MedWorm: Centers for Medicare and Medicaid Services (CMS)

Surgical Outcomes-Based Measures Developed: Approval Marks Latest Step In Path To National Implementation

Health News from Medical News Today — Thu, 09 Feb 2012 09:00:00 +0100

Two outcomes-based measures from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) were recently endorsed by the National Quality Forum (NQF). The two measures, surgical site infection (SSI) and urinary tract infection (UTI), were developed by ACS in partnership with the Centers for Medicare and Medicaid Services (CMS), as possible national outcomes measures that could be adopted by the governmental body as early as 2015. "Increasingly, our national health system is looking for better ways to measure quality care... (Source: Health News from Medical News Today)

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Healthcare IT Expert Exposes Hidden Risks of Lawsuits Due to Electronic Health Record

Medical News (via PRIMEZONE) — Wed, 08 Feb 2012 16:08:00 +0100

DELRAY BEACH, Fla., Feb. 8, 2012 (GLOBE NEWSWIRE) -- Since the American Recovery and Reinvestment Act (ARRA) passed in February 2009 and caused a digital tsunami in the healthcare industry, physicians have been scrambling to comply with the requirement to switch to electronic health record systems. (EHRs) While many in the healthcare industry laud the use of EHRs to improve quality of care and analyzing patient outcomes, Dr. Sam Bierstock, founder of Champions In Healthcare, (www.sambierstock.com) points out significant concerns regarding increased vulnerability to medical legal claims that may result from the use of EHRs without major tort reform that would relieve physicians of an onslaught of malpractice suits. "EHRs unquestionably have the potential to improve patient safety and the...

Seizing Opportunities Under The Affordable Care Act For Transforming The Mental And Behavioral Health System [Mental Health]

Health Affairs — Wed, 08 Feb 2012 05:00:00 +0100

The Affordable Care Act, along with Medicaid expansions, offers the opportunity to redesign the nation’s highly flawed mental health system. It promotes new programs and tools, such as health homes, interdisciplinary care teams, the broadening of the Medicaid Home and Community-Based Services option, co-location of physical health and behavioral services, and collaborative care. Provisions of the act offer extraordinary opportunities, for instance, to insure many more people, reimburse previously unreimbursed services, integrate care using new information technology tools and treatment teams, confront complex chronic comorbidities, and adopt underused evidence-based interventions. The Centers for Medicare and Medicaid Services and its Center for Medicare and Medicaid Innovation shoul...

U-M Researchers Call for More Robust Electronic Health Record Data Sharing Capabilities

ICMCC: The International Council on Medical and Care Compunetics — Tue, 07 Feb 2012 16:44:08 +0100

Source: The Sacramento Bee Content: “U-M researchers are calling for the Centers for Medicare and Medicaid Services to encourage a more seamless exchange of information between electronic health records and immunization registries. This means the criteria by which doctors’ offices qualify for Meaningful Use incentive payments would include an emphasis on synchronizing electronic health records and [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

National Quality Forum endorses 2 American College of Surgeons NSQIP measures

EurekAlert! - Social and Behavioral Science — Tue, 07 Feb 2012 05:00:00 +0100

(Weber Shandwick Worldwide) Two outcomes-based measures from the American College of Surgeons National Surgical Quality Improvement Program were recently endorsed by the National Quality Forum. The two measures, surgical site infection and urinary tract infection, were developed by ACS in partnership with the Centers for Medicare and Medicaid Services, as possible national outcomes measures that could be adopted by the governmental body as early as 2015. (Source: EurekAlert! - Social and Behavioral Science)

AMCP objects to proposed reporting requirements for Part D

Drug Topics - Top News — Thu, 02 Feb 2012 05:00:00 +0100

The Academy of Managed Care Pharmacy is not pleased with changes to the Medicare Part D reporting requirements proposed by the Centers for Medicare and Medicaid Services. (Source: Drug Topics - Top News)

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CMS's Final Regulations on Accountable Care Organizations

The Heritage Foundation Papers: Health Care — Wed, 01 Feb 2012 21:59:00 +0100

The Centers for Medicare and Medicaid Services (CMS) has issued final regulations for Accountable Care Organizations (ACOs). The outcome is disappointing (Source: The Heritage Foundation Papers: Health Care)

Patient and hospital characteristics associated with traditional measures of inpatient quality of care for patients with heart failure

American Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

Background: The purpose of this study was to determine patient and hospital characteristics associated with 4 measures of quality of inpatient heart failure care used by both the primary payer of heart failure care in the United States (Center for Medicare and Medicaid Services) and the main hospital accrediting organization (The Joint Commission).Methods: We used data from Get With The Guidelines Program for patients hospitalized with heart failure. Eligibility for receiving care based on the Center for Medicare and Medicaid Services performance measures was determined for assessment of left ventricular ejection fraction (LVEF; n = 60,601), use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) if LVEF (Source: American Heart Journal)

Wide Use of Doc ID Numbers Makes Fraud Easy

MedPage Today Public Health — Tue, 31 Jan 2012 21:23:30 +0100

(MedPage Today) -- Widespread distribution of physician identifiers makes it easy to fraudulently bill insurers in the doctor's name, two MDs who work at the Centers for Medicare and Medicaid Services charged. (Source: MedPage Today Public Health)

How Safe Are Our Hospitals?

RWJF News Digest - Quality/Equality — Mon, 30 Jan 2012 18:29:42 +0100

Centers for Medicare and Medicaid Services’ website, Hospital Compare, began reporting patient safety ratings for thousands of the nation’s hospitals, including those in the Washington area, in October 2011. (Source: RWJF News Digest - Quality/Equality)

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Frequently Asked Questions Section 6411(a) of the Affordable Care Act

Rural web sites and other tools via the Rural Assistance Center — Mon, 30 Jan 2012 14:43:55 +0100

Collection of common questions covering general information on the Medicaid RAC (Recovery Audit Contractor) and operational guidance to States. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

State Medicaid RACs At-A-Glance

Rural web sites and other tools via the Rural Assistance Center — Mon, 30 Jan 2012 14:39:03 +0100

Map summarizes the status of each state and territory RAC program, based on the information submitted in its Medicaid State Plan Amendment (SPA.) During the implementation phase of these RAC programs, this website will be updated on an ongoing basis. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

More Data Needed on Carotid AtherosclerosisMore Data Needed on Carotid Atherosclerosis

Medscape Today Headlines — Fri, 27 Jan 2012 22:31:15 +0100

The Centers for Medicare and Medicaid Services' Medicare Evidence Development and Coverage Advisory Committee met to once again discuss the latest available evidence on different treatments of carotid atherosclerosis, and the only clear message was these questions remain a moving target. Heartwire (Source: Medscape Today Headlines)

Physician fee schedule rate change delayed

Modern Medicine — Wed, 25 Jan 2012 05:00:00 +0100

The Centers for Medicare and Medicaid Services (CMS) released the final rule for its physician fee schedule November 1 and stated that providers would see an across-the-board reduction of 27.4% for services in 2012, but much is still unclear about this change. (Source: Modern Medicine)

Medicare Panel to Consider Carotid Therapy Evidence

MedPage Today State Required CME — Tue, 24 Jan 2012 18:43:12 +0100

WASHINGTON (MedPage Today) -- The Centers for Medicare and Medicaid Services (CMS) is seeking information on which carotid atherosclerosis treatments work best to prevent stroke and death in Medicare patients. (Source: MedPage Today State Required CME)

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Why the United States Center for Medicare and Medicaid Services should not extend reimbursement indications for carotid artery angioplasty/stenting.

Vascular — Mon, 23 Jan 2012 05:00:00 +0100

Authors: Abbott AL, Adelman MA, Alexandrov AV, Barnett HJ, Beard J, Bell P, Björck M, Blacker D, Buckley CJ, Cambria RP, Comerota AJ, Connolly ES, Davies AH, Eckstein HH, Faruqi R, Fraedrich G, Gloviczki P, Hankey GJ, Harbaugh RE, Heldenberg E, Kittner SJ, Kleinig TJ, Mikhailidis DP, Moore WS, Naylor R, Nicolaides A, Paraskevas KI, Pelz DM, Prichard JW, Purdie G, Ricco JB, Riles T, Rothwell P, Sandercock P, Sillesen H, Spence JD, Spinelli F, Tan A, Thapar A, Veith FJ, Zhou W PMID: 22271806 [PubMed - as supplied by publisher] (Source: Vascular)

Is U.S. Health Spending Finally Under Control?

RWJF News Digest - Quality/Equality — Sat, 21 Jan 2012 14:54:20 +0100

“Growth in U.S. health spending remains slow in 2010” was the headline of a news release on Jan. 9 by the Centers for Medicare and Medicaid Services, part of the Department of Health and Human Services. (Source: RWJF News Digest - Quality/Equality)

CWF president argues with feds over healthcare spending

Healthcare IT News — Fri, 20 Jan 2012 15:05:40 +0100

Karen Davis, president of the Commonwealth Fund and a nationally recognized economist, has a bone to pick with the federal government's recent report on U.S. healthcare spending. Growth in U.S. health spending remained slow in 2010 and the health share of the gross domestic product was unchanged from 2009, the Centers for Medicare and Medicaid Services reported. read more (Source: Healthcare IT News)

14 senators express concern about limits on Medicaid generic drug reimbursements

Drug Topics - Pharmacy News — Wed, 18 Jan 2012 05:00:00 +0100

Fourteen U.S. senators recently expressed their concerns with the Centers for Medicare and Medicaid Services’ proposed Federal Upper Limits for Medicaid generic drug reimbursements. (Source: Drug Topics - Pharmacy News)

CMS awards $2.5 billion for meaningful use in 2011

Modern Medicine — Wed, 18 Jan 2012 00:35:50 +0100

The Centers for Medicare and Medicaid Services gave $2.5 billion to doctors and hospitals in 2011 for using EHR systems. Find out what the bonus recipients have in common. (Source: Modern Medicine)

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14 senators express concern about limits on Medicaid generic drug reimbursements

Drug Topics - Top News — Tue, 17 Jan 2012 05:00:00 +0100

Growth in Health Spending Nears Record-Low Rate

MedPage Today Campaign '08 — Mon, 09 Jan 2012 20:00:00 +0100

WASHINGTON (MedPage Today) -- Healthcare spending grew slowly in 2010 -- at a rate of 3.9% -- in part because high unemployment and reduced household income led people to scrimp on doctors' visits and medications, new data from the Centers for Medicare and Medicaid Services show. (Source: MedPage Today Campaign '08)

Weak Economy Curbs U.S. Health Spending

RWJF News Digest - Public Health — Mon, 09 Jan 2012 05:00:00 +0100

The Centers for Medicare and Medicaid Services reports that total health spending in the U.S. increased by 3.9 percent in 2010, just a notch above the slowest rate since the government started keeping track — 3.8 percent in 2009. (Source: RWJF News Digest - Public Health)

Medicare Advantage Chronic Special Needs Plan Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients [Medical Management & Care]

Health Affairs — Mon, 09 Jan 2012 05:00:00 +0100

The Affordable Care Act of 2010 authorized the continued availability of Medicare Advantage Chronic Condition Special Needs Plans (C-SNPs). This case study examines the model of care used by the largest such plan, Care Improvement Plus, and compares utilization rates among its diabetes patients with those of other beneficiaries enrolled in fee-for-service Medicare in the same five states. This special-needs plan emphasizes direct contacts with patients to help identify gaps in care and promote primary and preventive health care. The comparative analysis indicates that people with diabetes in the special-needs plan—particularly nonwhite beneficiaries—had lower rates of hospitalization and readmission than their peers in fee-for-service Medicare. For example, risk-adjusted hospit...

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UofL geriatrician selected for new federal Innovation Advisors Program

EurekAlert! - Social and Behavioral Science — Fri, 06 Jan 2012 05:00:00 +0100

(University of Louisville) Christian Davis Furman, M.D., M.S.P.H., vice chair for geriatric medicine in the Department of Family and Geriatric Medicine at the University of Louisville, has been selected for the Centers for Medicare and Medicaid Services' Innovation Advisors Program. She is the only Kentuckian among the 73 individuals from 27 states and the District of Columbia selected to participate. (Source: EurekAlert! - Social and Behavioral Science)

MPPR Policy Applied to Professional Component in 2012

American College of Radiology — Thu, 05 Jan 2012 19:07:00 +0100

The Centers for Medicare and Medicaid Services (CMS) will begin applying its Multiple Procedure Payment Reduction (MPPR) policy to the professional component (PC) of certain diagnostic imaging services (computed tomography, magnetic resonance imaging, and ultrasound). (Source: American College of Radiology)

Medicare pushes home visits with new program

Modern Medicine — Thu, 05 Jan 2012 05:00:00 +0100

Everything old is new again. Primary care physicians and nurse practitioners could receive a financial bonus this year from the Centers for Medicare and Medicaid Services for visiting patients with several chronic conditions in their homes under a demonstration program. (Source: Modern Medicine)

Groups oppose CMS' LTC consultant pharmacists proposal

Drug Topics - Legal News — Thu, 05 Jan 2012 05:00:00 +0100

Pharmacists groups strongly oppose the Centers for Medicare and Medicaid Services? proposal to require long-term care (LTC) facilities to contract solely with consultant pharmacists who have no affiliation with any in-facility LTC pharmacy, pharmaceutical manufacturer, or drug wholesaler. (Source: Drug Topics - Legal News)

Why the United States Center for Medicare and Medicaid Services (CMS) Should not Extend Reimbursement Indications for Carotid Artery Angioplasty/Stenting.

PubMed: Eur J Vasc Endovasc ... — Thu, 05 Jan 2012 05:00:00 +0100

Authors: Abbott AL, Adelman MA, Alexandrov AV, Barnett HJ, Beard J, Bell P, Björck M, Blacker D, Buckley CJ, Cambria RP, Connolly ES, Comerota AJ, Davies AH, Eckstein HH, Faruqi R, Fraedrich G, Gloviczki P, Hankey GJ, Harbaugh RE, Heldenberg E, Kittner SJ, Kleinig TJ, Mikhailidis DP, Moore WS, Naylor R, Nicolaides A, Paraskevas KI, Pelz DM, Prichard JW, Purdie G, Ricco JB, Riles T, Rothwell P, Sandercock P, Sillesen H, Spence JD, Spinelli F, Tan A, Thapar A, Veith FJ, Zhou W PMID: 22226698 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

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Healthcare Professionals Selected for the New Innovation Advisors Program to Improve Care for Patients

News stories via the Rural Assistance Center — Wed, 04 Jan 2012 15:52:31 +0100

The Centers for Medicare and Medicaid Services (CMS) has announced that it has selected 73 individuals from 27 States and the District of Columbia for its Innovation Advisors program who will work with the CMS Innovation Center to test new models of care delivery in their own organizations and communities. (Source: News stories via the Rural Assistance Center)

ACR Comments to CMS Regarding MPPR and Other Provisions in the Physician Fee Schedule Final Rule

American College of Radiology — Wed, 04 Jan 2012 12:26:00 +0100

The American College of Radiology (ACR) submitted official comments the Centers for Medicare and Medicaid Services' (CMS regarding the final rule of the Medicare Physician Fee Schedule. (Source: American College of Radiology)

Merz Pharmaceuticals Receives J-Code For Xeomin® (incobotulinumtoxinA)

Pharmaceutical Online News — Wed, 04 Jan 2012 05:35:00 +0100

Merz Pharmaceuticals, LLC, today announced that the Centers for Medicare and Medicaid Services (CMS) has assigned a product-specific Healthcare Common Procedure Coding System (HCPCS) billing code, J0588 "INJECTION, INCOBOTULINUMTOXIN A, 1 UNIT" for Xeomin® (incobotulinumtoxinA), effective beginning January 1, 2012. (Source: Pharmaceutical Online News)

New code, reimbursement for osmolarity test

Modern Medicine — Wed, 04 Jan 2012 05:00:00 +0100

The Centers for Medicare and Medicaid Services has published instructions for updates to the clinical laboratory fee schedule for 2012, including a revised reimbursement rate for an osmolarity test (TearLab Osmolarity Test, TearLab Corp.) effective Jan. 1. (Source: Modern Medicine)

Groups oppose CMS' LTC consultant pharmacists proposal

Drug Topics - Top News — Tue, 03 Jan 2012 05:00:00 +0100

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Update on Accountable Care Organizations

PM and R — Sun, 01 Jan 2012 05:00:00 +0100

Since the publication of the article “What are the Implications of Accountable Care Organizations for Physical Medicine and Rehabilitation Practices?” in the November 2011 issue of PM&R, the Centers for Medicare and Medicaid Services (CMS) has issued the final rule for the Medicare Shared Savings Program Initiative that covers Accountable Care Organizations (ACOs). The final rule published in the November Federal Register contains what many consider significant changes to the initially proposed rule []. Because these modifications result in reduced burden and cost for groups to participate, there may be a renewed interest for many groups to form or enroll in an ACO. (Source: PM and R)

The Physician Payments Sunshine Act

Clinical Endocrinology News — Sun, 01 Jan 2012 05:00:00 +0100

, a provision of the Affordable Care Act, aims to bring transparency to the practice of pharmaceutical and device companies providing meals, gifts, and payments to physicians. It requires that these companies, as well as biologic manufacturers and medical suppliers, report any “payment or other transfer of value” of $10 or greater to physicians and teaching hospitals. The manufacturer must report alltpayments to a single physician if they reach $100 in aggregate value for a year. The Centers for Medicare and Medicaid Services released a proposed ruleonn December 2011 outlining how the disclosures would work. Drug and device manufacturers can hold off collecting information until the CMS issues a final rule later this year. Sine agency predicted that the first reports required under the...

Medicare Punished One in Four DME Suppliers

MedPage Today Public Health — Thu, 29 Dec 2011 17:00:00 +0100

WASHINGTON (MedPage Today) -- More than one-quarter of all durable medical equipment suppliers faced enforcement actions by the Centers for Medicare and Medicaid Services during their first year of Medicare participation, according to a new report from the Office of the Inspector General. (Source: MedPage Today Public Health)

BadgerCare receives $24.5 million bonus

bizjournals.com Health Care:Biotechnology headlines — Thu, 29 Dec 2011 16:25:02 +0100

Wisconsin received a $24.5 million “performance bonus” from the federal Centers for Medicare and Medicaid Services, recognizing the state’s success in covering uninsured children. To qualify for these bonus payments, states had to surpass a specified Medicaid enrollment target. They also must adopt procedures that improve access to Medicaid and the Children’s Health Insurance Program (CHIP), making it easier for eligible children to enroll and retain coverage. Wisconsin is one of 23 states to share over $296 million in Federal performance bonuses this year... (Source: bizjournals.com Health Care:Biotechnology headlines)

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Version 5010

Rural web sites and other tools via the Rural Assistance Center — Thu, 29 Dec 2011 14:34:27 +0100

Explains what Version 5010 is all about. Presents fact sheets, resources, timeline, and email updates regarding Version 5010, the revised set of HIPAA transaction standards that will replace the current version in 2012. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

McKenzie County Memorial Hospital first in state to receive Medicare funding for use of EHRs

Healthcare IT News Press Releases — Thu, 29 Dec 2011 13:30:39 +0100

McKenzie County Healthcare Systems (MCHS) today announced that McKenzie County Memorial Hospital is the first hospital in North Dakota to qualify for Medicare reimbursements for using a certified electronic health record (EHR). McKenzie County Healthcare Systems will receive the reimbursement from the Centers for Medicare and Medicaid Services EHR Incentive Program. read more (Source: Healthcare IT News Press Releases)

Meaningful use will change how you practice

Modern Medicine — Sun, 25 Dec 2011 05:00:00 +0100

With the final ruling on electronic health record incentive programs established in July 2010, the Centers for Medicare and Medicaid Services established financial incentives for providers who engage in "meaningful use of certified EHR technology" and beginning in 2015, will impose penalties on providers who do not. (Source: Modern Medicine)

Proposed Rules for Physician Payment Sunshine Act

Pharma Marketing News — Wed, 21 Dec 2011 12:25:33 +0100

This article reviews the strategic implications of the Sunshine Act and also presents highlights of the draft regulations rule released by the Centers for Medicare and Medicaid Services on December 15, 2011. (Source: Pharma Marketing News)

The Academy Of Nutrition And Dietetics Advocates For Expanded Nutritional Coverage Under Medicare

Health News from Medical News Today — Wed, 21 Dec 2011 08:00:00 +0100

The Academy of Nutrition and Dietetics has prepared a request to submit to the Centers for Medicare and Medicaid Services (CMS) to expand coverage of medical nutrition therapy (MNT) for specific diseases, including hypertension, obesity, and cancer, as part of the CMS National Coverage Determination (NCD) Process. Most chronic health conditions can be controlled or treated with medical nutrition therapy, yet Medicare will only reimburse nutrition therapy services provided by a registered dietitian for individuals with diabetes and renal disease... (Source: Health News from Medical News Today)

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CMS wants to post pharma, device payments to doctors

Modern Medicine — Wed, 21 Dec 2011 05:00:00 +0100

The fees you collect from pharmaceutical or device companies for consulting, speaking, or research could be posted on the Web as soon as 2013 if a proposed rule is finalized by the Centers for Medicare and Medicaid Services. (Source: Modern Medicine)

New Pathways to Medicare Coverage for Innovative PET Radiopharmaceuticals: Report of a Medical Imaging & Technology Alliance (MITA) Workshop

Journal of the American College of Radiology : JACR — Wed, 21 Dec 2011 05:00:00 +0100

PET and PET/CT have revolutionized the diagnosis, staging, and monitoring of treatment effect or recurrence for a wide range of cancers and shown promise for improving health outcomes for patients with cardiovascular and central nervous system diseases. However, this technology is challenged by insurance coverage policies that hinder patients' access to PET and discourage technologic innovation. Recently, the Medical Imaging & Technology Alliance (MITA), a Washington-based industry association, convened a workshop to consider new pathways for making decisions on Medicare coverage of new PET radiopharmaceuticals and imaging procedures that are currently subject to a national noncoverage decision, or “exclusionary rule.” Stakeholders from the government, medical professional societies, a...

CMS inaction leaves system holes for fraud, abuse

bizjournals.com Health Care:Hospitals headlines — Tue, 20 Dec 2011 18:30:04 +0100

A Department of Health and Human Services audit report found that the Centers for Medicare and Medicaid Services did not act on 77 percent of vulnerabilities reported by program safeguard contractors, zone program integrity contractors and Medicare drug integrity contractors, FierceHealthcare reported. Contractors' analysis of one-third of the vulnerabilities finds that inaction could cost $1.2 billion. (Source: bizjournals.com Health Care:Hospitals headlines)

Evaluation of quality of life over time among 453 patients with hyperhidrosis submitted to endoscopic thoracic sympathectomy

Journal of Vascular Surgery — Mon, 19 Dec 2011 23:06:57 +0100

CPT code 64818 denotes “lumbar sympathectomy.” The code description is fairly generic and is therefore appropriate to report such an operation done through either an open surgical (eg, a retroperitoneal exposure) or a laparoscopic approach. A 90-day associated global period has been assigned by the Centers for Medicare and Medicaid Services (CMS). The sympathetic chain is often divided during aortic surgery for aneurysm or occlusive disease. Remember that if the procedure is done either by accident or purposefully at the time of aortic reconstruction, it is not separately reimbursable and remains bundled with the bypass code description. The introductory wording to the “Arteries and Veins” section of the CPT manual specifically states “Sympathectomy, when done, is included in the...

Seton chosen for national Medicare pilot study

bizjournals.com Health Care:Biotechnology headlines — Mon, 19 Dec 2011 21:23:53 +0100

The Centers for Medicare and Medicaid Services have selected Seton Healthcare Family for an Accountable Care Organization pilot study. Seton is partnering with Austin Regional Clinic to create Seton Health Alliance, an ACO, that will enroll 11,000 Central Texans on Medicare. Seton was one of 32 health care providers nationally selected by CMS to participate in the pilot program. Tarrant County North Texas Specialty Physicians was the only other Texas provider selected for the program. Chris Hartle, president and CEO of Seton Insurance Services, said the contract with CMS will begin Jan... (Source: bizjournals.com Health Care:Biotechnology headlines)

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CMS will not apply MPPR to group practices in 2012

AuntMinnie.com Headlines — Mon, 19 Dec 2011 17:59:29 +0100

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

CMS Multiple Procedure Payment Reduction Not Happening Jan. 1

Diagnostic Imaging — Mon, 19 Dec 2011 12:00:00 +0100

The Centers for Medicare and Medicaid Services will not apply in 2012 the professional component Multiple Procedure Payment Reduction (MPPR) for imaging services performed by separate physicians in the same group practice, the American College of Radiology announced Sunday. This decision will affect both office and hospital practices. (Source: Diagnostic Imaging)

The Academy of Nutrition and Dietetics advocates for expanded nutritional coverage under Medicare

EurekAlert! - Medicine and Health — Mon, 19 Dec 2011 05:00:00 +0100

(Elsevier Health Sciences) Academy of Nutrition and Dietetics has prepared a request to submit to the Centers for Medicare and Medicaid Services to expand coverage of medical nutrition therapy for specific diseases, including hypertension, obesity, and cancer, as part of the CMS National Coverage Determination Process. Most chronic health conditions can be controlled or treated with medical nutrition therapy, yet Medicare will only reimburse nutrition therapy services provided by a registered dietitian for individuals with diabetes and renal disease. (Source: EurekAlert! - Medicine and Health)

UCSD Center For Transplantation VAD Therapy Approved

Health News from Medical News Today — Fri, 16 Dec 2011 09:00:00 +0100

The Joint Commission (TJC) has approved UC San Diego Health System's Disease-Specific Care (DSC) Certification for Ventricular Assist Device (VAD). Hospitals performing VAD as a "destination therapy" (for permanent use) receive a certification of distinction and receive reimbursement from Centers for Medicare and Medicaid Services (CMS)... (Source: Health News from Medical News Today)

CMS Gives Industry More Time on Sunshine Rule

MedPage Today Geriatrics — Thu, 15 Dec 2011 22:24:10 +0100

WASHINGTON (MedPage Today) -- The Centers for Medicare and Medicaid Services has pushed back the deadline by which drug and device makers must begin the process of reporting financial relationships with doctors and teaching hospitals. (Source: MedPage Today Geriatrics)

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CMS Coverage Reaffirmed For ZOLL LifeVest Wearable Defibrillator

Medical Design Online News — Thu, 15 Dec 2011 15:32:00 +0100

ZOLL Medical Corporation, a manufacturer of medical devices and related software solutions, announced today that the Centers for Medicare and Medicaid Services (CMS) Durable Medical Equipment Medical Administrative Contractors (DME MACs) reaffirmed the current coverage policy across all indications for the LifeVest Wearable Defibrillator (Source: Medical Design Online News)

PCMH-related expenses counted toward payers' medical loss ratio

Modern Medicine — Wed, 14 Dec 2011 05:00:00 +0100

Health insurance plans now are required to pay at least 80% of their members’ premiums on your fees and for the medications you prescribe, according to a final regulation issued by the Centers for Medicare and Medicaid Services in December. The good news for primary care physicians is that financial incentives for care coordination or meeting payer quality benchmarks can be counted toward the health plans’ medical loss ratio. So, if you’re collecting a payer bonus for care quality, it likely will continue. (Source: Modern Medicine)

Medicare to reimburse for obesity screening and counseling

Modern Medicine — Wed, 14 Dec 2011 05:00:00 +0100

The Centers for Medicare and Medicaid Services will reimburse you for preventive obesity screenings and counseling, but the agency has not instructed its contractors on how these services are to be billed and paid. (Source: Modern Medicine)

Prescriptions Blog: Final Rules Set for Insurers on Spending Ratios

NYT Health — Mon, 12 Dec 2011 18:32:38 +0100

The industry did not get an exemption for brokers' fees under the regulations for how much of a customer's premium must be spent on medical care. (Source: NYT Health)

Incidence and risk factors for progressive multifocal leukoencephalopathy among patients with selected rheumatic diseases

Arthritis Care and Research — Mon, 12 Dec 2011 05:00:00 +0100

AbstractWe conducted a large, population‐based study to describe the incidence and risk factors for progressive multifocal leukoencephalopathy (PML) among patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), psoriasis (PsO), juvenile idiopathic arthritis (JIA), inflammatory bowel disease (IBD), and ankylosing spondylitis (AS) using national inpatient and outpatient administrative data from the entire Center for Medicare and Medicaid Services (CMS) from 2000‐2009. Suspected PML cases were identified using hospital discharge diagnosis codes. Risk factors for PML were evaluated using outpatient data >= 6 months prior to PML diagnosis.Among 2,030,578 patients with autoimmune diseases of interest, a total of 53 PML cases were identified (2.6/100,000 patients). Most PML cas...

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Pay-for-Performance Spotlight: OB/GYN Hosts Competition among Practices

BWH News — Mon, 12 Dec 2011 00:00:00 +0100

Through the Centers for Medicare and Medicaid Services, the Health Information Technology for Economic and Clinical Health Act (HITECH) provides clinicians and hospitals with a financial incentive for “meaningful use” of electronic health records. (Source: BWH News)

States offering dual-eligibility demonstration projects

Modern Medicine — Sat, 10 Dec 2011 05:00:00 +0100

Thirty-seven states and the District of Columbia have answered a call from the Centers for Medicare and Medicaid Services to participate in demonstration projects to improve health outcomes for beneficiaries. (Source: Modern Medicine)

Our Health Care Spending, in One Map

News stories via the Rural Assistance Center — Fri, 09 Dec 2011 06:00:00 +0100

Washington Post, (DC) article gives the findings from a new, decade-long review of state health care spending published Wednesday by the Center for Medicare and Medicaid Services. (Source: News stories via the Rural Assistance Center)

Meaningful Use Webinar

Midcontinental Region News — Wed, 07 Dec 2011 22:16:55 +0100

Join in Tuesday December 13, 2011, @ noon MT for a free webinar - “Tips for Overcoming the Gray Areas of Meaningful Use Stage 1 for Safety Net Providers.” This webinar provides tips and guidance of how safety net providers, such as health centers, critical access hospitals, and rural health clinics can overcome common gray areas of meeting Meaningful Use Stage 1 objectives. Gray areas are objectives within the final rule that are still not clear to providers. Presenters include staff from both the Centers for Medicare and Medicaid Services and Regional Extension Centers. Questions to presenters are welcome ahead of the event and may be emailed to healthit@hrsa.gov. To register: http://webcast.streamlogics.com/audience/index.asp?eventid=84138124. [da] (Source: Midc...

Disparities in Provision of Transplant Information Affect Access to Kidney Transplantation

American Journal of Transplantation — Wed, 07 Dec 2011 05:00:00 +0100

Recently Centers for Medicare and Medicaid Services (CMS) began asking providers on Form‐2728 whether they informed patients about transplantation, and if not, to select a reason. The goals of this study were to describe national transplant education practices and analyze associations between practices and access to transplantation (ATT), based on United States Renal Data System (USRDS) data from 2005 to 2007. Multinomial logistic regression was used to examine factors associated with not being informed about transplantation, and modified Poisson regression to examine associations between not being informed and ATT (all models adjusted for demographics/comorbidities). Of 236 079 incident end‐stage renal disease (ESRD) patients, 30.1% were not informed at time of 2728 filing, for reason...

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Medicare Covers Screening and Counseling For Obesity

Diabetes News from dLife.com — Tue, 06 Dec 2011 20:32:52 +0100

November 28, 2011 (Centers for Medicare and Medicaid Services) — Decision adds a new preventive service for Medicare beneficiaries. read more (Source: Diabetes News from dLife.com)

Program Allows CMS to Audit 'Appropriate Use' of ProceduresProgram Allows CMS to Audit 'Appropriate Use' of Procedures

Medscape Today Headlines — Mon, 05 Dec 2011 22:31:42 +0100

Some have long been warning that if cardiologists don't police their own procedure appropriateness, someone else was going to step in and do it for them. Now, it seems, that someone is going to be the Centers for Medicare and Medicaid Services. Heartwire (Source: Medscape Today Headlines)

Parting Shot at ‘Waste’ By Key Obama Health Official

NYT — Mon, 05 Dec 2011 20:00:06 +0100

Dr. Donald M. Berwick, in charge of Medicare and Medicaid for the last 17 months, said that 20 percent to 30 percent of health spending is “waste” that yields no benefit. (Source: NYT)

Now Departed From The Centers For Medicare And Medicaid Services, Berwick Receives High Marks For His Tenure At Agency [Report From The Field]

Health Affairs — Mon, 05 Dec 2011 05:00:00 +0100

(Source: Health Affairs)

Dr. Berwick leaves the Centers for Medicare and Medicaid Services

About.com Pediatrics — Sun, 04 Dec 2011 18:24:32 +0100

The administrator of the Centers for Medicare and Medicaid Services, Donald M. Berwick, MD, stepped down the other day, as his temporary recess appointment was about to expire. Dr. Berwick, a pediatrician, listed five causes of wasteful health spending as he left office, including:...Read Full Post (Source: About.com Pediatrics)

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Parting Shot at ‘Waste’ By Key Obama Health Official

NYT Health — Sat, 03 Dec 2011 20:00:28 +0100

Dr. Donald M. Berwick, in charge of Medicare and Medicaid for the last 17 months, said that 20 percent to 30 percent of health spending is “waste” that yields no benefit. (Source: NYT Health)

Stents, ICDs, inappropriate? Then, under new audit program, CMS won't pay

theHeart.org — Sat, 03 Dec 2011 19:20:29 +0100

CGI to build health insurance exchange for CMS

bizjournals.com Health Care:Pharmaceuticals headlines — Thu, 01 Dec 2011 18:42:52 +0100

As the Affordable Care Act expands in 2012, CGI Federal Inc. will build the government’s facilitated health insurance exchange for the Centers for Medicare and Medicaid Services under a five-year contract that has an estimated total value of $93.7 million, Washington Technology reported. CGI has received the initial $55.7 million base contract from CMS’ Center for Consumer Information and Insurance Oversight to build the government-mandated Federal Exchange. (Source: bizjournals.com Health Care:Pharmaceuticals headlines)

Provider groups file lawsuit against DHCS, HHS over Medicaid program cuts

Drug Topics - Legal News — Thu, 01 Dec 2011 05:00:00 +0100

Pharmacy and medical groups are suing the California Department of Health Care Services and the U.S. Department of Health and Human Services over the Centers for Medicare and Medicaid Services’ recent approval of a 10% reimbursement rate cut in California’s Medicaid program. (Source: Drug Topics - Legal News)

Medicare Offers Co-Pay–Free Obesity Counseling

Clinical Endocrinology News — Thu, 01 Dec 2011 05:00:00 +0100

Medicare beneficiaries can now receive co-payment–free screening and counseling for obesity under a new benefit created through the Affordable Care Act. The Centers for Medicare and Medicaid Services has announced the addition of intensive behavioral therapy for obesity as a preventive service to be offered to Medicare beneficiaries without cost sharing, effective immediately. (Source: Clinical Endocrinology News)

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Prescriptions Blog: A Look at Berwick's Tenure as Medicare Chief

NYT Health — Wed, 30 Nov 2011 21:25:32 +0100

Health Affairs offers a retrospective on Dr. Donald Berwick, who is leaving his post as head of the Centers for Medicare and Medicaid Services. (Source: NYT Health)

Obesity Counseling - Medicare To Add Coverage

Health News from Medical News Today — Wed, 30 Nov 2011 20:00:00 +0100

Medicare beneficiaries will be able to get coverage for preventive obesity counseling, CMS (Centers for Medicare and Medicaid Services) announced today. The CMS says this is part of the widening range of preventive services CMS has been adding to its coverage since the signing of the Affordable Care Act. Covering the costs for preventive obesity counseling complements the Million Hearts initiate, CMS explained in a communiquÃ©. CMS Administrator Donald M. Berwick, MD... (Source: Health News from Medical News Today)

5010 compliance: You get 90-day reprieve

Modern Medicine — Wed, 30 Nov 2011 05:00:00 +0100

If your office isn’t prepared to submit claims using version 5010 electronic transaction standards, take a breath but keep on working. With so many of your fellow physicians in the same position, the Centers for Medicare and Medicaid Services has decided to wait until March 31 to begin enforcing adherence to the standards. Some caveats apply, however. (Source: Modern Medicine)

Now Departed From The Centers For Medicare And Medicaid Services, Berwick Receives High Marks For His Tenure At Agency [Web First]

Health Affairs — Wed, 30 Nov 2011 05:00:00 +0100

(Source: Health Affairs)

Don Berwick, Martyr for Socialized Medicine

Forbes.com Healthcare News — Tue, 29 Nov 2011 15:27:12 +0100

I have a piece up at National Review in which I reflect upon Don Berwick’s controversial tenure as Administrator of the Centers for Medicare and Medicaid Services, the 800-billion-dollar federal agency that dominates the American health-care landscape. Despite White House rhetoric to the contrary, I write, Berwick “wasn’t done in by Republican intransigence. He was done in by presidential cowardice. And therein lies a microcosm of everything that’s been wrong with Obamacare.” (Source: Forbes.com Healthcare News)

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Provider groups file lawsuit against DHCS, HHS over Medicaid program cuts

Drug Topics - Top News — Tue, 29 Nov 2011 05:00:00 +0100

CGI will build online health info system for CMS

bizjournals.com Health Care:Pharmaceuticals headlines — Mon, 28 Nov 2011 18:30:04 +0100

CGI Federal Inc. will develop a consumer information system for the Centers for Medicare and Medicaid Services under a two-year contract worth $8.9 million, Washington Technology reported. The award calls for the U.S. operating subsidiary of CGI Group Inc. to design, develop and implement the CMS Center for Consumer Information and Insurance Oversight’s Rate and Benefits Information System, which collects rate and benefits data from health insurance providers. (Source: bizjournals.com Health Care:Pharmaceuticals headlines)

Medicare Dec. 7th Open Enrollment Deadline Nears

News stories via the Rural Assistance Center — Mon, 28 Nov 2011 06:00:00 +0100

As the December 7th deadline grows closer for people with Medicare to change or choose their drug and health plan coverage for next year, the Centers for Medicare and Medicaid Services and its network of partners and advocates are available to assist with counseling and enrolling beneficiaries on their choices for 2012. (Source: News stories via the Rural Assistance Center)

Statement On Dr. Donald Berwick's Departure As Administrator Of The Centers For Medicare And Medicaid Services

Health News from Medical News Today — Sat, 26 Nov 2011 08:00:00 +0100

Donald Berwick, MD, MPP, the departing CMS Administrator, brought his deep expertise and vision for health care improvement to all he did at CMS. We thank him for his leadership there, in particular the role he played in helping shape the Medicare Shared Savings Program, Accountable Care Organizations regulatory framework. Dr. Berwick has been a friend to medical groups and the high standards of care which they practice and espouse. While Dr. Berwick will be leaving the Federal health care stage, he will not be exiting from the arena and we wish him well... (Source: Health News from Medical News Today)

Tavenner to Replace Berwick at CMS Helm

News stories via the Rural Assistance Center — Fri, 25 Nov 2011 06:00:00 +0100

Kaiser Health News article reports that Marilyn Tavenner, who has an extensive health background as a nurse, a health care official at both the state and federal level and a hospital chain executive, was tapped by President Barack Obama Wednesday to succeed Dr. Donald M. Berwick as administrator of the Centers for Medicare and Medicaid Services (Source: News stories via the Rural Assistance Center)

Donald Berwick Resigns as Head of CMSDonald Berwick Resigns as Head of CMS

Medscape Today Headlines — Wed, 23 Nov 2011 21:07:31 +0100

The advocate for patient safety will have served only 17 months as the head of the Centers for Medicare and Medicaid Services (CMS); Republicans had denied him Senate confirmation. Medscape Medical News (Source: Medscape Today Headlines)

Obama Taps Tavenner to Run CMS

MedPage Today Public Health — Wed, 23 Nov 2011 18:24:38 +0100

WASHINGTON (MedPage Today) -- President Obama has nominated Marilyn Tavenner, the current chief operating officer and principal deputy administrator of the Centers for Medicare and Medicaid Services, to become administrator of the agency. (Source: MedPage Today Public Health)

Collaborative lands federal contract that will reduce senior hospital admissions

bizjournals.com Health Care:Hospitals headlines — Wed, 23 Nov 2011 17:53:09 +0100

The Council on Aging of Southwestern Ohio and other Greater Cincinnati organizations have landed a federal contract designed to reduce hospital admissions among seniors. The contract comes from the U.S. Centers for Medicare and Medicaid Services. The council is the leading partner in the newly formed Southwest Ohio Community Care Transitions Collaborative, which will carry it out. The collaborative estimates that the program will serve nearly 5,400 seniors per year and bring annual net savings to Medicare of more than $1 million, according to a Council on Aging news release... (Source: bizjournals.com Health Care:Hospitals headlines)

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Report: ICD-10 presents challenges, opportunities for CMS

ICMCC: The International Council on Medical and Care Compunetics — Wed, 23 Nov 2011 10:35:48 +0100

Source: Tom Sullivan, Healthcare IT News Content: “The Centers for Medicare and Medicaid Services has its work cut out in transitioning to ICD-10. As the largest payer and the force driving the new code sets in the United States, CMS has a task at least as intimidating as anyone else when it comes to implementation. “Given [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

Dendreon: Medicare Will Cover More Provenge Costs

Drugs.com - Pharma News — Tue, 22 Nov 2011 16:15:12 +0100

SEATTLE (AP) - Dendreon Corp. said Monday that Medicare will reimburse doctors for administration costs associated with its prostate cancer therapy Provenge. Dendreon said the Centers for Medicare and Medicaid Services will retroactively cover... (Source: Drugs.com - Pharma News)

AMA opposes implementing ICD-10; industry leaders react

ICMCC: The International Council on Medical and Care Compunetics — Sat, 19 Nov 2011 15:48:01 +0100

Source: Don Fluckinger, SearchHealthIT Content: “In its 65th Interim Meeting in New Orleans, the American Medical Association’s House of Delegates voted to vigorously oppose implementing ICD-10 across health care, as mandated by the Centers for Medicare and Medicaid Services (CMS). AMA leadership will now assess just how it will try to stop the new disease [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

Medicare-covered heart screening sending more patients to PCPs

Modern Medicine — Wed, 16 Nov 2011 05:00:00 +0100

You might want to add a few more chairs in your waiting room. Just weeks after the Centers for Medicare and Medicaid Services announced screenings for depression and alcohol abuse free of charge to Medicare patients, it now has added similar coverage for preventive services to reduce cardiovascular disease. Find out what the Medicare policy specifies primary care providers should do during those once-a-year visits. (Source: Modern Medicine)

Readying the Centers for Medicare and Medicaid Services' Information Technology Systems to Meet Emerging Needs

News from the National Academies — Mon, 14 Nov 2011 14:26:06 +0100

The mission of the Centers for Medicare and Medicaid Services (CMS) is shifting from one primarily concerned with claims payment to one centered on improving the efficiency, quality, safety, and equity of U.S. health care services. CMS is also responsible for testing innovative care and payment models and overseeing and supporting the state-based insurance exchanges called for in the 2010 Patient Protection and Affordable Care Act. In light of these challenges, CMS asked the National Research Council to review the centers’ plans for modernizing and developing its information systems. (Source: News from the National Academies)

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Lab Accreditation and Credentials in Sonography: A Demographic Assessment of Facilities Receiving Federal Reimbursements

Journal of Diagnostic Medical Sonography — Fri, 11 Nov 2011 05:00:00 +0100

There is an increasing demand for sonographer credentials and facility accreditation associated with federal reimbursement of sonography examinations. Therefore, a national survey was conducted to identify the education/certification status of sonographers currently performing studies that receive federal reimbursement. The survey, addressed to sonography administrators, also investigated the sonography laboratory accreditation status. Results indicated that approximately 12% of the sonographers were reported to have no sonography-specific credentials. The primary age range of this group was 25 to 34 years, and 64% were graduates of a two-year (minimum) allied health education program other than sonography. Forty-two percent indicated their sonography lab was not accredited. Should the Cen...

CMS targets fraud with new analytics

Healthcare IT News — Thu, 10 Nov 2011 15:05:56 +0100

The Centers for Medicare and Medicaid Services intends to take a bigger bite out of fraud and abuse by strengthening its monitoring and analytics capabilities to prevent and detect suspicious activities. No read more (Source: Healthcare IT News)

Medicare to Cover Heart Disease Counseling

MedPage Today State Required CME — Wed, 09 Nov 2011 22:13:21 +0100

WASHINGTON (MedPage Today) -- The Centers for Medicare and Medicaid Services (CMS) announced it will begin paying for one office visit per year for Medicare patients that is aimed at preventing cardiovascular disease. (Source: MedPage Today State Required CME)

Payment cuts slightly less deep under new Medicare rule

Modern Medicine — Wed, 09 Nov 2011 05:00:00 +0100

Don’t spend it all in one place. The final rule issued early this month by the Centers for Medicare and Medicaid Services dictates that the reduction to Medicare provider rates next year will be 27.4%, not the 29.5% estimated in March, because costs in the program have not increased as much as anticipated. The rule also expands Medicare efforts to remedy undervalued primary care services. Find out how. (Source: Modern Medicine)

Payment models offer preview of future for primary care

Modern Medicine — Wed, 09 Nov 2011 05:00:00 +0100

What will the payment system for primary care look like in the future? A new government-sponsored program may offer a preview. Through the Comprehensive Primary Care Initiative announced by the Centers for Medicare and Medicaid Services, 75 high-performing primary care practices in each of five to seven markets will have the opportunity to earn additional revenue. Discover the payment models being tested under the program—and how they could innovate practice finance. (Source: Modern Medicine)

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CMS Hospital Center

Rural web sites and other tools via the Rural Assistance Center — Tue, 08 Nov 2011 19:53:04 +0100

Provides updates on regulations, various hospital prospective payment systems, certification, policies, legislation, and initiatives. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

CMS Ambulance Services Center

Rural web sites and other tools via the Rural Assistance Center — Tue, 08 Nov 2011 19:46:40 +0100

Includes information on CMS regulations and policies on ambulance fee schedule, fee-for-service, coding and billing, and payment. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

Code of Federal Regulations - Title 42, Part 418, Medicare Program: Hospice Wage Index for Fiscal Year 2012

Rural publications via the Rural Assistance Center — Tue, 08 Nov 2011 16:36:33 +0100

Presents the final rule set forth for the hospice wage index for fiscal year 2012, effective 10-1-11. Revises the hospice requirement for face-to-face encounters, begins implementation of a hospice quality reporting program, and changes the hospice aggregate cap calculation methodology. Includes chart with number of total hospices, broken down by rural and urban, and region. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Medicare Hospice Benefits

Rural publications via the Rural Assistance Center — Tue, 08 Nov 2011 15:53:14 +0100

Includes information on who is eligible for hospice care, what services are included, how to find a hospice program, and where to get information. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Prescriptions Blog: Doctor Groups Seem Less Wary of Medicare Changes

NYT Health — Mon, 07 Nov 2011 12:01:06 +0100

Regulations related to accountable care organizations include fewer benchmarks and provide upfront incentives for some groups. (Source: NYT Health)

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Home Health and Hospice Face-to-Face Encounter Visits

Geriatric Nursing — Mon, 07 Nov 2011 05:00:00 +0100

Performance and documentation regarding a face-to-face encounter with a Medicare beneficiary referred for home health and certain hospice services became a condition to receive Medicare payment when the Centers for Medicare and Medicaid Services (CMS) implemented federal regulations effective January 1, 2011. These regulations were mandated by the 2010 health care reform legislation (see Patient Protection and Affordable Care Act, Section 6407 [home health agency, or HHA] and Section 3131(b) [hospice]). Although the regulations became effective at the start of the year, because of concerns that providers might not have procedures in place to ensure compliance, CMS extended the full implementation date until April 1, 2011. CMS expected that HHAs and hospices would have established the inter...

Washington Week: Medicare Physician Pay Cut Announced

MedPage Today Public Health — Sat, 05 Nov 2011 16:00:00 +0100

WASHINGTON (MedPage Today) -- The Centers for Medicare and Medicaid Services (CMS) made official what everyone already knew -- doctors will face a huge cut in Medicare payments next year unless legislative action prevents it -- and President Obama issued an executive order telling the FDA and the Justice Department to do what it takes to address medication shortages. (Source: MedPage Today Public Health)

Medicare Benefit Policy Manual: Chapter 7 - Home Health Services

Rural publications via the Rural Assistance Center — Fri, 04 Nov 2011 16:32:22 +0100

Discusses the Home Health Prospective Payment System (PPS), requirements for home health coverage, services provided, physician certificates, supplies, and duration. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

WellPoint’s New Pay-for-Performance Program to Pay Hospitals More for Meeting Quality Measures

Dark Daily — Fri, 04 Nov 2011 10:00:03 +0100

Private payers taking first steps on a path toward value-based purchasing that could eventually include clinical pathology laboratory testing services Pay-for-performance just took a leap forward with news that one of the nation’s largest health insurers will link hospital reimbursement to specific quality measures. This development could be a precursor to similar payer initiatives that [...] (Source: Dark Daily)

Dialysis Facilities Get Bump in 2012 Medicare Payments

MedPage Today Nephrology — Fri, 04 Nov 2011 03:13:10 +0100

WASHINGTON (MedPage Today) -- Medicare will pay dialysis facilities 2.1% more in 2012 under a final rule issued by the Centers for Medicare and Medicaid Services. (Source: MedPage Today Nephrology)

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2011 Medicare Health and Drug Plans by State

Rural web sites and other tools via the Rural Assistance Center — Thu, 03 Nov 2011 16:53:08 +0100

Presents a page for each state containing fast facts, important dates, number of plans, and data regarding plan costs and coverage. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

ICD-10 Implementation Guide for Small Hospitals

Rural publications via the Rural Assistance Center — Thu, 03 Nov 2011 15:39:50 +0100

Step-by step guide specifically for small hospitals regarding the transition to the ICD-10 code set. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

ICD-10 Implementation Guide for Small and Medium Practices

Rural publications via the Rural Assistance Center — Thu, 03 Nov 2011 15:34:48 +0100

Step-by step guide specifically for small and medium provider practices regarding the transition to the ICD-10 code set. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Final Medicare Rule Cuts Doc Pay Drastically

MedPage Today Neurology — Wed, 02 Nov 2011 22:53:24 +0100

WASHINGTON (MedPage Today) -- The final physician payment rule for 2012 will cut Medicare payments to doctors by 27.4% starting Jan. 1, the Centers for Medicare and Medicaid Services announced. (Source: MedPage Today Neurology)

Sapien Transcatheter Valve Approved for Aortic-Valve DiseaseSapien Transcatheter Valve Approved for Aortic-Valve Disease

Medscape Today Headlines — Wed, 02 Nov 2011 21:46:37 +0100

After years of anticipating the arrival of this device, US physicians will be celebrating the US FDA decision to approve the Sapien transcatheter valve. Questions remain as to how many centers and physicians will be permitted to implant this device and just how patients will be able to pay for it, pending a coverage decision from the Centers for Medicare and Medicaid Services Heartwire (Source: Medscape Today Headlines)

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Sapien transcatheter valve approved for inoperable aortic-valve disease: FDA

theHeart.org — Wed, 02 Nov 2011 21:30:25 +0100

CMS Says Final 2012 Physician Fee Cut Is 27%, Not 29%

Clinical Endocrinology News — Tue, 01 Nov 2011 04:00:00 +0100

If current law stands, physician fees will be cut by 27% in 2012, not the 29% originally projected, according to the final payment rule issued Nov. 1 by the Centers for Medicare and Medicaid Services. (Source: Clinical Endocrinology News)

CMS 2012 Accountable Care Organizations Final Rule

American College of Radiology — Fri, 28 Oct 2011 18:25:00 +0100

The Patient Protection and Affordable Care Act included a provisions termed the "Shared Savings Program", a concept to implement a large scale, value-based purchasing program whereby providers are rewarded for high quality, efficient clinical care. The Centers for Medicare and Medicaid Services intend to implement the Shared Savings Program through the use of Accountable Care Organizations (ACOs). The ACR has provided this summary of the CMS Final Rule on ACOs. (Source: American College of Radiology)

Policymakers Should Prepare For Major Uncertainties With Medicaid Expansion

Health News from Medical News Today — Fri, 28 Oct 2011 08:00:00 +0100

The number of low-income, uninsured Americans enrolling in Medicaid under the expanded coverage made possible by the Affordable Care Act (ACA) of 2010 could vary considerably from the levels currently projected by the Congressional Budget Office (CBO) and the Centers for Medicare and Medicaid Services (CMS), according to a new study by Harvard School of Public Health (HSPH) researchers. They report that it's probably more realistic to say somewhere between 8 million and 22 million may enroll in Medicaid by 2014 instead of the 16 million predicted by the CBO... (Source: Health News from Medical News Today)

ACR Backed Diagnostic Imaging Services Protection Act Helps Preserve Access to Care

American College of Radiology — Thu, 27 Oct 2011 20:07:00 +0100

The American College of Radiology supports the Diagnostic Imaging Services Protection Act (H.R. 3269), which would prohibit any multiple procedure payment reduction to the "professional component" of CT, MRI and ultrasound exams received by the same patient, on the same day, in the same setting in 2012. A 50 percent cut was included in the Centers for Medicare and Medicaid Services 2012 Medicare Physician Fee Schedule Proposed Rule. Bipartisan H.R. 3269 was introduced in the U.S. House of Representatives today by Reps. Pete Olson (R-TX) and Betty McCollum (D-MN). It was cosponsored by 31 House Members. (Source: American College of Radiology)

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Predictors of wound complications following major amputation for critical limb ischemia

Journal of Vascular Surgery — Thu, 27 Oct 2011 11:45:46 +0100

In 2011, several coding changes occurred in the area of wound management. The commonly used CPT codes 11040 and 11041 were deleted, and replacing them for skin debridement are the active wound care management CPT codes 97597 and 97598. The second major change is the need to measure and report based on the surface area of wound(s) debrided. The first 20 square centimeters of area treated will be reported with a primary code, and any area beyond that will be billed using add-on CPT codes in 20 square centimeter increments or part thereof. As in the past, the debridements will still be reported based on depth of tissue removed. The first level involves only skin (either partial or full thickness), the second encompasses skin and subcutaneous tissue, the third comprises skin, subcutaneous tiss...

Pilot Program for Parallel Review of Medical Products; Correction

Federal Register updates via the Rural Assistance Center — Wed, 26 Oct 2011 06:00:00 +0100

The Food and Drug Administration and the Centers for Medicare and Medicaid Services are correcting a notice that appeared in the Federal Register of October 11, 2011. The document was published with an incorrect Web page address and an incorrect email address. (Source: Federal Register updates via the Rural Assistance Center)

Policymakers should prepare for major uncertainties with Medicaid expansion

EurekAlert! - Social and Behavioral Science — Wed, 26 Oct 2011 04:00:00 +0100

(Harvard School of Public Health) The number of low-income, uninsured Americans enrolling in Medicaid under the expanded coverage made possible by the Affordable Care Act of 2010 could vary considerably from the levels currently projected by the Congressional Budget Office (CBO) and the Centers for Medicare and Medicaid Services, according to a new study by Harvard School of Public Health researchers. They report that somewhere between 8 million and 22 million may enroll in Medicaid by 2014 instead of the 16 million predicted by the CBO. (Source: EurekAlert! - Social and Behavioral Science)

Physician groups initially pleased with final ACO rule

Healthcare IT News — Tue, 25 Oct 2011 14:45:48 +0100

Physician groups are pleased with their initial take of the final accountable care organization (ACO) rule issued by the Centers for Medicare and Medicaid Services on Oct. 20. American Medical Group Association (AMGA) President and CEO Donald Fisher said AMGA is pleased CMS heeded many of the group’s suggestions. Display on Best Hospitals page: No read more (Source: Healthcare IT News)

Medicare program; changes to the ambulatory surgical centers patient rights conditions for coverage. Final rule.

Fed Regist — Mon, 24 Oct 2011 04:00:00 +0100

Authors: Abstract This final rule revises the ambulatory surgical centers (ASCs) conditions for coverage (CfC) to allow patient rights information to be provided to the patient, the patient's representative, or the patient's surrogate prior to the start of the surgical procedure. In addition, we made minor changes to the CfC for patient rights requirements, as specified in the proposed rule. This final rule reflects the Centers for Medicare and Medicaid Services' (CMS') commitment to the general principles of the President's Executive Order 13563 released January 18, 2011, entitled "Improving Regulation and Regulatory Review.'' PMID: 22022736 [PubMed - in process] (Source: Fed Regist)

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ACOs Finally Final

American Academy of Neurology — Sun, 23 Oct 2011 01:26:07 +0100

On October 20, 2011, the Centers for Medicare and Medicaid Services (CMS) released a more flexible and potentially profitable final shared savings rule. (Source: American Academy of Neurology)

Some services billable under 'incident to' rule

Modern Medicine — Sun, 23 Oct 2011 00:57:50 +0100

The Centers for Medicare and Medicaid Services (CMS) allows services provided by advanced practice providers in the office setting to be billed as "incident to" physician services; in other words, billed to Medicare under the physician's name and provider number. On the claim form, the advanced practice provider is invisible as far as the billing of that service is concerned, and the claim is adjudicated at 100 percent of the physician fee schedule. (Source: Modern Medicine)

CMS Releases Final Rules for Accountable Care Organizations

American Academy of Neurology — Fri, 21 Oct 2011 22:39:00 +0100

On October 20, 2011, the Centers for Medicare and Medicaid Services (CMS) released a more flexible and potentially profitable final shared savings rule. (Source: American Academy of Neurology)

Missouri pursues new care surrounding mental illness

bizjournals.com Health Care:Physician Practices headlines — Fri, 21 Oct 2011 20:32:55 +0100

Missouri will become the first state in the nation to create coordinated care programs for mentally ill or substance abuse patients who also are dealing with other chronic health problems. The federal Centers for Medicare and Medicaid Services (CMS) on Friday announced that it had approved a proposal from Missouri’s Medicaid program to form so-called “health homes” for these types of patients, beginning Jan. 1. As part of a health home, the state’s community mental health centers will coordinate the various levels of health care for eligible Medicaid recipients with a team of area physicians, behavioral health professionals and long-term care providers... (Source: bizjournals.com Health Care:Physician Practices headlines)

Strengthening the Direct Service Workforce in Rural Areas

Rural publications via the Rural Assistance Center — Fri, 21 Oct 2011 16:14:46 +0100

Contains a summary of the challenges of the direct service workforce in rural areas and strategies that rural stakeholders can use to provide high-quality long-term care services and supports. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

State electronic disease surveillance systems --- United States, 2007 and 2010.

MMWR Morb Mortal Wkl... — Fri, 21 Oct 2011 04:00:00 +0100

This report summarizes the results of that assessment, which indicated a 17.5% increase from 40 states in 2007 to 47 states in 2010 with fully operational general communicable disease (GCD) electronic surveillance systems, a 211.5% increase from 13 to 39 states in the number of systems that were interoperable, a 22.4% increase from 23 to 34 states in the number with integrated systems, and a 20.0% increase to 42 states with the capacity to receive electronic laboratory reports (ELRs). New Centers for Medicare and Medicaid Services rules for meaningful use of health information technology encourage data exchange between electronic health record systems and public health agencies, including submission of ELRs. To meet national goals for health information exchange to improve population healt...

Accreditation Boosts Hospital Performance (CME/CE)

MedPage Today Public Health — Wed, 19 Oct 2011 23:01:26 +0100

(MedPage Today) -- The gap in performance on quality measures between accredited and nonaccredited hospitals has widened over time, according to an analysis of data from the Joint Commission and the Centers for Medicare and Medicaid Services. (Source: MedPage Today Public Health)

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CMS Proposes Rule to 'Cut Red Tape' at Hospitals

MedPage Today Public Health — Wed, 19 Oct 2011 21:04:48 +0100

WASHINGTON (MedPage Today) -- The Centers for Medicare and Medicaid Services has proposed the first major revision in more than two decades to the rules that hospitals must abide by in order to participate in Medicare and Medicaid -- a move that was welcomed by hospitals. (Source: MedPage Today Public Health)

CMS Sponsored ICD-10 Teleconferences

Rural web sites and other tools via the Rural Assistance Center — Wed, 19 Oct 2011 15:27:16 +0100

Archived teleconference from August 3, 2011 discussing the change to ICD-10 for medical diagnosis and inpatient procedure coding. Includes four podcasts, slide presentation, audio file, and written transcript. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

FAQs: Versions 5010 and D.O Transition Basics

Rural publications via the Rural Assistance Center — Tue, 18 Oct 2011 19:32:14 +0100

Answers frequently asked questions regarding the transition to Version 5010 and D.O software. Version 5010 pertains to standards for electronic administrative transactions. D.O is the version of the National Council for Prescription Drug (NCPDP) standards for pharmacy transactions that replaces version 5.1. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

FAQs: ICD-10 Transition Basics

Rural publications via the Rural Assistance Center — Tue, 18 Oct 2011 19:29:21 +0100

Answers frequently asked questions regarding the ICD-10 medical coding transition. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

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Icd-10

Rural web sites and other tools via the Rural Assistance Center — Tue, 18 Oct 2011 19:24:38 +0100

Provides resources, timelines, and news to help vendors, payers, and providers prepare for the U.S. health care's transition to Version 5010 and ICD-10. Version 5010 standards pertain to electronic health transactions and ICD-10 pertain to medical diagnosis and inpatient procedure coding. -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

Medicare to Cover Alcohol, Depression Screening

MedPage Today Pediatrics — Mon, 17 Oct 2011 21:35:27 +0100

WASHINGTON (MedPage Today) -- Medicare will pay for annual screenings for alcohol misuse and depression, the Centers for Medicare and Medicaid Services announced. (Source: MedPage Today Pediatrics)

Last Opportunity to Apply for Exemption From Medicare e-Prescribing Program

American College of Radiology — Mon, 17 Oct 2011 19:50:00 +0100

The vast majority of ACR members are automatically exempt from the incentives and penalties for the Centers for Medicare and Medicaid Services' (CMS) e-Prescribing (eRx) Incentive Program. In order to be subject to the eRx penalties, a physician would need to meet the criteria outlined here. (Source: American College of Radiology)

Integrated Care Resource Center

Rural web sites and other tools via the Rural Assistance Center — Mon, 17 Oct 2011 16:15:18 +0100

Helps States learn about best practices for delivering coordinated health care to Medicaids high-need, high-cost beneficiaries. The resource center is a joint technical assistance project of the Centers for Medicare & Medicaid Services (CMS) Medicare-Medicaid Coordination Office and the Center for Medicaid, CHIP, and Survey & Certification (CMCS). -- Centers for Medicare and Medicaid Services (Source: Rural web sites and other tools via the Rural Assistance Center)

CMS pays out nearly $90M in MU incentives in September

Healthcare IT News — Thu, 13 Oct 2011 14:29:13 +0100

The Centers for Medicare and Medicaid Services in September paid out $25 million to 1400 eligible providers and $61 million to 30 dually eligible hospitals under the meaningful use EHR incentive program, according to Robert Anthony from the CMS Office of E-Health Standards and Services. Anthony made the announcement at the Oct. 12 meeting of the HIT Policy Committee. Display on Best Hospitals page: No read more (Source: Healthcare IT News)

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AMA Panel Wants Medicare to Pay for Care Coordination

MedPage Today Public Health — Tue, 11 Oct 2011 23:13:10 +0100

WASHINGTON (MedPage Today) -- The AMA committee that recommends changes in the Medicare pay scale is asking the Centers for Medicare and Medicaid Services to reimburse doctors for four types of activities that involve coordinating care for chronically ill patients. (Source: MedPage Today Public Health)

The ICD-10 Transition: An Introduction

Rural publications via the Rural Assistance Center — Tue, 11 Oct 2011 21:07:46 +0100

Provides an introduction to ICD-10 code sets, which will replace ICD-9 code sets used to report medical diagnoses and inpatient procedures as of October 1, 2013. -- Centers for Medicare and Medicaid Services (Source: Rural publications via the Rural Assistance Center)

Pilot Program for Parallel Review of Medical Products

Federal Register updates via the Rural Assistance Center — Tue, 11 Oct 2011 14:56:28 +0100

The Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid Services (CMS) are soliciting nominations from sponsors of innovative device technologies to participate in a pilot program for concurrent review of certain FDA premarket review submissions and CMS national coverage determinations. (Source: Federal Register updates via the Rural Assistance Center)

Federal Register: Pilot Program for Parallel Review of Medical Products

Food and Drug Adminstration (FDA): CDRHNew — Tue, 11 Oct 2011 04:00:00 +0100

The FDA and the Centers for Medicare and Medicaid Services (CMS) (the Agencies) are soliciting nominations from sponsors of innovative device technologies to participate in a pilot program for concurrent review of certain FDA premarket review... (Source: Food and Drug Adminstration (FDA): CDRHNew)