Tuesday, December 31, 2013

ICD-10 Training


 
ICD-10 Coalition main image
December ICD-10 webinar now available on-demand
During the Dec. 17 webinar we checked in with three volunteers from earlier this year. Sandra Robben-Weber and Chris Hall updated us on their ICD-10 project planning efforts, and Elizabeth Etzler shared how they have used what was learned from their workflow analysis. All speakers lent their insights and experiences gained.
View this informative webinar for some practical advice from your peers. You'll gain a better understanding of where to start and how, what to look out for, how to engage others in the practice, and much more!
Click here to access the on-demand webinar. Click here to download the program slides. Interested in more ICD-10 webinars? View the full series at www.cms.org/icd-10/archived-webinars.


 
Resources from the December webinar
Sandra mentioned the following document during the webinar and asked us to share it with the group: Pikes Peak PAHCOM ICD-10 Resources
Triche mentioned the following article during the webinar and also asked us to share it with the group: Upcoming Healthcare Initiatives: Are you Ready, Have a Gameplan, or Starting to Stress?


 
Pledge to be ready by 10/1/14
Show your commitment to being ready for the transition to ICD-10. Add your name to the list of those who have pledged to participate in the Colorado ICD-10 Training Coalition's campaign.
Sign our pledge and commit to having your practice ready for the transition to ICD-10 by Oct. 1, 2014. Click here.

THE Consortium Webinar



THE Consortium webinar on January 23, 2014.

 


Novitas Updates, Customer Service Training


Novitas Updates

 
Customer Service Training


JH Customer Contact Center January 10, 2014 Training Time Update - 1-855-252-8782 The Customer Service Units will close for training on January 10, 2014 at 3:30 CT. Our self- service technology, the Interactive Voice Response Unit (IVR), Direct Data Entry (DDE) and Professional Provider Telecommunication Network (PPTN) will still be available during this time.

 
JH Part A Webinar Handout: "Update - New Novitas Website" - January 7, 2014 (1:00pm-2:30pm CT)
Join us as we kick off the New Year with the new and improved Novitas Website.  We will demonstrate the improved Novitas Solutions website and show you how to navigate it.  We will inform you of the new available search tools while providing new tips to enhance your search results. You do not want to miss this event.  Register Today!

Monday, December 30, 2013

Novitas Update: New Law Includes Physician Update Fix through March 2014


Novitas Update:

 President Obama Signs the Pathway for SGR Reform Act of 2013



New Law Includes Physician Update Fix through March 2014


On December 26, 2013, President Obama signed into law the Pathway for SGR Reform Act of 2013. This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking effect on January 1, 2014. The new law provides for a 0.5 percent update for such services through March 31, 2014. President Obama remains committed to a permanent solution to eliminating the Sustainable Growth Rate (SGR) reductions that result from the existing statutory methodology. The Administration will continue to work with Congress to achieve this goal. The new law extends several provisions of the Middle Class Tax Relief and Job Creation Act of 2012 (Job Creation Act) as well as provisions of the Affordable Care Act. Specifically, the following Medicare fee-for-service policies have been extended. We also have included Medicare billing and claims processing information associated with the new legislation. Please note that these provisions do not reflect all of the Medicare provisions in the new law, and more information about other provisions will be forthcoming.

HCPF’s ACA Implementation Newsletter


HCPF’s ACA Implementation Newsletter


The latest issue of the Department of Health Care Policy and Financing’s ACA Implementation News is now available online here.

Thursday, December 26, 2013

CMS Call - 2-Midnight Benchmark for Inpatient Hospital Admissions — Registration Now Open


CMS Call - 2-Midnight Benchmark for Inpatient Hospital Admissions — Registration Now Open 

Tuesday, January 14; 1:30-3pm ET

 

To Register: Visit MLN Connects™ Upcoming Calls. Space may be limited, register early.

 

This MLN Connects Call provides an overview of the inpatient hospital admission and medical review criteria (also known as the 2-Midnight Rule) that was released on August 2, 2013 in the FY 2014 Inpatient Prospective Payment System/Long-Term Care Hospital final rule (CMS-1599-F). CMS will present case scenarios on the application of the rule to sample medical records. Following the presentation, CMS will address frequently asked questions received from providers.

 

Agenda:

  • Summary of the 2-Midnight Rule
  • Case example presentation
  • Question and answer session

Target Audience: Hospitals, physicians and non-physician practitioners, case managers, medical and specialty societies, and other healthcare professionals.

Fee Schedule Calculator (Novitas Tools)


Novitas Tools

Fee Schedule Calculator
This self-service tool is now operational again. While the 2014 Physician fee schedules can be downloaded from our website, they are not yet available in this calculator, but will be coming soon! You can still check 2010-2013 codes.

Appeals Status Tool
As a reminder, our Appeals Status Tool is now working, you can check to see if your appeal was received, and whether it's pending or finalized! Please Note: It does take approximately 1 week from the date received to be entered in the tool

Monday, December 23, 2013

How to Let Grant Reviewers Know Your Sustainability Plan


How to Let Grant Reviewers Know Your Sustainability Plan:

 

No funders like to think that their grant will only fund a project for a short time.  Before investing in your project, your funder will want to know your plans for carrying the project into the future, with or without this particular funders help. Think of the sustainability part of your grant as the sequel to the story you told throughout your application. Make sure that your future funding section provides a solid and specific blueprint of how your agency intends to continue operating its programs and continuing to serve its clients and community. 
 
There is a menu of funding strategies out there that a volunteer organization for example, can draw on to compose a future funding plan.  It’s important to demonstrate that your entity has an effective strategy for raising funds to cover activities in the event the grant program goes away or doesn’t fund your project as you planed.  Don’t pull the rug out at the end of your proposal….instead provide reassurance that the training will go on, and that your organization will remain strong.  For more application assistance and questions, contact Lakesha Jones, Grants Manager at 720.248.2742 or by email at lj@coruralhealth.org.

 

Thursday, December 19, 2013

2014 Physician Fee Schedule Novitas Update

Novitas is working diligently to post the 2014 physician fee schedule in file formats to which you are accustomed. In order to give you an opportunity to review the 2014 fees, we are posting the files in a basic text only format. This text file is formatted for viewing only. It is not formatted for importing into billing systems or other types of computer systems. We will notify you on our website and by electronic mail message when the 2014 physician fee schedules are available in formats appropriate for importing. We thank you for your patience.

Wednesday, December 18, 2013

Funding Opportunities for EMS and Trauma!

Now Accepting Applications -- Approximately $6.7 million is available through grants and system improvement funding for organizations involved in providing emergency medical and trauma services in Colorado.

Apply for these funds at www.coems.info under the "Funding Program" tab and the "Apply" link.

1. Read the FY15 funding Guide
2. Get your username and password for www.cemsis.com
3. Log in, update and submit your 2014 organizational profile
4. Complete and submit your funding application before 5 p.m. on Feb. 14, 2014

Contact your RETAC coordinator, Jeanne-Marie Bakehouse or Michael Gerber with questions.

Revalidation for Jurisdiction H (JH) Providers and Suppliers

Novitas has updated the Revalidation Request Mailing Schedule on our website. As outlined in the Schedule, mailings began on November 22, 2013 and will continue through December 30, 2013. These mailings comprise approximately 10,200 providers/suppliers. The Centers for Medicare and Medicaid Services (CMS) will publish the listing of providers/suppliers included in these mailings on their website approximately 3-4 weeks after all contractors have provided their mailing information for the months of November and December.

If you have questions related to the revalidation initiative, please visit our Enrollment Center for more information.

Thursday, December 12, 2013

iCARE: Improving Communication and Readmissions in the Rural Setting Webinar

iCARE: Improving Communication and Readmissions 
in the Rural Setting Webinar

December 19th, 1:00-2:00 pm MT 
Hosted by the Colorado Rural Health Center 

Preventing readmissions is never easy, but addressing readmissions in a rural setting poses unique challenges that can be hard to overcome. Four years ago, the Colorado Rural Health Center (CRHC) started the Improving Communication and Readmissions project (iCARE). iCARE is a rural-focused statewide improvement project aligning with national trends and initiatives. Through iCARE Colorado's rural Critical Access Hospitals and their provider-based clinics are focused on three primary goals:
  • Improving communication in transitions of care, 
  • Reducing readmission rates, and 
  • Improving clinical processes that contribute to readmission rates. 
During this webinar you'll learn more about iCARE, the work done to-date, and accomplishments of project participants. Join us to learn more about how readmissions are being addressed across Colorado and how some of these approaches may work for you!

Click Here for Free Registration

Speaker Bio:
Jen Dunn, Director of Programs, Colorado Rural Health Center
As the Director of Programs, Ms. Dunn is responsible for the oversight of the Critical Access Hospital, Rural Health Clinics, and EMS/Emergency Preparedness programs. She works extensively with the iCare program at CRHC and is an active member of the Healthy Transitions Colorado Operating Team. Through iCare, Ms. Dunn works with rural hospitals and clinics to reduce readmissions and make sure that Colorado's rural facilities stay ahead of national trends. Ms. Dunn earned a Bachelor's Degree from Concordia College in Moorhead, Minnesota and a Master's Degree in Public Administration from the University of Colorado at Denver.

ICD-10 Coder Academy by RT Welter

The Discounted Registration Deadline for the ICD-10 Coder Academy is quickly approaching! Sign any time between now and December 15th to save!

This interactive and hands-on ICD-10 training is designed to prepare coders for the AAPC and AHIMA ICD-10 proficiency examinations. Participants will gain the tools they need to appropriately select ICD-10-CM and ICD-10-PCS codes. These training sessions will be coder centric, and the content will be designed for those staff who will be responsible for applying (or verifying) these codes to documentation. Throughout the academy, participants will be given an assortment of scenarios to code to obtain the proficiency they need for coding in ICD-10.

Participants only needing ICD-10-CM training (physician and outpatient coding) should register for the first day of the academy only (Day 1).

Participants needing ICD-10-PCS training (hospital/inpatient coding) will need to register for the entire 3-day academy.
Overview of ICD-10 Academy Agenda — (lunch, snacks and drinks will be provided each day)

ICD-10-CM (Day 1) AHIMA-approved ICD-10-CM/PCS trainers will educate coding staff regarding ICD-10-CM with a focus on:
  • Convention changes and additions 
  • Concept changes and additions 
  • Chapter specific guideline changes and additions 
  • Live coding workshop 

**This training has the approval of 8.0 CEU’s from the American Health Information Management Association (AHIMA) (AAPC members can submit these CEU’s to AAPC for credit)

ICD-10-PCS (Days 2 and 3)AHIMA-approved ICD-10-CM/PCS trainers will educate coding staff regarding ICD-10-PCS with a focus on:
  • The structure of ICD-10-PCS text and codes 
  • The definition and application of each root operation 
  • The method by which an ICD-10-PCS code is selected 
  • Live coding workshops 

**This training has the approval of 16.0 CEU’s from the American Health Information Management Association (AHIMA) (AAPC members can submit these CEU’s to AAPC for credit)

Registration Discounts:
  • Register by December 15, 2013 and receive $50.00 off the registration fee (per participant)!
  • Practices registering 3+ participants will receive $50.00 off each registration fee (in addition to early registration discount if registered by December 15, 2013)
  • Seating is limited, register now
  • to guarantee your spot today!
CLICK HERE TO READ MORE

ICD-10 Webinar and Provider Readiness Survey

It's not too late to register for Dec. 17 
ICD-10 webinar: Year End Check-Up 

Time for a reality check - as of Dec. 17 there will be 288 days until the Oct. 1, 2014 ICD-10 deadline. Will you be ready?

During this webinar we will check in with three volunteers from earlier this year. Sandra Robben-Weber and Chris Hall will update us on their ICD-10 project planning efforts, and Elizabeth Etzler will let us know how they have used what was learned from their workflow analysis. They will share their insights and experiences gained.

Register for this informative webinar for some practical advice from your peers. You'll gain a better understanding of where to start and how, what to look out for, how to engage others in the practice, and much more!

Join us on Tuesday, Dec. 17, 12 - 1 p.m. for the year end check-up. Click here to register.

ICD-10 Provider Readiness Survey is now open The Department of Health Care Policy and Financing has developed an ICD-10 Provider Readiness Survey and encourages all providers and trading partners to complete it.

To access the survey, go to the ICD-10 page of the HCPF website and select "Click here to take the ICD-10 Readiness Survey." Or click here to go to the survey directly. The survey will close at the end of the year. Thank you in advance for your participation.

For more information, please head to the Colorado Medical Society website.

THE Consortium Webinar - Stage 2 MU and HIPAA

THE Consortium: December 17, 2013 Webinar  
Continued Deeper Dive into Stage 2 MU and HIPAA

Please gather your IT, QI and ICD-10 team and join us for the next in our series of Meaningful Use webinars on Tuesday, December 17, 2013 from 12:00 pm to 1:15 pm. We will continue our ongoing discussion regarding meaningful use and continue our deep dive into Stage 2-2014 Edition requirements!

To register, please click here. For more information or questions please email Danette Swanson at ds@couralhealth.org.

Monday, December 9, 2013

CMS Open Door Forum

Special Open Door Forum: Final Rule CMS-1599-F: 
Hospital Inpatient Admissions 

Discussion of the Hospital Inpatient Admission Order and Certification; 2 Midnight Benchmark for Inpatient Hospital Admissions

Thursday, December 19; 1-2 pm ET

CMS will host a third, follow-up call in its Special Open Door Forum (ODF) series to allow hospitals, practitioners, and other interested parties to ask questions on the physician order and physician certification, inpatient hospital admission and medical review criteria that were released on August 2, 2013 in the FY 2014 Inpatient Prospective Payment System (IPPS)/Long-Term Care Hospital (LTCH) final rule (CMS-1599-F) and corresponding medical review instruction. For recently released provider information, including updates to the frequently asked questions and a recently identified “rare & unusual circumstance,” please visit the Inpatient Hospital Reviews web page. Note: The “rare & unusual circumstance” appears in Section III.D.2 of the Download, “Reviewing Hospital Claims for Patient Status 11/27/2013.”

Feedback and questions on the two midnight provision for admission and medical review can be sent to IPPSAdmissions@cms.hhs.gov. Questions on Part B inpatient billing and the clarifications regarding the physician order and certification should be sent to the subject matter staff listed in the final rule.

Special Open Door Participation Instructions:
Conference call only
Participant Dial-In Number(s): (866) 501-5502; Conference ID # 16505942

For more information about ODF calls, see the Special Open Door website.



Therapy Caps for CAHs

Click here to view excerpts from the advance Federal Register of the CY 2014 Final Physician fee schedule dealing with therapy caps. As proposed, CMS has finalized their position, subjecting outpatient therapy services in CAHs to the therapy caps beginning 1/1/14. 

For more information or questions contact Samantha Hiner at sh@coruralhealth.org



CMS ICD - 10 Training Webinar

ICD-10 Training Webinar Video: 
Navigating ICD-10, the Provider Perspective

CMS has released a new recording of an ICD-10 training webinar conducted for the National Association of Community Health Centers. The video is available on the ICD-10 Provider Resources page.

This webinar includes information on:
  • Changes in ICD code structure, code definitions, and the recurring patterns that help providers to understand the organization and content of ICD-10 codes 
  • The importance of clinical documentation in order to accurately and thoroughly capture medical concepts to inform ICD-10 coding 
  • Approaches to assess ICD-10 readiness, identify gaps, prioritize tasks, and monitor progress through continuous quality improvement 
Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter.

Novitas Website Updates and Enhancements

Latest Website Updates and Enhancements
Novitas Solutions has been listening to your feedback, and we continue to focus on improving our website. Here are a few of the things we 've recently completed:

Search Function
  • Filtering: Results may now be filtered by category (Claims, Customer Service, FAQs, etc)
  • You can now search by phrases or using punctuation marks, such as quotation marks, e.g. "Functional Therapy Reporting G codes"
  • Pressing the "enter" key will now initiate the search.
Appeals Status Tool
Our Appeals Status Tool is now properly functioning.
  • Make sure to save this link as a favorite, for the quickest access!!
  • Please Note: It takes approximately 1 week from the date received to be entered in the tool.
Here are a few things coming soon:
  • An Enhanced, Interactive Fee Schedule Calculator (Part B)
  • CERT Claim Identifier Look-up Tool
  • We continue to split out the remaining content between JL and JH
For a full list of website issues and enhancements, please click here, or you can find the list at the top our homepage under "Pardon Our Dust..."

Medicare News from Novitas Solutions

The following JH MAC Local Coverage Determinations (LCDs) which were posted for notice on October 10, 2013 are now effective: 

SHIP Webinar January - ICD-10 Implementation Series

ICD-10 Implementation series
January 16, 2014 - Webinar #4


Click here to register your ICD-10 Implementation Team for this meeting.

Meeting Description:Please join us Thursday, January 16, 2013, from 12:00pm - 1:15pm to continue this step by step journey toward a successful ICD-10 Implementation on October 1, 2014.

During this second live webinar we will discuss:
  • Progress with your homework assignment from previous webinars
    • Are you on track?
    • What's your next step?
  • Discussion / Homework Remediation / Next Step
  • Helpful resources and project materials will be provided throughout the series.

Click here to register or email Danette Swanson at ds@coruralhealth.org for more information.

CMS Customer Service Units and EDI Holiday Availability

Novitas Solutions, Inc. will be observing the Christmas holiday on Tuesday, December 24, 2013, and Wednesday, December 25, 2013, and the New Year’s holiday on Wednesday, January 1, 2014. Our business doors will be closed and the Customer Service Units will not be available. Please click here for full details of system availabilities.

Thursday, December 5, 2013

CREATE Tip of the Week - Narrative Details

You have decided what type of training your staff requires to meet the service need. You have looked at your budget and decided that the money is not there, but how do you get this message across to grant reviewers effectively?

The answer is to be specific! The best way to get the ERC's attention is to be specific by providing as many details as you can about all the aspects of the training (course costs, other costs, travel costs, etc.) and the benefits of incorporating that training into your region (more providers, better quality of care, increasing knowledge, etc.). Your aim should be to offer support or evidence for everything you say. Make sure each sentence is information rich. Inevitably, this means it will be very dense reading, but that’s the nature of the genre.

One good way to save space, while maintaining the focus on your course request meeting the service needs of your area, try including community and service request statistical information. Examples included numbers of providers vs. number of type of service requests. Strings of multiple statistics help show the depth of your familiarity with your service area need and how the training you are seeking would help meet that need successfully.

For more ideas of how to be concise while including all the important information, within your CREATE application contact Lakesha Jones, Grants Manager at lj@coruralhealth.org or by phone at 720.248.2742.

REMEMBER our December CREATE application deadline is quickly approaching. Please submit your request for funding by December 9th in order to receive a review this month.

Wednesday, December 4, 2013

CMS Webinar onDurable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

The Centers for Medicare & Medicaid Services will be hosting several webinars for partners and providers on
The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: Round 1 Recompete


The webinars will be conducted on the following dates:
  • December 09, 2013 (11:00 am to 12:00 noon (EST))
  • December 11, 2013 (1:00 pm to 2:00 pm (EST))
  • December 12, 2013 (2:00 pm to 3:00 pm (EST)
Sign up for one of our webinars via the following link:
http://dmeposcb2013.eventbrite.com/

The Round 1 Rebid of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program was successfully implemented in nine areas on January 1, 2011. CMS is required by law to recompete contracts under the DMEPOS Competitive Bidding Program at least once every three years. The Round 1 Rebid contracts will expire on December 31, 2013. The Round 1 Recompete contracts and prices are scheduled to go into effect on January 1, 2014 in the same nine areas. There will also be some changes to the specific DMEPOS items that are part of the program in these areas starting on January 1, 2014.

When a round of the program goes into effect in a competitive bidding area (CBA), Original Medicare beneficiaries who obtain competitively bid items in that CBA will need to use a Medicare contract supplier for that round for Medicare to help pay unless an exception applies. It is important that prescribing physicians, social workers, discharge planners, and others who assist Medicare beneficiaries in Round 1 competitive bid areas with their health care needs and decisions understand this program so that they can help Medicare patients get covered medical equipment and supplies. To ensure that Medicare can help pay for Medicare patients’ medical equipment and supplies, partners and providers will have to help beneficiaries find a supplier that is a Medicare contract supplier.
Please forward this message to any partner who may benefit from this educational session. We also look forward to your participation and the opportunity to educate partners and providers about the program.

PLEASE NOTE: This program is intended for partners and providers who assist beneficiaries in obtaining and ordering items of DMEPOS. Each program is limited to 1,000 participants, so please register early. Additionally, please try to limit your registration to 1 event if possible. We have scheduled 3 webinars in order to accommodate everyone and will add additional webinars if we reach our maximum attendance.

This webinar will be presented in a lecture format only. Questions may be asked using the webinar chat feature but will not be answered live. All questions will be compiled into a Question and Answer document and distributed to all webinar participants.

If you would like to receive regular updates about the DMEPOS Competitive Bidding initiative sign up for our Referral Agent ListServ via the below link. https://public.govdelivery.com/accounts/USCMS/subscriber/new?pop=t&topic_id=USCMS_7814

If you have any questions about these webinars or are unable to attend due to reaching maximum attendance, please contact Tom Robinson at Thomas.robinson@cms.hhs.gov or Lynne Tierney at lynne.tierney@cms.hhs.gov.

MLN Matters and CMS: Medicare Benefit Policy Manual

Click here for the MLN Matters on Medicare Benefit Policy Manual and here for the CMS Manual System on Medicare Benefit Policy Manual.

SHIP Webinar - ICD-10 Implementation Series

ICD-10 implementation series - Webinar #3 
December 10, 2013

Please join us on Tuesday, December 10, 2013, from 12:00pm - 1:15pm to start this step by step journey toward a successful ICD-10 Implementation on October 1, 2014.

During this third live webinar we will continue our discussion about ICD-10 readiness and the tasks that should be completed as we move into the new year. We will also work on clinic settings, LTC, Home Health and Hospice -- please forward this information to any staff in those facilities in your organization and to other facilities in your community.

Rural Health Clinic Technical Assistance Call

The next Rural Health Clinic technical assistance call will be held Thursday, December 12th at 3:00 pm EASTERN.

As many of you may know, December 1st was World AIDS Day, and this call will focus on the role that RHCs can serve in prevention, testing, treatment, and resource referral in their communities.Speakers will provide information about HIV prevalence in rural areas and clinical resources available to RHCs.


Speakers include:
  • Janice C Probst, PhD, South Carolina Rural Health Research Center 
  • Deborah Parham Hopson, PhD, HRSA 
  • Ronald H. Goldschmidt, MD, National HIV/AIDS Clinicians' Consultation Center 
  • A representative from a regional AIDS Education Telehealth Training Center 
The call-in number is: 888-469-0986. The access code is: 2255226. There is no charge to participate. Please feel free to share with others whom you think might benefit from hearing this presentation.A recording and transcript of the call will be made available for those unable to listen/participate live.

The presenters will take questions from the audience. If you would like to submit a question ahead of time, please send it to: info@narhc.org and put “RHC TA Question” in the subject line.

The presenters’ slides will be available for download from the NARHC Website closer to the day of the call. A link will be provided when they are available.

Additional information:
As the result of advances in treatment, HIV has become a manageable chronic disease. However, many Americans living with HIV aren’t aware of their status, and others struggle to access lifesaving drug therapies due to cost and geography. Therefore, it is important that Americans at risk get tested, and those who have HIV begin and adhere to drug treatment regimens.

Earlier this year, the South Carolina Rural Health Research Center released a report titled HIV/AIDS in Rural America: Prevalence and Service Availability.Although rates of HIV/AIDS are lower in rural areas, rural residents disproportionately lack resources to treat HIV/AIDS. HRSA’s Ryan White Program funds a variety of resources, including the National HIV/AIDS Clinicians' Consultation Center and regional AIDS Education and Training Centers.

CMS releases OPPS and PFS final rules

Last week the Centers for Medicare and Medicaid Services (CMS) released their final rules for calendar 2014 for the outpatient prospective payment system (OPPS) and the physician fee schedule (PFS). Among other modifications to the OPPS, CMS announced its final determination to end the current enforcement moratorium for small, rural hospitals and Critical Access Hospitals in regards to compliance with “direct supervision” requirements for outpatient therapy services. As part of the physician fee schedule update, CMS indicated the method and manner in which they plan to enforce SGR and GPCI cuts that will take affect in January if Congress does not intervene. They also outlined how therapy caps will be applied to Critical Access Hospitals and modified their definition of “rural” for purposes of telehealth reimbursement. The OPPS final rule is available here and the PFS final rule is available here.

Updated Information about Incarcerated Beneficiary Claim Denial Corrections

CMS has a new web page focused on the 2013 claims denials associated with a beneficiary’s incarceration status.

CMS Makes Outpatient Facility Policy and Payment Changes

Rule would give hospitals and ASCs flexibility to lower per-case costs

On November 27, CMS released a final CY 2014 hospital outpatient and ambulatory surgical center (ASC) payment rule [CMS-1601-FC] that will give hospitals and ASCs new flexibility to lower outpatient facility costs and strengthen the long-term financial stability of Medicare. In addition, CMS will replace the current five levels of hospital clinic visit codes for both new and established patients with a single code describing all outpatient clinic visits. A single code and payment for clinic visits is more administratively simple for hospitals and better reflects hospital resources involved in supporting an outpatient visit. The current five levels of outpatient visit codes are designed to distinguish differences in physician work.

Provisions in the final Hospital Outpatient Prospective Payment System (OPPS) rule encourage more efficient delivery of outpatient facility services by packaging the payment for multiple supporting items and services into a single payment for a primary service similar to the way Medicare pays for hospital inpatient care. Supporting items and services that will be included in a single payment for a primary service to the hospital and not paid separately include drugs, biologicals, and radiopharmaceuticals that function as supplies when used in a diagnostic test or procedure; drugs and biologicals that function as supplies when used in a surgical procedure, including skin substitutes; certain clinical diagnostic laboratory services; certain procedures that are never done without a primary procedure (add-ons); and device removal procedures.

The CY 2014 final rule with comment period increases overall payments for hospital outpatient departments by an estimated 1.7 percent. The increase is based on the projected hospital market basket—an inflation rate for goods and services used by hospitals—of 2.5 percent, minus both a 0.5 percent adjustment for economy-wide productivity and a 0.3 percentage point adjustment required by statute. The rule also updates partial hospitalization payment rates for hospitals and community mental health centers.

As part of this broader proposal to consolidate payment for larger groups of services, the final rule with comment period also establishes an encounter-based or “comprehensive” payment for certain device-related procedures like cardiac stents and defibrillators, but in a change from the proposed rule, delays its effective date to 2015.

Full text of this excerpted CMS press release (issued November 27).



CMS Extends 2014 Annual Participation Enrollment Period through January 31

The 2014 Annual Participation Enrollment Program allows eligible physicians, practitioners, and suppliers an opportunity to change their participation status by December 31, 2013. Due to the later than usual release of the Medicare Physician Fee Schedule Final Rule, CMS is extending the 2014 annual participation enrollment period through January 31, 2014. Therefore, participation elections and withdrawals must be post-marked on or before January 31, 2014. The effective date for any participation status changes elected by providers during the extension remains January 1, 2014.

CMS Finalizes Physician Payment Rates for 2014

Final Rule Focuses on Improved Care Coordination

On November 27, CMS finalized payment rates and policies for 2014, including a major proposal to support care management outside the routine office interaction as well as other policies to promote high quality care and efficiency in Medicare. CMS’ care coordination policy is a milestone, and demonstrates Medicare’s recognition of the importance of care that occurs outside of a face-to-face visit for a wide range of beneficiaries beginning in 2015. The final rule sets payment rates for physicians and non-physician practitioners paid under the Medicare Physician Fee Schedule for 2014 and addresses the policies included in the proposed rule issued in July. CMS projects that total payments under the fee schedule in 2014 will be approximately $87 billion.

As part of CMS’ continuing effort to recognize the critical role primary care plays in providing care to beneficiaries with multiple chronic conditions, beginning in 2015, the agency is establishing separate payments for managing a patient’s care outside of a face-to-face visit for practices equipped to provide these services.

The 2014 payment rates increase payments for many medical specialties with some of the greatest increases going to providers of mental health services including psychiatry, clinical psychologists and clinical social workers.

CMS is finalizing a process to adjust payment rates for test codes on the Clinical Laboratory Fee Schedule (CLFS) based on technological changes. Currently, the payment rates for test codes on the CLFS do not change once they have been set (except for changes due to inflation and other statutory adjustments). This review process will enable CMS to pay more accurately for laboratory tests on the CLFS.

The final rule also includes several provisions regarding physician quality programs and the Physician Value-Based Payment Modifier (Value Modifier). As CMS continues to phase-in the Physician Value-Based Payment Modifier, for 2016 CMS is finalizing its proposals to apply the Physician Value Modifier to groups of physicians with 10 or more eligible professionals, and to apply upward and downward payment adjustments based on performance to groups of physicians with 100 or more eligible professionals. However, only upward adjustments based on performance (not downward adjustments) will be applied to groups of physicians with between 10 and 99 eligible professionals.

CMS also is finalizing several related proposals to the Physician Quality Reporting System (PQRS) for 2014, including a new option for individual eligible professionals to report quality measures through qualified clinical data registries. In 2014, quality measures will be aligned across quality reporting programs so that physicians and other eligible professionals may report a measure once to receive credit in all quality reporting programs in which that measure is used. Additionally, CMS is better aligning PQRS measures with the National Quality Strategy and meaningful use requirements, and transitioning away from process measures in favor of performance and outcome measures. Finally, certain data collected in 2012 for groups reporting certain PQRS measures under the Group Practice Reporting Option (GPRO) will be publicly reported on the CMS Physician Compare website in 2014.

“Aligning measures across quality programs focuses providers on the most important measures and makes it easier to participate in programs like PQRS, which are designed to emphasize quality for Medicare beneficiaries,” said Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer.

Full text of this excerpted CMS press release (issued November 27).



CMS Special Open Door Forum

The next Special Open Door Forum: Final Rule CMS-1599-F: Discussion of the Hospital Inpatient Admission Order and Certification; 2 Midnight Benchmark for Inpatient Hospital Admissions is scheduled for Thursday December 19, 2013 from 1:00pm – 2:00pm, ET. If you wish to participate, dial 1-866-501-5502; Conference ID: 16505942. Please see the Downloads section for the full announcement. 

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