality reporting alignment on the way

Healthcare IT News — Mon, 31 Dec 2012 15:02:02 +0100

Certified electronic health records will make it easier for providers to report clinical quality measures not only for meaningful use but also for other federal programs. The Centers for Medicare and Medicaid Services (CMS) plans to align some of those measures. read more (Source: Healthcare IT News)

N.C. gets $18M to aid low-income families

bizjournals.com Health Care:Pharmaceuticals headlines — Thu, 27 Dec 2012 18:23:24 +0100

North Carolina is one of 23 states to receive a bonus for enrolling children from low-income families in Medicaid programs. The state received $18 million from the Centers for Medicare and Medicaid Services as part of $306 million in bonuses the federal program dispersed for work done during the fiscal year that ended June 30. The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) allowed for performance bonuses, giving states an incentive to support enrollment and retention… (Source: bizjournals.com Health Care:Pharmaceuticals headlines)

CMS reports fraud prevention savings

AuntMinnie.com Headlines — Thu, 27 Dec 2012 17:51:17 +0100

The U.S. Centers for Medicare and Medicaid Services (CMS) Fraud Prevent System (more) (Source: AuntMinnie.com Headlines)

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Surgeons make more than 4,000 mistakes each year

bizjournals.com Health Care:Pharmaceuticals headlines — Wed, 26 Dec 2012 17:11:41 +0100

About 39 times a week, a surgeon somewhere in the U.S. leaves a sponge or other object in a patient's body, a study suggests. Such "never events," meaning preventable errors, happen pretty often in hospitals across the country. In fact, more than 4,000 never events occur each year, researchers wrote in the journal Surgery. Among the events, as designated by the Centers for Medicare and Medicaid Services, are patient falls, late-stage pressure sores and several types of infections. Medicare no longer… (Source: bizjournals.com Health Care:Pharmaceuticals headlines)

The Association of Center Performance Evaluations and Kidney Transplant Volume in the United States

American Journal of Transplantation — Wed, 26 Dec 2012 05:00:00 +0100

Report cards evaluating transplant center performance have received significant attention in recent years corresponding with the Centers for Medicare and Medicaid Services issue of the 2007 Conditions of Participation. Our primary aim was to evaluate the association of report card evaluations with transplant center volume. We utilized data from the Scientific Registry of Transplant Recipients (SRTR) along with six consecutive program‐specific reports from January 2007 to July 2009 for adult kidney transplant centers. Among 203 centers, 46 (23%) were low performing (LP) with statistically significantly lower than expected 1‐year graft or patient survival at least once during the study period. Among LP centers, there was a mean decline in transplant volume of 22.4 cases compared to a mea...

Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting

Alzheimer's and Dementia: The Journal of the Alzheimer's Association — Wed, 26 Dec 2012 05:00:00 +0100

Abstract: The Patient Protection and Affordable Care Act added a new Medicare benefit, the Annual Wellness Visit (AWV), effective January 1, 2011. The AWV requires an assessment to detect cognitive impairment. The Centers for Medicare and Medicaid Services (CMS) elected not to recommend a specific assessment tool because there is no single, universally accepted screen that satisfies all needs in the detection of cognitive impairment. To provide primary care physicians with guidance on cognitive assessment during the AWV, and when referral or further testing is needed, the Alzheimer's Association convened a group of experts to develop recommendations. The resulting Alzheimer's Association Medicare Annual Wellness Visit Algorithm for Assessment of Cognition includes review of patient Health ...

CMS reports 2012 health IT fraud prevention system savings

AuntMinnie.com Headlines — Mon, 24 Dec 2012 21:51:40 +0100

The U.S. Centers for Medicare and Medicaid Services (CMS) Fraud Prevent System (more) (Source: AuntMinnie.com Headlines)

Preface

Clinics in Laboratory Medicine — Thu, 20 Dec 2012 05:00:00 +0100

This issue of Clinics in Laboratory Medicine, with a focus on “Quality Control (QC) Clinic,” addresses changes that are occurring in QC in medical laboratories. In 2012, a new option for satisfying the Clinical Laboratory Improvement Amendments (CLIA) requirements for QC was endorsed by Centers for Medicare and Medicaid Services (CMS). This option follows a new Clinical and Laboratory Standards Institute (CLSI) guideline EP23A, “Laboratory Quality Control Based on Risk Management,” that was published in late 2011. CLSI EP23A describes a methodology to identify failure modes, assess their risks, and develop a QC plan that is assembled from a wide variety of control mechanisms in a recommended “QC toolbox.” This new approach represents a major change and laboratories will need to...

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Perspectives on Quality Control, Risk Management, and Analytical Quality Management

Clinics in Laboratory Medicine — Thu, 20 Dec 2012 05:00:00 +0100

Quality control (QC) practices are changing in US laboratories as Centers for Medicare and Medicaid Services adopts individualized QC plans as a new option for compliance with the Clinical Laboratory Improvement Amendments regulations. The Joint Commission provides general guidance for applying risk management in health care organizations. The EP23A (Evaluation Protocol 23A) document from the Clinical and Laboratory Standards Institute provides specific guidance on the use of risk management for developing analytical QC plans. Medical laboratories should integrate risk management tools with existing quality management techniques and activities to provide an overall plan for analytical quality management. (Source: Clinics in Laboratory Medicine)

Satisfying Regulatory and Accreditation Requirements for Quality Control

Clinics in Laboratory Medicine — Thu, 20 Dec 2012 05:00:00 +0100

The Clinical Laboratory Improvement Amendments of 1988 (CLIA) requires all US clinical laboratories that test “materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease…” to be regulated. The CLIA mandates are site neutral; based on test complexity; and focus on the three phases of the testing process (preanalytical, analytical, and postanalytical). Many testing sites choose to meet the CLIA requirements by following the testing standards of a professional accreditation organization deemed by the Centers for Medicare and Medicaid Services. The three principal organizations are The Joint Commission, the College of American Pathologists, and COLA. (Source: Clinics in Laboratory Medicine)

CMS takes steps to implement 27% cut

Modern Medicine — Wed, 19 Dec 2012 05:00:00 +0100

The Centers for Medicare and Medicaid Services has begun taking steps to implement the 27% reduction in the 2013 Medicare Physician Fee Schedule that will take effect January 1 if Congress does not address the sustainable growth rate. (Source: Modern Medicine)

Start preparing for ICD-10 now

ICMCC: The International Council on Medical and Care Compunetics — Tue, 18 Dec 2012 15:53:05 +0100

“Establishing structured timelines and plans for software upgrades, training and testing are essential elements of a good plan for transitioning to ICD-10, said Renee Richard, health insurance specialist and ICD-10 lead at the Boston regional office of the Centers for Medicare and Medicaid Services (CMS), speaking at the Massachusetts Health Data Consortium’s Dec. 13 program [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

Medicaid Eligibility, Enrollment Simplification, and Coordination under the Affordable Care Act: A Summary of CMSs March 23, 2012 Final Rule

Rural publications via the Rural Assistance Center — Mon, 17 Dec 2012 16:04:06 +0100

Provides a summary of the Centers for Medicare and Medicaid Services' (CMS) March 23, 2012 final rule to implement the ACA provisions relating to Medicaid eligibility, enrollment simplification and coordination. -- Kaiser Commission on Medicaid and the Uninsured (Source: Rural publications via the Rural Assistance Center)

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Consultation fee cut by CMS increased overall outpatient spending

Modern Medicine — Mon, 17 Dec 2012 05:00:00 +0100

A cut in consultation fees by the Centers for Medicare and Medicaid Services increased total outpatient spending in the first year after the policy change, but it did help close the payment gap between specialists and primary care physicians. (Source: Modern Medicine)

CMS proposal could ease payment path for oncology PET tracers

AuntMinnie.com Headlines — Fri, 14 Dec 2012 23:44:25 +0100

The U.S. Centers for Medicare and Medicaid Services (CMS) this week proposed (more) (Source: AuntMinnie.com Headlines)

Maryland health exchange wins federal approval

bizjournals.com Health Care:Physician Practices headlines — Tue, 11 Dec 2012 12:19:52 +0100

Maryland received conditional approval Monday for its health benefit exchange, a key step toward having the insurance marketplace up and running by federal deadlines in 2014. Maryland is among the first six states to receive approval from the Centers for Medicare and Medicaid Services. Federal approval is a milestone for the exchange and state leaders, who have made a point of making Maryland a trailblazer in implementing this federal health reform measure. (Source: bizjournals.com Health Care:Physician Practices headlines)

The National Direct Service Workforce (DSW) Resource Center

Rural web sites and other tools via the Rural Assistance Center — Mon, 10 Dec 2012 19:03:12 +0100

Supports recruitment and retention for professionals who work with the elderly and disabled. Includes resources such as recruitment and retention strategies, funding sources for those who promote direct care workforce development, training resources, state registries for direct service workers, a newsletter, and webinars. Includes a Rural Issues section. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

Health Homes

Rural web sites and other tools via the Rural Assistance Center — Fri, 07 Dec 2012 15:43:44 +0100

Discusses the Affordable Care Act of 2010, Section 2703, which created an optional Medicaid State Plan benefit for states to establish Health Homes to coordinate care for people with Medicaid who have chronic conditions by adding Section 1945 of the Social Security Act. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

Medicare Claims Processing Manual, Chapter 11: Processing Hospice Claims

Rural publications via the Rural Assistance Center — Thu, 06 Dec 2012 22:08:21 +0100

Discusses the process of billing and payment for hospice services under Medicare. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Medicare Benefit Policy Manual: Chapter 9 - Coverage of Hospice Services Under Hospital Insurance

Rural publications via the Rural Assistance Center — Thu, 06 Dec 2012 22:04:36 +0100

Describes what hospice services are covered by Medicare under hospital insurance. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Hospice Payment System: Payment System Fact Sheet Series

Rural publications via the Rural Assistance Center — Thu, 06 Dec 2012 20:51:43 +0100

Provides information about the Medicare hospice benefit. Discusses Medicare Part A, what is and what is not paid, certification requirements, election periods, how payment rates are set, and the 2013 hospice payment rates. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

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More Changes to the Reporting of Intraoperative Monitoring Services in 2013

American Academy of Neurology — Thu, 29 Nov 2012 22:53:00 +0100

A recent decision by the Centers for Medicare and Medicaid Services (CMS) will prevent neurologists from reporting more than one intraoperative monitoring case simultaneously. (Source: American Academy of Neurology)

Why the US Center for Medicare and Medicaid Services Should Not Extend Reimbursement Indications for Carotid Artery Angioplasty/Stenting

Angiology — Thu, 29 Nov 2012 05:00:00 +0100

(Source: Angiology)

New Transitional Care Management Codes to Benefit...

NurseZone.com Nursing News — Wed, 28 Nov 2012 06:07:24 +0100

November 20, 2012 - Recognizing the costs associated with hospital readmissions, the Centers for Medicare and Medicaid Services (CMS) has decided to reimburse physicians, nurse practitioners and other primary care professionals for “transitional care management” services, to more efficiently manage patients moving from one health care setting to another and prevent complications. (Source: NurseZone.com Nursing News)

Does Value-Based Purchasing Enhance Quality of Care and Patient Outcomes in the ICU?

Critical Care Clinics — Tue, 27 Nov 2012 18:48:01 +0100

As health care expenditures increase, payers, including the Centers for Medicare and Medicaid Services, are moving away from reimbursement based on types and volume of services to an emphasis on quality of provided care, an approach called value-based purchasing (VBP). Because it is tied to reimbursement, VBP creates economic motivation to measure and improve care. VBP is proceeding without high-level evidence supporting its effectiveness in improving health care quality. Rising health care costs, however, make VBP an attractive approach for curtailing costs and emphasizing improved quality, and VBP is likely to become a more prevalent mechanism of reimbursement for providers and facilities. (Source: Critical Care Clinics)

New Transitional Care Management Codes to Benefit Nurses

NurseZone.com Nursing News — Tue, 27 Nov 2012 06:00:50 +0100

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[News] Radiation oncology escapes drastic cuts to Medicare fees

The Lancet Oncology — Sat, 24 Nov 2012 13:04:47 +0100

Payments for radiation oncology under Medicare are to be cut by 7–9% from January, 2013, according to the Centers for Medicare and Medicaid Services. The 2013 Medicare Physician Fee Schedule sets out reductions of 7% for funding allocations for radiation oncology and 9% for radiation treatment centres, with cash redirected to primary care specialties. (Source: The Lancet Oncology)

Medicare to Pay for Transitional Care Management

NurseZone.com Nursing News — Wed, 21 Nov 2012 15:56:07 +0100

CMS awards up to $15B for data center

Healthcare IT News — Wed, 21 Nov 2012 14:58:10 +0100

The Centers for Medicare and Medicaid Services has awarded a 10-year contract valued at up to $15 billion to eight vendors to compete to build various aspects of a virtual datacenter, which will provide the agency’s IT infrastructure and services that operate its business systems and better safeguard its healthcare information. read more (Source: Healthcare IT News)

Spec sheets available for meaningful use

Healthcare IT News — Wed, 14 Nov 2012 15:16:23 +0100

The Centers for Medicare and Medicaid Services has added descriptive specification sheets for meaningful use Stage 2 to help eligible physicians and hospitals participate and complete the measures for the electronic health record incentive programs. read more (Source: Healthcare IT News)

What Factors Contribute to Successful Appeals of Nursing Homes' Deficiencies in the Informal Dispute Resolution Process?

Journal of the American Medical Directors Association — Thu, 08 Nov 2012 05:00:00 +0100

Discussion: Overall, 2.6% of deficiencies issued were overturned through the IDR process. Further study is required to determine the appropriateness of these overturned cases and the opportunities they offer to improve the survey process. (Source: Journal of the American Medical Directors Association)

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MU Nursing School receives $14.8 million for project to reduce re-hospitalizations

EurekAlert! - Medicine and Health — Mon, 05 Nov 2012 05:00:00 +0100

(University of Missouri-Columbia) The University of Missouri Sinclair School of Nursing today announced a nearly $15 million grant from the US Department of Health and Human Services Centers for Medicare and Medicaid Services. MU researchers will use the funds, distributed over four years, to implement a project aimed at reducing avoidable re-hospitalizations among nursing home residents. Insights gained from this project could provide a nationwide model for senior care and significantly reduce national health care spending. (Source: EurekAlert! - Medicine and Health)

AHA: Medicare Rule Irks Cardiologists

MedPage Today State Required CME — Sat, 03 Nov 2012 20:13:12 +0100

LOS ANGELES--The Centers for Medicare and Medicaid Services served up something for cardiologists gathering here to digest: a decision on the 2013 physician fee schedule gives primary care clinicians a pay raise and gives recognition to clinicians who follow guidelines when treating cardiovascular disease. (Source: MedPage Today State Required CME)

Medicare Sets 2013 Physician Fee Schedule

MedPage Today Public Health — Fri, 02 Nov 2012 11:13:20 +0100

WASHINGTON (MedPage Today) -- Family physicians will receive up to a 7% boost in Medicare payments in 2013, and other primary care providers will receive 3% to 5% more, under a final rule announced Thursday by the Centers for Medicare and Medicaid Services. (Source: MedPage Today Public Health)

The Impact of Hospital Readmission Penalties on Assisted Living

Geriatric Nursing — Fri, 02 Nov 2012 04:00:00 +0100

Starting October 1, 2012 the Centers for Medicare and Medicaid Services (CMS) began implementing financial penalties to hospitals for high readmission rates of patients discharged for heart attacks, heart failure and pneumonia. Although the penalties start at a relatively low 1% of a hospital's Medicare payments, they will eventually climb to 3%; a number that the federal government hopes will be high enough to provide a financial incentive to bring down high readmission rates among Medicare recipients. These new readmission penalties are the latest component of the Affordable Care Act to be implemented by CMS. (Source: Geriatric Nursing)