The following information is provided by Novitas Solutions.
Part B Top Inquiries Frequently Asked Questions (FAQs)
January FAQs are here! A new question has been added “How do we list the referring provider on the claim?” Take time to review our FAQs for answers to this and other questions.
New Medicare Insights Weekly Podcasts now available!
In this week's Medicare Insights Weekly Podcast, we review the 2015 Deductible, Coinsurance and Therapy Caps.
Wednesday, February 25, 2015
Medicare Part A and B News-Jurisdiction H for February 20th, 2015
The following information is provided by Novitas Soluations
Medicare News
Medical Policy Local Coverage Determination (LCD) and Article Updates
Medical Policy Updates
Due to system limitations, between February 20, 2015 and April 8, 2015, the following JH Local Coverage Determinations (LCDs) accessed through the policy search application are future LCDs that will become effective on April 9, 2015. The active (current) LCDs can be accessed below or by the Full Index of Current Active LCDs and Future Effective LCDs.
The following JH Draft LCDs posted for comment on September 18, 2014 and presented at the October 2014 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective April 9, 2015.
The following JH Draft LCD posted for comment on May 15, 2014 and presented at the June 2014 CAC Meeting has been posted for notice. It will become effective April 9, 2015.
Comments Received and Contractor Responses
The following JH draft will not be finalized at this time. Please continue to watch our website for further updates:
Medicare Learning Network (MLN) Articles from CMS
New:
Medicare News
Medical Policy Local Coverage Determination (LCD) and Article Updates
Medical Policy Updates
Due to system limitations, between February 20, 2015 and April 8, 2015, the following JH Local Coverage Determinations (LCDs) accessed through the policy search application are future LCDs that will become effective on April 9, 2015. The active (current) LCDs can be accessed below or by the Full Index of Current Active LCDs and Future Effective LCDs.
- Diagnostic Abdominal Aortography and Renal Angiography (L32709)
- Hydration Therapy (L32738)
- Non-Coronary Vascular Stents (L32641)
- Monitored Anesthesia Care (L32628)
- Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L32673)
The following JH Draft LCDs posted for comment on September 18, 2014 and presented at the October 2014 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective April 9, 2015.
- Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L27549)
- Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (L27475)
- Co-Management of Surgical Procedures (L27481)
- Coverage of Services and Procedures in Nursing Facilities (L27485)
- Diagnostic Abdominal Aortography and Renal Angiography (L32709)
- Evaluation and Management Services Provided in a Nursing Facility (L27496)
- Hemophilia Factor Products (L33658)
- Hydration Therapy (L32738)
- Lower Extremity Major Joint Replacement (Hip and Knee) (L35594)
- Non-Coronary Vascular Stents (L32641)
- Speech-Language Pathology (SLP) Services: Communication Disorders (L27531)
- Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim® Therapy (L27537)
- Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L32673)
The following JH Draft LCD posted for comment on May 15, 2014 and presented at the June 2014 CAC Meeting has been posted for notice. It will become effective April 9, 2015.
- Monitored Anesthesia Care (L32628)
Comments Received and Contractor Responses
The following JH draft will not be finalized at this time. Please continue to watch our website for further updates:
- Gender Reassignment Surgery (DL35573)
Medicare Learning Network (MLN) Articles from CMS
New:
Successful ICD-10 Testing Shows Industry Ready to Take Next Step to Modernize Health Care
Successful ICD-10 Testing Shows Industry Ready to Take Next Step to Modernize Health Care
By Marilyn Tavenner, Administrator, Centers for Medicare and Medicaid Services.
I am delighted to announce that CMS has recently successfully completed the first week of end-to-end testing of new ICD-10 coding.
The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. While most countries already use the 10th revision of these codes (or ICD-10), the United States has yet to adopt this convention. Since ICD-10 codes are more specific than ICD-9, doctors can capture much more information, meaning they can better understand important details about the patient’s health than with ICD-9-CM.
Approximately 660 providers and billing companies submitted nearly 15,000 test claims. This successful week of testing continues to put us on course for successful implementation of this important initiative that better reflects modern practice of medicine by Oct. 1, 2015.
Health care professionals use codes from the International Classification of Diseases—or ICD—to record their patients’ health conditions and document inpatient hospital procedures.
The U.S. is the last major industrialized nation to make the switch to ICD-10. The structure of ICD-9, which is more than 35 years old, limits the number of new codes that can be created, and many ICD-9 categories are full. ICD-10 provides room for code expansion, so providers can use codes more specific to patient diagnoses. Fact sheet on ICD-10.
To promote the health care community’s smooth transition from ICD-9 to ICD-10, CMS is conducting a comprehensive program of testing. Because ICD codes are required on medical bills, we want health care providers to be confident they can submit Medicare claims and get paid as the nation switches to ICD-10.
To that end, Medicare recently tested ICD-10 claims processing with a variety of stakeholders including health care providers, billing agencies, and equipment suppliers. Overall, participants in the January 26 to February 3 testing were able to successfully submit ICD-10 claims and have them processed through our billing systems. To the extent that some claims were rejected, most didn’t meet the mark because of errors unrelated to ICD-9 or ICD-10.
Testing allows us to identify areas of improvement, and we will work with outside entities and stakeholders to improve those very small deficiencies identified. And we will continue to do testing, especially in those areas we identify as needing improvement.
We’ve also identified one point that’s caused some confusion in the health care community and beyond. So, we are communicating far and wide that everyone must use:
That means ICD-10 can be used only for test purposes before October 1. And, only ICD-10 can be used for doctor’s visits and other services that happen on or after October 1. ICD-9 cannot be used to bill for services provided on or after October 1. This rule applies no matter when the claim is submitted, so claims submitted after October 1, 2015, for services provided before that date must use ICD-9 codes.
These rules and others around adopting ICD-10 apply to all health care providers, not just those who accept Medicare or Medicaid. So, like CMS, health insurance plans across the country are engaging in robust testing programs with doctors, hospitals, and other health care providers and suppliers. No major issues have emerged in the course of testing.
As the ICD-10 deadline draws near, I especially encourage medical practices and hospitals that bill Medicare to take advantage of testing opportunities. Beyond testing, CMS has undertaken an unprecedented level of outreach, training, and education to prepare the health care community for ICD-10. Our website cms.gov/ICD-10, offers many resources, including the Road to 10 tool, designed especially for small medical practices.
CMS is ready for ICD-10. And, thanks to our many partners—spanning providers, health plans, coders, clearinghouses, professional associations and vendor groups—the health care community at large will be ready for ICD-10 on October 1.
I appreciate the tremendous efforts and achievements of health professionals as we work together to realize the benefits of ICD-10 and other advances toward the ultimate goal of improving the quality and affordability of health care for all Americans.
Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare. Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter
By Marilyn Tavenner, Administrator, Centers for Medicare and Medicaid Services.
I am delighted to announce that CMS has recently successfully completed the first week of end-to-end testing of new ICD-10 coding.
The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. While most countries already use the 10th revision of these codes (or ICD-10), the United States has yet to adopt this convention. Since ICD-10 codes are more specific than ICD-9, doctors can capture much more information, meaning they can better understand important details about the patient’s health than with ICD-9-CM.
Approximately 660 providers and billing companies submitted nearly 15,000 test claims. This successful week of testing continues to put us on course for successful implementation of this important initiative that better reflects modern practice of medicine by Oct. 1, 2015.
Health care professionals use codes from the International Classification of Diseases—or ICD—to record their patients’ health conditions and document inpatient hospital procedures.
The U.S. is the last major industrialized nation to make the switch to ICD-10. The structure of ICD-9, which is more than 35 years old, limits the number of new codes that can be created, and many ICD-9 categories are full. ICD-10 provides room for code expansion, so providers can use codes more specific to patient diagnoses. Fact sheet on ICD-10.
To promote the health care community’s smooth transition from ICD-9 to ICD-10, CMS is conducting a comprehensive program of testing. Because ICD codes are required on medical bills, we want health care providers to be confident they can submit Medicare claims and get paid as the nation switches to ICD-10.
To that end, Medicare recently tested ICD-10 claims processing with a variety of stakeholders including health care providers, billing agencies, and equipment suppliers. Overall, participants in the January 26 to February 3 testing were able to successfully submit ICD-10 claims and have them processed through our billing systems. To the extent that some claims were rejected, most didn’t meet the mark because of errors unrelated to ICD-9 or ICD-10.
Testing allows us to identify areas of improvement, and we will work with outside entities and stakeholders to improve those very small deficiencies identified. And we will continue to do testing, especially in those areas we identify as needing improvement.
We’ve also identified one point that’s caused some confusion in the health care community and beyond. So, we are communicating far and wide that everyone must use:
- ICD-9 for services provided before the October 1 deadline
- ICD-10 for services provided on or after October 1
That means ICD-10 can be used only for test purposes before October 1. And, only ICD-10 can be used for doctor’s visits and other services that happen on or after October 1. ICD-9 cannot be used to bill for services provided on or after October 1. This rule applies no matter when the claim is submitted, so claims submitted after October 1, 2015, for services provided before that date must use ICD-9 codes.
These rules and others around adopting ICD-10 apply to all health care providers, not just those who accept Medicare or Medicaid. So, like CMS, health insurance plans across the country are engaging in robust testing programs with doctors, hospitals, and other health care providers and suppliers. No major issues have emerged in the course of testing.
As the ICD-10 deadline draws near, I especially encourage medical practices and hospitals that bill Medicare to take advantage of testing opportunities. Beyond testing, CMS has undertaken an unprecedented level of outreach, training, and education to prepare the health care community for ICD-10. Our website cms.gov/ICD-10, offers many resources, including the Road to 10 tool, designed especially for small medical practices.
CMS is ready for ICD-10. And, thanks to our many partners—spanning providers, health plans, coders, clearinghouses, professional associations and vendor groups—the health care community at large will be ready for ICD-10 on October 1.
I appreciate the tremendous efforts and achievements of health professionals as we work together to realize the benefits of ICD-10 and other advances toward the ultimate goal of improving the quality and affordability of health care for all Americans.
Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare. Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter
CMS Announces Extension for EPs Participating in PQRS via EHR and QCDR (QRDA III format)
CMS Announces Extension for EPs Participating in PQRS via EHR and QCDR (QRDA III format)
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the submission deadlines for the PQRS reporting methods below have been extended. All other submission timeframes for other PQRS reporting methods remain the same.
The revised submission deadline is March 20, 2015 at 8 pm ET for the following reporting methods:
EHR Direct or Data Submission Vendor that is certified EHR technology (CEHRT)
Qualified clinical data registries (QCDRs) (using QRDA III format) reporting for PQRS and the clinical quality measure (CQM) component of meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program
An Individuals Authorized Access to CMS Computer Services (IACS) account with the “PQRS Submitter Role” is required for these PQRS data submission methods. Please see the IACS Quick Reference Guides for specifics.
PQRS provides an incentive payment to individual eligible professionals (EPs) and group practices that satisfactorily participate or satisfactorily report data on quality measures for covered Medicare Physician Fee Schedule (PFS) services. Additionally, those who do not meet the 2014 PQRS reporting requirements will be subject to a negative payment adjustment on all Medicare Part B PFS services rendered in 2016.
Note: The deadline listed above does apply to individual EPs and Group Practices participating in other CMS programs such as the Medicare EHR Incentive Program and Comprehensive Primary Care Initiative that are utilizing the reporting methods listed above. Additionally, CMS has extended the deadline for EPs wishing to attest to meaningful use for the EHR reporting period in 2014 for the Medicare Electronic EHR Incentive Program to March 20, 2015. Please be on the lookout for a separate listserv with information regarding the attestation extension.
For questions, please contact the QualityNet Help Desk 1-866-288-8912 or via email at Qnetsupport@hcqis.org from 7:00 a.m. - 7:00 p.m. Central Time. Complete information about PQRS is available at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html
CMS NEWS: Transitioning to ICD-10
FACT SHEET
FOR IMMEDIATE RELEASE
February 25, 2015 Contact: CMS Media Relations
(202) 690-6145 | press@cms.hhs.gov
Transitioning to ICD-10
The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. While most countries already use the 10th revision of these codes (or ICD-10), the United States has yet to adopt this convention. The Centers for Medicare & Medicaid Services (CMS) is working closely with all industry stakeholders to provide support in transitioning to ICD-10 on Oct. 1, 2015.
ICD-9 is out of date.
ICD-9 is more than 35 years old and contains outdated, obsolete terms that are inconsistent with current medical practice. The structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full. ICD-10 provides room for code expansion, so providers can use codes more specific to patient diagnoses. The United States is the last major industrialized nation to make the switch to ICD-10.
ICD-10 codes will provide better support for patient care, and improve management, quality measurement, and analytics.
Since ICD-10 codes are more specific than ICD-9, doctors can capture much more information, meaning they can better understand important details about the patient’s health than with ICD-9-CM. This will:
Improve coordination of a patient’s care across providers over time;
Advance public health research, public health surveillance, and emergency response through detection of disease outbreaks and adverse drug events;
Support innovative payment models that drive quality of care; and
Enhance fraud detection efforts.
Physicians and physician specialty groups in the U. S. provided extensive input into the development and timing of implementation of ICD-10-CM to the Centers for Disease Control and Prevention.
In 2008, the U.S. Department of Health and Human Services (HHS) issued a proposed rule to transition to ICD-10 on Oct. 1, 2011. Stakeholders commented that they needed additional time to prepare for the transition. In the 2009 final rule, HHS established Oct. 1, 2013, as the date for the transition to give providers two additional years to prepare.
In 2012, as part of President Obama’s commitment to reducing regulatory burden, HHS moved the ICD-10 compliance date to Oct. 1, 2014, providing the industry with an additional year to work toward a successful transition. The Protecting Access to Medicare Act of 2014 (PAMA), which was enacted on April 1, 2014, prohibited the Secretary from adopting ICD-10 prior to Oct. 1, 2015.
Stopping or delaying the ICD-10 transition date would be costly to providers and all health care sectors.
The industry has invested significant resources toward the implementation of ICD-10. Many providers, including physicians, hospitals, and health plans, have already completed the necessary system changes to transition to ICD-10. Additional delays pose significant costs for providers who have updated their system.
CMS and many commercial health plans are unable to process claims for both ICD-9 and ICD-10 codes submitted for the same dates of service, so a “transition period” – in which providers could submit claims using either ICD-9 or ICD-10 – is not possible.
At the same time it is not feasible to skip directly to ICD-11 because ICD-10 is a foundational building block prior to moving to ICD-11. The earliest the ICD-11 code set will be released by the World Health Organization (WHO) is 2017. Several prominent industry groups, including the American Medical Association, have issued statements opposing transitioning directly to ICD-11 because of the complexity of the coding system and the best practice to implement ICD-10 to gain experience with that system first.
CMS has conducted extensive ICD-10 outreach, education, and testing, including use of social media, webinars, on-site training, educational articles, and national provider calls to help providers learn about ICD-10 and prepare for the transition.
CMS has developed multiple tools and resources that are available on the ICD-10 website (http://www.cms.gov/ICD10), including ICD-10 implementation guides, tools for small and rural providers, and general equivalency mappings (ICD-9 to ICD-10 crosswalk).
CMS has completed rigorous and comprehensive internal testing to ensure that CMS systems can accept and pay provider claims with ICD-10 codes on Oct. 1, 2015.
CMS has also been conducting external testing with Medicare fee-for-service providers, including two successful acknowledgement testing weeks in March and November 2014. Providers that participated in the testing received electronic acknowledgement confirming whether the submitted test claims were accepted or rejected. While providers, suppliers, billing companies, and clearinghouses can participate in acknowledgement testing at any time, CMS will be conducting the next two special acknowledgment testing periods in March and June 2015 to highlight the testing.
Separately, CMS is offering three end-to-end testing weeks for a sample of volunteer Medicare fee-for-service providers and suppliers leading up to Oct. 1, 2015. The testing weeks (Jan. 26 – Feb. 3, April 27 - May 1 and July 27-31) allow selected providers and suppliers to submit test claims to CMS with ICD-10 codes and receive a remittance advice explaining how the claims were processed. CMS is also working with state Medicaid agencies to conduct end-to-end testing.
Additional ideas on ways to ease this transition are welcome.
New EHR Attestation Deadline for Medicare Eligible Professionals
New EHR Attestation Deadline for Medicare Eligible Professionals: March 20, 2015
Eligible professionals now have until 11:59 pm ET on March 20, 2015, to attest to meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 2014 reporting year.
CMS extended the deadline to allow providers extra time to submit their meaningful use data. CMS continues to urge providers to begin attesting for 2014 as soon as they can.
This extension also allows eligible professionals, who have not already used their one “switch”, to switch programs (from Medicare to Medicaid, or vice versa) for the 2014 payment year until 11:59 pm ET on March 20, 2015. After that time, eligible professionals will no longer be able to switch programs.
Medicare eligible professionals must attest to meaningful use every year to receive an incentive and avoid a payment adjustment. Providers who successfully attest for the 2014 program year will:
Receive an incentive payment
Avoid the Medicare payment adjustment, which will be applied January 1, 2016
Note: The Medicare extension does not affect deadlines for the Medicaid EHR Incentive Program. Additionally, the EHR reporting option for PQRS has been extended until March 20, 2015. Please be on the lookout for a separate listserv with information regarding the PQRS program extension.
How to Attest
Submit your data to the Registration and Attestation System, which includes2014 Certified EHR Technology (CEHRT) Flexibility Rule options.
Tips for speed:
For help, call the EHR Information Center: 1-888-734-6433
TTY for people with hearing impairments: 1-888-734-6563
Monday – Friday, 8:30 am – 7:30 pm (ET)
Eligible professionals now have until 11:59 pm ET on March 20, 2015, to attest to meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 2014 reporting year.
CMS extended the deadline to allow providers extra time to submit their meaningful use data. CMS continues to urge providers to begin attesting for 2014 as soon as they can.
This extension also allows eligible professionals, who have not already used their one “switch”, to switch programs (from Medicare to Medicaid, or vice versa) for the 2014 payment year until 11:59 pm ET on March 20, 2015. After that time, eligible professionals will no longer be able to switch programs.
Medicare eligible professionals must attest to meaningful use every year to receive an incentive and avoid a payment adjustment. Providers who successfully attest for the 2014 program year will:
Receive an incentive payment
Avoid the Medicare payment adjustment, which will be applied January 1, 2016
Note: The Medicare extension does not affect deadlines for the Medicaid EHR Incentive Program. Additionally, the EHR reporting option for PQRS has been extended until March 20, 2015. Please be on the lookout for a separate listserv with information regarding the PQRS program extension.
How to Attest
Submit your data to the Registration and Attestation System, which includes2014 Certified EHR Technology (CEHRT) Flexibility Rule options.
Tips for speed:
- Attest during non-peak hours, such as evenings and weekends
- Start now to:
- Check that your information is up to date
- Begin entering your 2014 data
For help, call the EHR Information Center: 1-888-734-6433
TTY for people with hearing impairments: 1-888-734-6563
Monday – Friday, 8:30 am – 7:30 pm (ET)
Medicare Part A News-Jurisdiction H for February 24th, 2015
The following information is provided by Novitas Solutions.
Open Claim Issues for Medicare Part A
Reason code 36616 is assigning on ESRD claims and suspending to status location SMRATE. It appears the cause is due to incorrect CBSAs (Core-Based Statistical Areas) assigned to some ESRD facilities. FISS (Fiscal Intermediary Shared System) installed a correction to add the correct CBSAs. Some of the affected claims were released today as a test to ensure the new CBSAs corrected the problem. Once this is confirmed, the remaining claims will be released.
New Medicare Insights Weekly Podcasts now available!
In this week's Medicare Insights Weekly Podcast, we review our mailing list and all it has to offer.
Open Claim Issues for Medicare Part A
Reason code 36616 is assigning on ESRD claims and suspending to status location SMRATE. It appears the cause is due to incorrect CBSAs (Core-Based Statistical Areas) assigned to some ESRD facilities. FISS (Fiscal Intermediary Shared System) installed a correction to add the correct CBSAs. Some of the affected claims were released today as a test to ensure the new CBSAs corrected the problem. Once this is confirmed, the remaining claims will be released.
New Medicare Insights Weekly Podcasts now available!
In this week's Medicare Insights Weekly Podcast, we review our mailing list and all it has to offer.
Rural Health Open Door Forum Update
The next CMS Rural Health Open Door Forum is scheduled for:
Date: Thursday, February 26, 2015;
Start Time: 2:00pm Eastern Time (ET);
Please dial in at least 15 minutes prior to call start time.
Conference Leaders: Marge Watchorn, John Hammarlund and Jill Darling.
**This Agenda is Subject to Change**
Opening Remarks
Chair- Marge Watchorn, (CMCS)
Co-Chair – John Hammarlund, Regional Administrator, Seattle Regional Office
Moderator – Jill Darling, Office of Communications
Announcements & Updates
The Veterans Choice Program Update
b. New Model Announcement: CMS Oncology Care Model (OCM)
OCM Website: http://innovation.cms.gov/initiatives/Oncology-Care/
OCM Inbox: OncologyCareModel@cms.hhs.gov
c. PQRS Letters-CAHs Payment Reductions
Open Q&A
**Next ODF: April 9th, 2015**
---------------------------------------------------------------------
Open Door Forum Participation Instructions:
This call will be Conference Call Only.
1. To participate by phone:
Dial: 1-800-837-1935 & Reference Conference ID: 12634026
Persons participating by phone are not required to RSVP. TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
Encore: 1-855-859-2056; Conference ID: 12634026
Encore is an audio recording of this call that can be accessed by dialing 1-855-859-2056 and entering the Conference ID. Encores for ODFs held on Thursdays can be accessed the following Monday. The recording is available for 3 business days.
For ODF schedule updates & E-Mailing List registration, visit our website at http://www.cms.gov/OpenDoorForums/.
Date: Thursday, February 26, 2015;
Start Time: 2:00pm Eastern Time (ET);
Please dial in at least 15 minutes prior to call start time.
Conference Leaders: Marge Watchorn, John Hammarlund and Jill Darling.
**This Agenda is Subject to Change**
Opening Remarks
Chair- Marge Watchorn, (CMCS)
Co-Chair – John Hammarlund, Regional Administrator, Seattle Regional Office
Moderator – Jill Darling, Office of Communications
Announcements & Updates
The Veterans Choice Program Update
b. New Model Announcement: CMS Oncology Care Model (OCM)
OCM Website: http://innovation.cms.gov/initiatives/Oncology-Care/
OCM Inbox: OncologyCareModel@cms.hhs.gov
c. PQRS Letters-CAHs Payment Reductions
Open Q&A
**Next ODF: April 9th, 2015**
---------------------------------------------------------------------
Open Door Forum Participation Instructions:
This call will be Conference Call Only.
1. To participate by phone:
Dial: 1-800-837-1935 & Reference Conference ID: 12634026
Persons participating by phone are not required to RSVP. TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.
Encore: 1-855-859-2056; Conference ID: 12634026
Encore is an audio recording of this call that can be accessed by dialing 1-855-859-2056 and entering the Conference ID. Encores for ODFs held on Thursdays can be accessed the following Monday. The recording is available for 3 business days.
For ODF schedule updates & E-Mailing List registration, visit our website at http://www.cms.gov/OpenDoorForums/.
Supplemental Webinar for Assisters: Connecting Marketplace Outreach, Education, and Enrollment to Free Tax Preparation
Connecting Marketplace Outreach, Education, and Enrollment to Free Tax Preparation
Come learn about best practices for connecting free tax preparation (Volunteer Income Tax Assistance-VITA) with enrollment assistance. CMS will feature Navigator grantees that are VITA sites or partner with VITA sites that will share their experiences and tips for connecting consumers to both these services. Some consumers might still qualify for a Special Enrollment Period or Medicaid, and making these connections is very important.
When: Tuesday, February 24 @ 1:00pm EST
Webinar url: https://webinar.cms.hhs.gov/c4cwebinar022415/
Call in information:
Participant: (800) 837-1935
Conference ID: 91590419
Come learn about best practices for connecting free tax preparation (Volunteer Income Tax Assistance-VITA) with enrollment assistance. CMS will feature Navigator grantees that are VITA sites or partner with VITA sites that will share their experiences and tips for connecting consumers to both these services. Some consumers might still qualify for a Special Enrollment Period or Medicaid, and making these connections is very important.
When: Tuesday, February 24 @ 1:00pm EST
Webinar url: https://webinar.cms.hhs.gov/c4cwebinar022415/
Call in information:
Participant: (800) 837-1935
Conference ID: 91590419
Rural Research Alert: Rural Provider Perceptions of the ACA: Case Studies in Four States
Rural Provider Perceptions of the ACA: Case Studies in Four States
The Affordable Care Act (ACA) expanded health insurance coverage to previously uninsured populations by allowing states to expand Medicaid coverage to adults with incomes up to 138% of the federal poverty level (FPL) as well as by creating health insurance marketplaces to subsidize affordable coverage. However, states with a higher number or proportion of rural residents were less likely to expand Medicaid than were more urban states. In addition, rural residents eligible for insurance coverage through the new health insurance market place were less likely to enroll in coverage compared to eligible urban residents.
In order to inform timely policy development, the North Carolina Rural Health Research Program surveyed rural providers’ early experiences of the ACA in four states: two that chose to expand Medicaid (Arizona and North Dakota), and two that chose not to expand Medicaid (Georgia and Maine). Our findings brief, Rural Provider Perceptions of the ACA: Case Studies in Four States summarizes perceptions from these states regarding the early effects of the ACA, including changes to patient populations, financial health, and capacity for rural hospitals and rural FQHCs.
Contact Information:
Pam Silberman, JD, DrPH
North Carolina Rural Health Research and Policy Analysis Center
Phone: 919-966-4525
pam_silberman@unc.edu
Additional Resources of Interest:
More information about the North Carolina Rural Health Research and Policy Analysis Center
More information from the Rural Assistance Center, Critical Access Hospitals, Federally Qualified Health Centers, Health Insurance Outreach and Enrollment , Medicaid, Rural Health Clinics, Rural Health Policy topic guide
The Affordable Care Act (ACA) expanded health insurance coverage to previously uninsured populations by allowing states to expand Medicaid coverage to adults with incomes up to 138% of the federal poverty level (FPL) as well as by creating health insurance marketplaces to subsidize affordable coverage. However, states with a higher number or proportion of rural residents were less likely to expand Medicaid than were more urban states. In addition, rural residents eligible for insurance coverage through the new health insurance market place were less likely to enroll in coverage compared to eligible urban residents.
In order to inform timely policy development, the North Carolina Rural Health Research Program surveyed rural providers’ early experiences of the ACA in four states: two that chose to expand Medicaid (Arizona and North Dakota), and two that chose not to expand Medicaid (Georgia and Maine). Our findings brief, Rural Provider Perceptions of the ACA: Case Studies in Four States summarizes perceptions from these states regarding the early effects of the ACA, including changes to patient populations, financial health, and capacity for rural hospitals and rural FQHCs.
Contact Information:
Pam Silberman, JD, DrPH
North Carolina Rural Health Research and Policy Analysis Center
Phone: 919-966-4525
pam_silberman@unc.edu
Additional Resources of Interest:
More information about the North Carolina Rural Health Research and Policy Analysis Center
More information from the Rural Assistance Center, Critical Access Hospitals, Federally Qualified Health Centers, Health Insurance Outreach and Enrollment , Medicaid, Rural Health Clinics, Rural Health Policy topic guide
Medicare Learning Network Updates, February 23rd, 2015
Medicare News
Medicare Learning Network (MLN) Articles from CMS
Revised:
Medicare Learning Network (MLN) Articles from CMS
Revised:
CMS Strengthens Five Star Quality Rating System for Nursing Homes
CMS Strengthens Five Star Quality Rating System for Nursing Homes
The Centers for Medicare & Medicaid Services (CMS) today strengthened the Five Star Quality Rating System for Nursing Homes on the Nursing Home Compare website to give families more precise and meaningful information on quality when they consider facilities for themselves or a loved one. Today’s announcement also marks an important milestone to achieving the goal of implementing further improvements to the Five Star system in 2015, as the Administration announced last October.
Star ratings allow users to see important differences in quality among nursing homes to help them make better care decisions. CMS rates nursing homes on three categories: results from onsite inspections by trained surveyors, performance on certain quality measures, and levels of staffing. CMS uses these three categories to offer an overall star rating, but consumers can see and focus on any of the three individual categories.
Beginning today, nursing home star ratings will:
Include use of antipsychotics in calculation of the star ratings. These medications are often used for diagnoses that do not warrant them. The two existing quality measures – for short stay and long stay patients – will now be part of the calculation for the quality measures star rating.
Have improved calculations for staffing levels. Research indicates that staffing is important to overall quality in a nursing home.
Reflect higher standards for nursing homes to achieve a high rating on the quality measure dimension on the website.
“CMS is committed to improving Nursing Home Compare and the Five Star Quality Rating System to ensure they are the most trusted and easy-to-use resources we can provide,” said Patrick Conway, M.D., CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer for CMS. “Consumers can feel confident that Nursing Home Compare’s star ratings include measures that matter most to nursing home residents and their families and challenge nursing homes to continuously improve care.”
Since CMS standards for performance on quality measures are increasing, many nursing homes will see a decline in their quality measures star rating. By making this change, Nursing Home Compare will include more meaningful distinctions in performance for consumers and focus nursing homes on continuously improving care focused on residents, families, and their caregivers. About two thirds of nursing homes will see a decline in their quality measures rating and about one third of nursing homes will experience a decline in their Overall Five Star Rating.
For example, before the recalibration, about 80 percent of nursing homes received either a 4 or 5-star rating on their quality measures. Now, about 49 percent of nursing homes will receive a 4 or 5 stars on their quality measure rating. Also, the number of nursing homes receiving one star for their quality measures has increased from 8.5 percent to 13 percent after the recalibration.
CMS is also focusing changes in areas identified by consumers and other stakeholders as important. For example, by the end of 2013 nursing homes achieved a 15 percent reduction in the use of anti-psychotics compared to 2011 levels. As part of the National Partnership to Improve Dementia Care, CMS is working with the nursing home community, patients, families and other important stakeholders to achieve a 30 percent reduction by the end of CY2016.
The Nursing Home Compare website was launched in 1998, and CMS added the Five Star Quality Rating System (“NH Compare 2.0”) in 2008. Nursing Home Compare gets approximately 1.4 million visits per year and users report high satisfaction with the site. More than 85 percent of users have indicated that they found the information they were seeking. CMS recommends that consumers rely on multiple factors – including star ratings, visits and community reputation -- when selecting a nursing home.
To achieve better care, smarter spending and healthier people, the Department of Health and Human Services is focused on sharing information more broadly to providers, consumers, and others to support better decisions while enforcing patient privacy. The Five Star Quality Rating System for Nursing Homes is part of an administration-wide effort to increase the availability and accessibility of information on quality, utilization and costs for effective, informed decision-making by consumers.
To read a fact sheet on Nursing Home Compare 3.0, visit http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-02-12-2.html.
To search for nursing homes in local areas, visit Medicare.gov/nursinghomecompare/search.html.
For more information on the national partnership, visit CMS.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-14-19.pdf.
For more information on the Advancing Excellence campaign, visit nhqualitycampaign.org/news.aspx#17.
The Centers for Medicare & Medicaid Services (CMS) today strengthened the Five Star Quality Rating System for Nursing Homes on the Nursing Home Compare website to give families more precise and meaningful information on quality when they consider facilities for themselves or a loved one. Today’s announcement also marks an important milestone to achieving the goal of implementing further improvements to the Five Star system in 2015, as the Administration announced last October.
Star ratings allow users to see important differences in quality among nursing homes to help them make better care decisions. CMS rates nursing homes on three categories: results from onsite inspections by trained surveyors, performance on certain quality measures, and levels of staffing. CMS uses these three categories to offer an overall star rating, but consumers can see and focus on any of the three individual categories.
Beginning today, nursing home star ratings will:
Include use of antipsychotics in calculation of the star ratings. These medications are often used for diagnoses that do not warrant them. The two existing quality measures – for short stay and long stay patients – will now be part of the calculation for the quality measures star rating.
Have improved calculations for staffing levels. Research indicates that staffing is important to overall quality in a nursing home.
Reflect higher standards for nursing homes to achieve a high rating on the quality measure dimension on the website.
“CMS is committed to improving Nursing Home Compare and the Five Star Quality Rating System to ensure they are the most trusted and easy-to-use resources we can provide,” said Patrick Conway, M.D., CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer for CMS. “Consumers can feel confident that Nursing Home Compare’s star ratings include measures that matter most to nursing home residents and their families and challenge nursing homes to continuously improve care.”
Since CMS standards for performance on quality measures are increasing, many nursing homes will see a decline in their quality measures star rating. By making this change, Nursing Home Compare will include more meaningful distinctions in performance for consumers and focus nursing homes on continuously improving care focused on residents, families, and their caregivers. About two thirds of nursing homes will see a decline in their quality measures rating and about one third of nursing homes will experience a decline in their Overall Five Star Rating.
For example, before the recalibration, about 80 percent of nursing homes received either a 4 or 5-star rating on their quality measures. Now, about 49 percent of nursing homes will receive a 4 or 5 stars on their quality measure rating. Also, the number of nursing homes receiving one star for their quality measures has increased from 8.5 percent to 13 percent after the recalibration.
CMS is also focusing changes in areas identified by consumers and other stakeholders as important. For example, by the end of 2013 nursing homes achieved a 15 percent reduction in the use of anti-psychotics compared to 2011 levels. As part of the National Partnership to Improve Dementia Care, CMS is working with the nursing home community, patients, families and other important stakeholders to achieve a 30 percent reduction by the end of CY2016.
The Nursing Home Compare website was launched in 1998, and CMS added the Five Star Quality Rating System (“NH Compare 2.0”) in 2008. Nursing Home Compare gets approximately 1.4 million visits per year and users report high satisfaction with the site. More than 85 percent of users have indicated that they found the information they were seeking. CMS recommends that consumers rely on multiple factors – including star ratings, visits and community reputation -- when selecting a nursing home.
To achieve better care, smarter spending and healthier people, the Department of Health and Human Services is focused on sharing information more broadly to providers, consumers, and others to support better decisions while enforcing patient privacy. The Five Star Quality Rating System for Nursing Homes is part of an administration-wide effort to increase the availability and accessibility of information on quality, utilization and costs for effective, informed decision-making by consumers.
To read a fact sheet on Nursing Home Compare 3.0, visit http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-02-12-2.html.
To search for nursing homes in local areas, visit Medicare.gov/nursinghomecompare/search.html.
For more information on the national partnership, visit CMS.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-14-19.pdf.
For more information on the Advancing Excellence campaign, visit nhqualitycampaign.org/news.aspx#17.
National Provider ICD 10 Implementation Call
CMS Schedules ICD-10 Implementation and Testing Call
The Centers for Medicare & Medicaid Services (CMS) has announced it will host a National Provider Call next week to help providers prepare for the upcoming ICD-10 implementation date on Oct. 1, 2015. Providers will have the opportunity to discuss ICD-10 implementation issues, testing opportunities and resources which will be followed by a question and answer session.
The call is scheduled from 11:30 – 1 p.m. MST on Thursday, Feb. 26. Click on the following lick to register http://www.eventsvc.com/blhtechnologies/register/64a79bdb-499f-42aa-b2d1-c66ef3591201
For more information, contact Scott Anderson, CHA vice president of professional activities, at scott.anderson@cha.com or 720.330.6028.
The Centers for Medicare & Medicaid Services (CMS) has announced it will host a National Provider Call next week to help providers prepare for the upcoming ICD-10 implementation date on Oct. 1, 2015. Providers will have the opportunity to discuss ICD-10 implementation issues, testing opportunities and resources which will be followed by a question and answer session.
The call is scheduled from 11:30 – 1 p.m. MST on Thursday, Feb. 26. Click on the following lick to register http://www.eventsvc.com/blhtechnologies/register/64a79bdb-499f-42aa-b2d1-c66ef3591201
For more information, contact Scott Anderson, CHA vice president of professional activities, at scott.anderson@cha.com or 720.330.6028.
CMS EHR Survey
Long-term and Post-Acute Providers are invited to participate in a voluntary survey to help CMS understand the role technology is playing in the delivery of health care services in these settings. This survey helps identify the benefits and challenges providers encounter when participating in CMS programs that promote health care interoperability.
· Survey period: February 17, 2015 to March 3, 2015
· To access survey, click the link or paste it into your web browser: https://www.surveymonkey.com/s/3T9MV3J
· Survey period: February 17, 2015 to March 3, 2015
· To access survey, click the link or paste it into your web browser: https://www.surveymonkey.com/s/3T9MV3J
Webinar: Telemedicine to Revolutionize Rural Healthcare
Telemedicine to Revolutionize Rural Healthcare
Wednesday, March 4, 2015
12:00-1:00 pm Central Time
Join us for an educational webinar to learn how to leverage telemedicine to lower costs and improve clinical care within a rural health environment.
Presenters: Maitrayee Vadali, MD and Scott Rombach
Dr. Vadali has been a practicing cardiologist for 15 years and specializes in interpreting diagnostic exams. Dr. Vadali is licensed in 10 different states, and has two internal medicine board-certifications including cardiovascular disease. Dr. Vadali received her undergraduate degree from Massachusetts Institute of Technology and her MD from the UCLA School of Medicine.
Scott Rombach has an MBA from Georgia State University and a BA in Marketing from Michigan State University. Mr. Rombach is committed to providing rural facilities with access to world-class specialists at a low cost and assisting more hospitals in delivering top patient care within local communities.
Learn more and register now.
Wednesday, March 4, 2015
12:00-1:00 pm Central Time
Join us for an educational webinar to learn how to leverage telemedicine to lower costs and improve clinical care within a rural health environment.
Presenters: Maitrayee Vadali, MD and Scott Rombach
Dr. Vadali has been a practicing cardiologist for 15 years and specializes in interpreting diagnostic exams. Dr. Vadali is licensed in 10 different states, and has two internal medicine board-certifications including cardiovascular disease. Dr. Vadali received her undergraduate degree from Massachusetts Institute of Technology and her MD from the UCLA School of Medicine.
Scott Rombach has an MBA from Georgia State University and a BA in Marketing from Michigan State University. Mr. Rombach is committed to providing rural facilities with access to world-class specialists at a low cost and assisting more hospitals in delivering top patient care within local communities.
Learn more and register now.
Rural Hospital Improves Clinical Care and Lowers the Cost of Healthcare Delivery
Rural Hospital Improves Clinical Care and Lowers the Cost of Healthcare Delivery
Crossing Rivers Health (formerly Prairie du Chien Memorial Hospital) is utilizing the CompuMed, Inc. Enterprise Telemedicine Solution for Rural Healthcare to improve clinical care and lower the cost of healthcare delivery within its clinics and hospitals.
The CompuMed solution provides real-time access to its network of Board-Certified specialists for interpretation of diagnostic studies and critical care consulting, as well as world-class, telemedicine-enabled medical devices.
"CompuMed's Enterprise Telemedicine Solution for Rural Healthcare enables Crossing Rivers to deliver on our mission of meeting the health and wellness needs of our communities. We particularly like the quality and timeliness of the reports we receive from CompuMed's team of Board-Certifified specialists. Furthermore, their specialists and 24/7 customer support team is dependable and available when we need them most," said Tim Clark, Crossing Rivers Health, Director of Medical Imaging.
Crossing Rivers Health (formerly Prairie du Chien Memorial Hospital) is utilizing the CompuMed, Inc. Enterprise Telemedicine Solution for Rural Healthcare to improve clinical care and lower the cost of healthcare delivery within its clinics and hospitals.
The CompuMed solution provides real-time access to its network of Board-Certified specialists for interpretation of diagnostic studies and critical care consulting, as well as world-class, telemedicine-enabled medical devices.
"CompuMed's Enterprise Telemedicine Solution for Rural Healthcare enables Crossing Rivers to deliver on our mission of meeting the health and wellness needs of our communities. We particularly like the quality and timeliness of the reports we receive from CompuMed's team of Board-Certifified specialists. Furthermore, their specialists and 24/7 customer support team is dependable and available when we need them most," said Tim Clark, Crossing Rivers Health, Director of Medical Imaging.
Wednesday, February 18, 2015
Medicare Part A and B News-Jurisdiction H for February 17th, 2015
The following information is provided by Novitas Solutions.
Availability of the Proposed Federal Fiscal Year (FY) 2016 Wage Index Public Use Files (PUFs) and Deadline for Requesting Corrections to the Wage Index Data
On Friday, February 13, 2015, the Centers for Medicare & Medicaid Services (CMS) released the proposed FY 2016 wage index PUFs. Two PUFs are available on CMS’s Web site on February 13, 2015. One PUF contains three spreadsheets of data: the Worksheet S-3 wage data (which includes Worksheet S-3, Parts II and III wage data from cost reporting periods beginning on or after October l, 2011 through September 30, 2012; that is, FY 2012 wage data) is included in 1 spreadsheet; the occupational mix data (which includes data from the calendar year (CY) 2013 occupational mix survey, Form CMS-10079) is included in the 2nd spreadsheet. This PUF includes data for all hospitals in CMS’s database through February 12, 2015. The data in the PUF will be used in the development of the proposed FY 2016 wage index, to be published in the Federal Register in Spring 2015. The second PUF displays a comparison of area average hourly wages for FY 2015 versus FY 2016 (preliminary).
More information is available on the Novitas website, at the Wage Index / Occupational Mix page.
New Medicare Insights Weekly Podcasts now available!
In this week's Medicare Insights Weekly Podcast, we review the 2015 Deductible, Coinsurance and Therapy Caps.
MLN Connects Provider eNews, February 6th, 2015
CMS Provider Education Message:
MLN Connects™ Provider eNews for February 5, 2015
View this edition as a PDF
In This Edition:
MLN Connects™ National Provider Calls
MLN Connects™ Videos
CMS Events
Announcements
Claims, Pricers, and Codes
Medicare Learning Network® Educational Products
The Top Claim Submission Errors and resolutions for January 2015 are now available. Please take time to review these errors and avoid them on future claims.
Educational Event Added to February Events Calendar
The following webinar has been added to the February Events Calendar:
MLN Connects™ Provider eNews for February 5, 2015
View this edition as a PDF
In This Edition:
MLN Connects™ National Provider Calls
- Payment of Chronic Care Management Services under CY 2015 Medicare PFS — Register Now
- ICD-10 Implementation and Medicare Testing — Register Now
- New MLN Connects™ National Provider Call Audio Recordings and Transcripts
MLN Connects™ Videos
- Monthly Spotlight: Individualized Quality Control Plan for CLIA Laboratory Non-Waived Testing
CMS Events
- Special Open Door Forum: Home Health Clinical Templates
Announcements
- HHS Proposes Path to Improve Health Technology and Transform Care
- Extension of Temporary Moratoria on Enrollment of New HHAs, HHA Sub-units and Part B Ambulance Suppliers
- CLIA Individualized Quality Control Plan: Education and Transition Period Ends December 31, 2015
- 2015 PQRS Payment Adjustment and Providers who Rendered Services at RHCs/FQHCs
- Open Payments: Second Year of Data Submission Begins
- CMS Intends to Engage in Rulemaking for EHR Incentive Program Changes for 2015
- Get Started with Hospice CAHPS
- Proposed Decision Memo: Screening for the HIV Infection
Claims, Pricers, and Codes
- Home Health Pricer will be Updated on April 1
- FY 2015 Inpatient PPS PC Pricer Update Available
Medicare Learning Network® Educational Products
- “Payment Codes on Home Health Claims Will Be Matched Against Patient Assessments” MLN Matters® Article — Released
- “Extension of Provider Enrollment Moratoria for Home Health Agencies and Part B Ambulance Suppliers” MLN Matters® Article — Revised
- “Internet-based PECOS Contact Information” Fact Sheet — Reminder
- Medicare Learning Network® Products Available In Electronic Publication Format
- Subscribe to the MLN Matters® Electronic Mailing List
- Helpful Tips on Medicare Learning Network® Products and Learning Management System — Subscribe Now
The Top Claim Submission Errors and resolutions for January 2015 are now available. Please take time to review these errors and avoid them on future claims.
Educational Event Added to February Events Calendar
The following webinar has been added to the February Events Calendar:
- 02/25/2015 Part A Proper Use of Modifiers
SAMHSA's Service Members, Veterans, and their Families Technical Assistance Center
Opportunity for Mental Health Clinicians: Project (On-line User Training for Intervention in Trauma) OUTFIT
Mental health clinicians have an opportunity to take part in Project OUTFIT, a PTSD training study based at the National Center for PTSD (U.S. Department of Veteran Affairs). This research project is investigating the impact of different delivery methods of a state-of-the art skills training curriculum for addressing trauma. Community-based mental health providers who have treated at least one veteran with stress-related issues in the past year are invited to enroll in the study. Participants receive free training in one of three formats, and will take part in an online survey and mock phone session at three time points (baseline, 3-month, and 6-month). Five continuing education credits will be issued for completion of the training (see letter for specific accreditations).
Learn more….
Public Comment Requested on Criteria for Community Clinics
SAMHSA is seeking public comment on the draft criteria for Certified Community Behavioral Health Clinics. These clinics will focus on improving outcomes by increasing access to community-based behavioral healthcare, expanding the availability and array of services, and improving the quality of care delivered to people with mental and/or substance use disorders.
Learn more…
WEBINAR: Veterans Choice Program
March 3, 2015; 3:00-4:00 p.m. ET
The Federal Office of Rural Health Policy (FORHP) will be hosting a Veterans Choice Program Webinar consisting of a presentation of the new program, which expands access to healthcare to thousands of veterans by allowing them to receive care from non-VA health care providers.
Learn more and register…
Mental health clinicians have an opportunity to take part in Project OUTFIT, a PTSD training study based at the National Center for PTSD (U.S. Department of Veteran Affairs). This research project is investigating the impact of different delivery methods of a state-of-the art skills training curriculum for addressing trauma. Community-based mental health providers who have treated at least one veteran with stress-related issues in the past year are invited to enroll in the study. Participants receive free training in one of three formats, and will take part in an online survey and mock phone session at three time points (baseline, 3-month, and 6-month). Five continuing education credits will be issued for completion of the training (see letter for specific accreditations).
Learn more….
Public Comment Requested on Criteria for Community Clinics
SAMHSA is seeking public comment on the draft criteria for Certified Community Behavioral Health Clinics. These clinics will focus on improving outcomes by increasing access to community-based behavioral healthcare, expanding the availability and array of services, and improving the quality of care delivered to people with mental and/or substance use disorders.
Learn more…
WEBINAR: Veterans Choice Program
March 3, 2015; 3:00-4:00 p.m. ET
The Federal Office of Rural Health Policy (FORHP) will be hosting a Veterans Choice Program Webinar consisting of a presentation of the new program, which expands access to healthcare to thousands of veterans by allowing them to receive care from non-VA health care providers.
Learn more and register…
Hospitals Must Start Medicare EHR Participation in 2015 to Earn Incentives
Not participating in the Medicare EHR Incentive Program yet? 2015 is the last year for eligible hospitals to begin and still earn incentive payments.
To earn a 2015 incentive payment and avoid a 2016 payment adjustment, first-time participants should:
Begin their 90-day reporting period no later than April 1, 2015
Attest by July 1, 2015
Eligible hospitals that miss this deadline can still earn a 2015 incentive payment—and avoid the 2017 payment adjustment—if they begin their reporting period by July 1 and attest by November 30. However, they will be subject to the 2016 payment adjustment unless they apply and qualify for a hardship exception.
Hospitals that successfully attest in 2015 will also be eligible to earn a 2016 incentive if they continue to participate.
Eligible hospitals that begin participating after 2015 will not be able to earn incentive payments. They will also be subject to payment adjustments in 2016 and 2017.
Additional Resources
The EHR Incentive Programs website offers tools and resources to help eligible hospitals to successfully participate:
To earn a 2015 incentive payment and avoid a 2016 payment adjustment, first-time participants should:
Begin their 90-day reporting period no later than April 1, 2015
Attest by July 1, 2015
Eligible hospitals that miss this deadline can still earn a 2015 incentive payment—and avoid the 2017 payment adjustment—if they begin their reporting period by July 1 and attest by November 30. However, they will be subject to the 2016 payment adjustment unless they apply and qualify for a hardship exception.
Hospitals that successfully attest in 2015 will also be eligible to earn a 2016 incentive if they continue to participate.
Eligible hospitals that begin participating after 2015 will not be able to earn incentive payments. They will also be subject to payment adjustments in 2016 and 2017.
Additional Resources
The EHR Incentive Programs website offers tools and resources to help eligible hospitals to successfully participate:
Thursday, February 12, 2015
Quick Tip for CREATE Grant Applications
Use Your Words.
We learned it in Kindergarten! It’s important to explain what you need and why you need it. Remember to put those skills to use in your CREATE Grant applications – especially when explaining your budget. The budget narrative is essential in justifying project costs to the grant reviewers. An effective budget narrative explains how the funds would be spent, why the course is important, and why it is cost effective. The narrative must tell the reader more then why the costs are needed but give a tangible view of the impact that can be made with the grant funds being requested. Addressing unorthodox purchases or large expenditures will help the reviewers understand the budgeting practices of the entity and help justify the need. Write each justification with “cost effectiveness” in mind. Show evidence to convince the reviewer that the course would make an impact worth the price and is a necessity. Identify the specific goals and objectives of the proposal that correspond with each budget category, equally, state why the course is important to the mission of the organization. Identifying prices of expected costs when writing your budget narrative are always important as well, do not require the reader to look back at the budget and “assume” what things will cost. If costs are based on projections only, give details on how the costs were estimated, and attach copies of estimates to the proposal.
Thank you for all you do for all our Colorado communities! We are here to support you, so please do not hesitate to contact us with questions or concerns.
If you have any questions about the CREATE Grant process, please contact Megan Lyda at ml@coruralhealth.org.
We learned it in Kindergarten! It’s important to explain what you need and why you need it. Remember to put those skills to use in your CREATE Grant applications – especially when explaining your budget. The budget narrative is essential in justifying project costs to the grant reviewers. An effective budget narrative explains how the funds would be spent, why the course is important, and why it is cost effective. The narrative must tell the reader more then why the costs are needed but give a tangible view of the impact that can be made with the grant funds being requested. Addressing unorthodox purchases or large expenditures will help the reviewers understand the budgeting practices of the entity and help justify the need. Write each justification with “cost effectiveness” in mind. Show evidence to convince the reviewer that the course would make an impact worth the price and is a necessity. Identify the specific goals and objectives of the proposal that correspond with each budget category, equally, state why the course is important to the mission of the organization. Identifying prices of expected costs when writing your budget narrative are always important as well, do not require the reader to look back at the budget and “assume” what things will cost. If costs are based on projections only, give details on how the costs were estimated, and attach copies of estimates to the proposal.
Thank you for all you do for all our Colorado communities! We are here to support you, so please do not hesitate to contact us with questions or concerns.
If you have any questions about the CREATE Grant process, please contact Megan Lyda at ml@coruralhealth.org.
Veterans Choice Program Webinar
The Federal Office of Rural Health Policy (FORHP) will be hosting a webinar on the Veterans Choice Program on Tuesday, March 3, 2015 from 3pm – 4pm. The Veterans Choice Program is a new program from the Department of Veterans Affairs (VA) that expands access to health care to thousands of veterans by allowing them to receive care from non-VA health care providers.
This will be an opportunity for FORHP grantees, stakeholders in State Offices of Rural Health, Rural Health Clinics, Critical Access Hospitals, Medicare Dependent Hospitals, Sole Community Hospitals, Federal Qualified Health Clinics, and other providers who serve the rural community to learn more about the Veterans Choice Program, including the processes and requirements to participate in the program and provide services to rural veterans.
More details on the webinar will be provided shortly. We hope that grantees and other stakeholders in the rural community will participate in this informative webinar!
This will be an opportunity for FORHP grantees, stakeholders in State Offices of Rural Health, Rural Health Clinics, Critical Access Hospitals, Medicare Dependent Hospitals, Sole Community Hospitals, Federal Qualified Health Clinics, and other providers who serve the rural community to learn more about the Veterans Choice Program, including the processes and requirements to participate in the program and provide services to rural veterans.
More details on the webinar will be provided shortly. We hope that grantees and other stakeholders in the rural community will participate in this informative webinar!
Webinar: Colorado Rural Health Center's Improving Communication and Readmissions (iCARE)
Colorado Rural Health Center's Improving Communication and Readmissions (iCARE)
Webinar: Wednesday, February 18 12:00pm-1:00pm MT
Hosted by the Center for Improving Value in Health Care
Click Here for Free Registration
Join us for an introduction to the Colorado Rural Health Center's Improving Communication and Readmissions (iCARE) project as well as an inside look at Sedgwick County Health Center's discharge follow up process which has made an impact to the transition process for their patients.
Webinar: Wednesday, February 18 12:00pm-1:00pm MT
Hosted by the Center for Improving Value in Health Care
Click Here for Free Registration
Join us for an introduction to the Colorado Rural Health Center's Improving Communication and Readmissions (iCARE) project as well as an inside look at Sedgwick County Health Center's discharge follow up process which has made an impact to the transition process for their patients.
MLN Connects Provider eNews-Thursday, February 12th, 2015
View this edition as a PDF
In This Edition:
MLN Connects™ National Provider Calls
Announcements
Claims, Pricers, and Codes
Medicare Learning Network® Educational Products
In This Edition:
MLN Connects™ National Provider Calls
- Payment of Chronic Care Management Services under CY 2015 Medicare PFS — Last Chance to Register
- ICD-10 Implementation and Medicare Testing — Register Now
- National Partnership to Improve Dementia Care in Nursing Homes and QAPI — Registration Now Open
- Physician Compare Benchmark Discussion Webinars
Announcements
- DMEPOS Competitive Bidding: Register by Tuesday in Order to Bid
- February is American Heart Month
- IRF Quality Reporting Program: Data Submission Deadline February 15
- LTCH Quality Reporting Program: Data Submission Deadline February 15
- EHR Incentive Program: 2014 Attestation Deadline for Eligible Professionals February 28
- EHR Incentive Programs: Public Health Objectives: Reporting Requirements in Stage 1 and 2
- NCD for Screening for Lung Cancer with Low Dose Computed Tomography
- Background Fingerprints: Check Your Status Online
- Antipsychotic Drug use in Nursing Homes: Trend Update
- CMS is Accepting Suggestions for Potential PQRS Measures
Claims, Pricers, and Codes
- CY 2015 HH PPS PC Pricer and PPS Main Frame Pricer Updates Available
Medicare Learning Network® Educational Products
- “Hospital Outpatient Prospective Payment System” Fact Sheet — Revised
- “DMEPOS Quality Standards” Booklet — Reminder
- “Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Information for Pharmacies” Fact Sheet — Reminder
- “Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services” Fact Sheet — Reminder
Colorado Healthy Hospital Compact Webinar
The Colorado Healthy Hospital Compact offers a webinar on Using Price Differential to Promote Healthy Choices. Centura Health: St. Anthony Hospital and Penrose hospitals, and LiveWell Colorado will present.
When: Thursday, Feb. 19, 9:30 -10:30 a.m.
Where: St. Anthony Hospital, 11600 West 2nd Place, Lakewood, 80228, Auditorium A & B
Online: Adobe Connect Meeting - https://cdphe.adobeconnect.com/chhc
When: Thursday, Feb. 19, 9:30 -10:30 a.m.
Where: St. Anthony Hospital, 11600 West 2nd Place, Lakewood, 80228, Auditorium A & B
Online: Adobe Connect Meeting - https://cdphe.adobeconnect.com/chhc
THE Consortium: HIT Educational Webinar - Feb. 24, 2015
THE Consortium: HIT Educational Webinar - Feb. 24, 2015
Please join us for the next webinar in our HIT EDUCATIONAL SERIES on Thursday, February 24, 2015 from 12:00 pm to 1:00 pm.
Meeting Description:
The recent breach of health plan member PHI (“protected health information”) has caused an enormous amount of discussion related to the a variety of HIPAA compliance requirements.
This month’s webinar will take a deep dive into what this means for our rural hospitals and clinics including:
1. To encrypt or not-that is the question!
2. And if so, encrypt what?
3. What this breach teaches us?
Please invite your IT staff, C level staff, HIM and of course your HIPAA compliance officials!
This webinar series is free to hospitals participating in the Colorado FY2014 SHIP grant program as well as CRHC members. All other facilities will be charged $49 for the webinar.
**Register here for the webinar, and be sure to enter in the member code at check-out if you are a CRHC member or are a participant of THE Consortium.**
Please join us for the next webinar in our HIT EDUCATIONAL SERIES on Thursday, February 24, 2015 from 12:00 pm to 1:00 pm.
The recent breach of health plan member PHI (“protected health information”) has caused an enormous amount of discussion related to the a variety of HIPAA compliance requirements.
This month’s webinar will take a deep dive into what this means for our rural hospitals and clinics including:
1. To encrypt or not-that is the question!
2. And if so, encrypt what?
3. What this breach teaches us?
Please invite your IT staff, C level staff, HIM and of course your HIPAA compliance officials!
This webinar series is free to hospitals participating in the Colorado FY2014 SHIP grant program as well as CRHC members. All other facilities will be charged $49 for the webinar.
**Register here for the webinar, and be sure to enter in the member code at check-out if you are a CRHC member or are a participant of THE Consortium.**
Webinar: Creating a Culture of Safety...Where Do You Start?
Creating a Culture of Safety...Where Do You Start?
Tuesday, February 17, 2015
12:00-1:00 pm Central Time
Medical errors occur for a number of reasons: breakdowns in technology, lack of communication, failures in procedures, etc. When an organization can identify why errors are happening, they can take action and make changes to prevent further Incidents. But what if errors are not being reported or staff are not embracing the changes? How do we improve patient care?
A big part of the answer is an organization's culture. Safety improvements cannot be made without the support and involvement of those closest to patient care. An effective safety culture uses a proactive approach to preventable harm and is based on transparency, communication and mutual trust. When staff feel empowered to speak up about issues and are given the proper tools, they are more likely to embrace changes and drive patient safety improvements. But how do you do this?
Join us for a webinar to learn how your organization can create an effective safety culture and not only improve patient care but staff satisfaction.
Objectives:
Kari Congenie, RN, MSN, CNL is a Registered Nurse with more than eighteen years' experience in both clinical and academic areas. Most of her career has been spent at a major academic medical center caring for neurosurgical, neurological and orthospine patients. Kari also served as staff educator in the Neuro/Orthospine unit before moving into academia where she facilitated baccalaureate nursing education as the Simulation and Skills Coordinator. Kari currently holds a part-time position in critical care and serves as a clinical analyst for Clarity Group.
Learn more and register now.
Tuesday, February 17, 2015
12:00-1:00 pm Central Time
Medical errors occur for a number of reasons: breakdowns in technology, lack of communication, failures in procedures, etc. When an organization can identify why errors are happening, they can take action and make changes to prevent further Incidents. But what if errors are not being reported or staff are not embracing the changes? How do we improve patient care?
A big part of the answer is an organization's culture. Safety improvements cannot be made without the support and involvement of those closest to patient care. An effective safety culture uses a proactive approach to preventable harm and is based on transparency, communication and mutual trust. When staff feel empowered to speak up about issues and are given the proper tools, they are more likely to embrace changes and drive patient safety improvements. But how do you do this?
Join us for a webinar to learn how your organization can create an effective safety culture and not only improve patient care but staff satisfaction.
Objectives:
- Define safety culture and its characteristics
- Discuss the rationale and challenges of creating and sustaining a culture of safety.
- Identify components necessary to support an effective safety culture
- Identify safety culture assessment strategies
Kari Congenie, RN, MSN, CNL is a Registered Nurse with more than eighteen years' experience in both clinical and academic areas. Most of her career has been spent at a major academic medical center caring for neurosurgical, neurological and orthospine patients. Kari also served as staff educator in the Neuro/Orthospine unit before moving into academia where she facilitated baccalaureate nursing education as the Simulation and Skills Coordinator. Kari currently holds a part-time position in critical care and serves as a clinical analyst for Clarity Group.
Learn more and register now.
Survey and Certification Update Letters
Please take a look at these CMS Survey and Certification update letters:
#15-19 CAH - http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-15-19.pdf;
#15-22 RHC - http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-15-22.pdf
#15-19 CAH - http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-15-19.pdf;
#15-22 RHC - http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-15-22.pdf
"This is My World": Perspectives of Senior Farmers and Their Families
"This Is My World": Perspectives of senior farmers and their families on risk and behavior
Date: Wednesday, February 25, 2015
Time: 12:00pm - 1:00pm Central Time
Objectives
At the end of the presentation participants will be able to:
1. Describe the agreement and discordance between senior farmers and their families about health and injury risk of the senior farmer.
2. Value the importance of culture and social norms in the behavior toward risks.
3. Apply the collective community voice to interventions to reduce risk and promote health among senior farmers
Register Here
Date: Wednesday, February 25, 2015
Time: 12:00pm - 1:00pm Central Time
Objectives
At the end of the presentation participants will be able to:
1. Describe the agreement and discordance between senior farmers and their families about health and injury risk of the senior farmer.
2. Value the importance of culture and social norms in the behavior toward risks.
3. Apply the collective community voice to interventions to reduce risk and promote health among senior farmers
Register Here
Beware of Scams that Use the USA.gov Name
USA.gov will never request your personal information
Beware: scammers are using the USA.gov name as part of an e-mail phishing scam to collect your personal information on a fake IRS website. Don't take the bait. USA.gov will never contact you to request your personal information.
If your receive an e-mail that's supposed to be from a government program, and it seems legitimate, do your homework:
Beware: scammers are using the USA.gov name as part of an e-mail phishing scam to collect your personal information on a fake IRS website. Don't take the bait. USA.gov will never contact you to request your personal information.
If your receive an e-mail that's supposed to be from a government program, and it seems legitimate, do your homework:
- Step 1: Double check any offers or demands by contacting the agency mentioned in the claim.
- Step 2: Use the contact information listed in the USA.gov Index of U.S. Government Departments and Agencies to contact the agency and not the contact information provided in the e-mail.
- Step 3: Forward tax related phishing e-mails to the IRS at phishing@IRS.gov.
Thursday, February 5, 2015
CRHC Webinars
To see which webinars are being offered through the Colorado Rural Health Center, visit our webinar page here!
Many of these webinars are free for CRHC Members! Be sure to use the member code at checkout.
Many of these webinars are free for CRHC Members! Be sure to use the member code at checkout.
Member and Family Advisory Council
We need your voice!
Interested in contributing to the Department of Health Care Policy and Financing’s person-centered work?
The goal of this advisory council is to gather feedback and ideas on how to integrate more person- and family-centered practices into policies, partnerships and programs. The advisory council plans to meet 6 to 8 times in 2015. Mileage reimbursement and incentives for participation are available. We appreciate your interest and thank you for your time!
Interested in contributing to the Department of Health Care Policy and Financing’s person-centered work?
The goal of this advisory council is to gather feedback and ideas on how to integrate more person- and family-centered practices into policies, partnerships and programs. The advisory council plans to meet 6 to 8 times in 2015. Mileage reimbursement and incentives for participation are available. We appreciate your interest and thank you for your time!
Application: https://www.colorado.gov/hcpf/mfac
Hospital EHR and systems vendor consolidation
Cerner Completes Acquisition of Siemens Health Services:http://www.cerner.com/Cerner_Completes_Acquisition_of_Siemens_Health_Services/
Medicare Part A and B News-Jurisdiction H- for February 3rd, 2015
The following information is provided by Novitas Solutions.
New:
- MM9066 – Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens
- SE1504 – Payment Codes on Home Health Claims Will Be Matched Against Patient Assessments
- MM9066 – Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens
IACS Password Resets completed from January 30, 2015 through February 7, 2015.
As part of the IACS to EIDM Transition preparation, IACS data was migrated as of 5:00 PM Eastern Time (ET) on January 30, 2015. This data migration may have impacts to your password. To avoid potential issues, carefully read the below information regarding the action we need you to take.
Password changes made between 5:00 PM ET on January 30, 2015 through February 7, 2015 will not be migrated to EIDM. Customers that changed their password during this timeframe will need to use the password you had prior to 5:00 PM ET on January 30, 2015 to log in after February 7. If you do not know this password, you will need to call the appropriate Help Desk below.
After the transition on February 7, 2015, customers may be prompted to complete new security questions upon their first login to EIDM.
All other IACS Application Users please contact the appropriate help desk if you have additional questions.
MLN Connects Provider eNews
MLN Connects Provider eNews- Thursday, February 5th, 2015
View this edition as a PDF
In This Edition:
View this edition as a PDF
In This Edition:
- MLN Connects™ National Provider Calls
- Payment of Chronic Care Management Services under CY 2015 Medicare PFS — Register Now
- ICD-10 Implementation and Medicare Testing — Register Now
- New MLN Connects™ National Provider Call Audio Recordings and Transcripts
- Monthly Spotlight: Individualized Quality Control Plan for CLIA Laboratory Non-Waived Testing
- Special Open Door Forum: Home Health Clinical Templates
- HHS Proposes Path to Improve Health Technology and Transform Care
- Extension of Temporary Moratoria on Enrollment of New HHAs, HHA Sub-units and Part B Ambulance Suppliers
- CLIA Individualized Quality Control Plan: Education and Transition Period Ends December 31, 2015
- 2015 PQRS Payment Adjustment and Providers who Rendered Services at RHCs/FQHCs
- Open Payments: Second Year of Data Submission Begins
- CMS Intends to Engage in Rulemaking for EHR Incentive Program Changes for 2015
- Get Started with Hospice CAHPS
- Proposed Decision Memo: Screening for the HIV Infection
- Home Health Pricer will be Updated on April 1
- FY 2015 Inpatient PPS PC Pricer Update Available
- “Payment Codes on Home Health Claims Will Be Matched Against Patient Assessments” MLN Matters® Article — Released
- “Extension of Provider Enrollment Moratoria for Home Health Agencies and Part B Ambulance Suppliers” MLN Matters® Article — Revised
- “Internet-based PECOS Contact Information” Fact Sheet — Reminder
- Medicare Learning Network® Products Available In Electronic Publication Format
- Subscribe to the MLN Matters® Electronic Mailing List
- Helpful Tips on Medicare Learning Network® Products and Learning Management System — Subscribe Now
ACA Implementation News--February 5, 2015
The latest issue of the Department of Health Care Policy and Financing’s ACA Implementation News is now available online here. Please feel free to forward this along to your colleagues that may find the content of interest.
If you would like to receive ACA Implementation News or our ACA Communication Updates please click here.
If you would like to receive ACA Implementation News or our ACA Communication Updates please click here.
Essential Community Providers (ECP)
FORHP is pleased to note that CMS recently agreed to include RHCs on the 2016 list of Essential Community Providers (ECPs), which Marketplace/Exchange plans use when setting up their provider networks. However, not all RHCs are on the list because of the qualification requirements. To determine whether your RHC is on the list and learn how to get on the list, please read the following:
For the 2016 Marketplace benefit year, CMS has released a draft updated list of ECPs to assist Qualified Health Plan (QHP) issuers in complying with the requirements of the Affordable Care Act. ECPs are defined as providers who serve predominantly low-income, medically underserved individuals. Visit http://www.cms.gov/cciio/programs-and-initiatives/health-insurance-marketplaces/qhp.html and scroll down to the section titled “Other QHP Application Resources” to view the draft list and a description of the list (3rd and 4th bullets).
A Medicare-certified RHC is included on the 2016 ECP list if it meets the following two requirements:
1) Based on attestation, it accepts patients regardless of ability to pay and offers a sliding fee schedule, or is located in a primary care Health Professional Shortage Area (geographic, population, or automatic); and
2) Accepts patients regardless of coverage source (i.e., Medicare, Medicaid, CHIP, Marketplace plan, etc.).
More than 3,300 RHCs currently meet these requirements and are included on the 2016 list. In addition, any RHC that is not currently on the list is eligible to be added to a future version of the list by completing an attestation form (the same form used for automatic HPSA designation) available at: http://bhpr.hrsa.gov/shortage/hpsas/certofeligibility.pdf. More info about the RHC auto HPSA designation process is available at: http://bhpr.hrsa.gov/shortage/hpsas/ruralhealthhpsa.html.
In addition, CMS is providing an opportunity to make corrections to the draft list. Public comments will be accepted until 5 p.m. EST on January 9 to improve the accuracy of the list. CMS considers the following to be within the scope of request for comments:
· Detailed corrections to the draft ECP list, including documentation that points CMS to a valid source of data that supports the correction; and
· Additions to the draft ECP list that contain sufficient data for inclusion in the list, as well as documentation that points CMS to a valid source of data that confirms that the added entity is a member of one of the ECP groups listed in the “Description and Purpose of the Draft HHS List of ECPs” document posted at the above link.
FORHP is pleased to note that CMS recently agreed to include RHCs on the 2016 list of Essential Community Providers (ECPs), which Marketplace/Exchange plans use when setting up their provider networks. However, not all RHCs are on the list because of the qualification requirements. To determine whether your RHC is on the list and learn how to get on the list, please read the following:
For the 2016 Marketplace benefit year, CMS has released a draft updated list of ECPs to assist Qualified Health Plan (QHP) issuers in complying with the requirements of the Affordable Care Act. ECPs are defined as providers who serve predominantly low-income, medically underserved individuals. Visit http://www.cms.gov/cciio/programs-and-initiatives/health-insurance-marketplaces/qhp.html and scroll down to the section titled “Other QHP Application Resources” to view the draft list and a description of the list (3rd and 4th bullets).
A Medicare-certified RHC is included on the 2016 ECP list if it meets the following two requirements:
3) Based on attestation, it accepts patients regardless of ability to pay and offers a sliding fee schedule, or is located in a primary care Health Professional Shortage Area (geographic, population, or automatic); and
4) Accepts patients regardless of coverage source (i.e., Medicare, Medicaid, CHIP, Marketplace plan, etc.).
More than 3,300 RHCs currently meet these requirements and are included on the 2016 list. In addition, any RHC that is not currently on the list is eligible to be added to a future version of the list by completing an attestation form (the same form used for automatic HPSA designation) available at: http://bhpr.hrsa.gov/shortage/hpsas/certofeligibility.pdf. More info about the RHC auto HPSA designation process is available at: http://bhpr.hrsa.gov/shortage/hpsas/ruralhealthhpsa.html.
In addition, CMS is providing an opportunity to make corrections to the draft list. Public comments will be accepted until 5 p.m. EST on January 9 to improve the accuracy of the list. CMS considers the following to be within the scope of request for comments:
· Detailed corrections to the draft ECP list, including documentation that points CMS to a valid source of data that supports the correction; and
· Additions to the draft ECP list that contain sufficient data for inclusion in the list, as well as documentation that points CMS to a valid source of data that confirms that the added entity is a member of one of the ECP groups listed in the “Description and Purpose of the Draft HHS List of ECPs” document posted at the above link.
For the 2016 Marketplace benefit year, CMS has released a draft updated list of ECPs to assist Qualified Health Plan (QHP) issuers in complying with the requirements of the Affordable Care Act. ECPs are defined as providers who serve predominantly low-income, medically underserved individuals. Visit http://www.cms.gov/cciio/programs-and-initiatives/health-insurance-marketplaces/qhp.html and scroll down to the section titled “Other QHP Application Resources” to view the draft list and a description of the list (3rd and 4th bullets).
A Medicare-certified RHC is included on the 2016 ECP list if it meets the following two requirements:
1) Based on attestation, it accepts patients regardless of ability to pay and offers a sliding fee schedule, or is located in a primary care Health Professional Shortage Area (geographic, population, or automatic); and
2) Accepts patients regardless of coverage source (i.e., Medicare, Medicaid, CHIP, Marketplace plan, etc.).
More than 3,300 RHCs currently meet these requirements and are included on the 2016 list. In addition, any RHC that is not currently on the list is eligible to be added to a future version of the list by completing an attestation form (the same form used for automatic HPSA designation) available at: http://bhpr.hrsa.gov/shortage/hpsas/certofeligibility.pdf. More info about the RHC auto HPSA designation process is available at: http://bhpr.hrsa.gov/shortage/hpsas/ruralhealthhpsa.html.
In addition, CMS is providing an opportunity to make corrections to the draft list. Public comments will be accepted until 5 p.m. EST on January 9 to improve the accuracy of the list. CMS considers the following to be within the scope of request for comments:
· Detailed corrections to the draft ECP list, including documentation that points CMS to a valid source of data that supports the correction; and
· Additions to the draft ECP list that contain sufficient data for inclusion in the list, as well as documentation that points CMS to a valid source of data that confirms that the added entity is a member of one of the ECP groups listed in the “Description and Purpose of the Draft HHS List of ECPs” document posted at the above link.
FORHP is pleased to note that CMS recently agreed to include RHCs on the 2016 list of Essential Community Providers (ECPs), which Marketplace/Exchange plans use when setting up their provider networks. However, not all RHCs are on the list because of the qualification requirements. To determine whether your RHC is on the list and learn how to get on the list, please read the following:
For the 2016 Marketplace benefit year, CMS has released a draft updated list of ECPs to assist Qualified Health Plan (QHP) issuers in complying with the requirements of the Affordable Care Act. ECPs are defined as providers who serve predominantly low-income, medically underserved individuals. Visit http://www.cms.gov/cciio/programs-and-initiatives/health-insurance-marketplaces/qhp.html and scroll down to the section titled “Other QHP Application Resources” to view the draft list and a description of the list (3rd and 4th bullets).
A Medicare-certified RHC is included on the 2016 ECP list if it meets the following two requirements:
3) Based on attestation, it accepts patients regardless of ability to pay and offers a sliding fee schedule, or is located in a primary care Health Professional Shortage Area (geographic, population, or automatic); and
4) Accepts patients regardless of coverage source (i.e., Medicare, Medicaid, CHIP, Marketplace plan, etc.).
More than 3,300 RHCs currently meet these requirements and are included on the 2016 list. In addition, any RHC that is not currently on the list is eligible to be added to a future version of the list by completing an attestation form (the same form used for automatic HPSA designation) available at: http://bhpr.hrsa.gov/shortage/hpsas/certofeligibility.pdf. More info about the RHC auto HPSA designation process is available at: http://bhpr.hrsa.gov/shortage/hpsas/ruralhealthhpsa.html.
In addition, CMS is providing an opportunity to make corrections to the draft list. Public comments will be accepted until 5 p.m. EST on January 9 to improve the accuracy of the list. CMS considers the following to be within the scope of request for comments:
· Detailed corrections to the draft ECP list, including documentation that points CMS to a valid source of data that supports the correction; and
· Additions to the draft ECP list that contain sufficient data for inclusion in the list, as well as documentation that points CMS to a valid source of data that confirms that the added entity is a member of one of the ECP groups listed in the “Description and Purpose of the Draft HHS List of ECPs” document posted at the above link.
Quick Tip for CREATE Grant Applications
Dating is Important to CREATE Happiness.
It is almost Valentine’s Day, and here at CRHC, we started thinking about the importance of dates. They are a critical part of any successful grant process, and CREATE is no different. There are rules to dates and they can be the difference between a successful CREATE grant and application and a failed CREATE grant application. Before you even begin your application process, remember this very important rule: you must apply for the review date (dates listed here) at least 45 days prior to the beginning of the course for which you are applying. This is not just a guideline – it is a hard and fast rule and it benefits everyone. The scoring process is lengthy and may not be complete before the requested start date, which could make your course ineligible for funding. Ensure you allot enough time to receive application results when planning to apply for CREATE. To review some other important rules about dates:
· Applicants will not be accepted for courses with start dates further out than 5 months.
· Do not assume these costs will be accepted for reimbursement without receiving your CREATE grant approval.
· Each application must start with the pre-application and requires a new application code.
· Again, you must apply at least 45 days prior to the beginning of the course for which you are applying.
Thank you for all you do for all our Colorado communities! We are here to support you, so please do not hesitate to contact us with questions or concerns.
If you have any questions about the CREATE Grant process, please contact Megan Lyda at ml@coruralhealth.org.
It is almost Valentine’s Day, and here at CRHC, we started thinking about the importance of dates. They are a critical part of any successful grant process, and CREATE is no different. There are rules to dates and they can be the difference between a successful CREATE grant and application and a failed CREATE grant application. Before you even begin your application process, remember this very important rule: you must apply for the review date (dates listed here) at least 45 days prior to the beginning of the course for which you are applying. This is not just a guideline – it is a hard and fast rule and it benefits everyone. The scoring process is lengthy and may not be complete before the requested start date, which could make your course ineligible for funding. Ensure you allot enough time to receive application results when planning to apply for CREATE. To review some other important rules about dates:
· Applicants will not be accepted for courses with start dates further out than 5 months.
· Do not assume these costs will be accepted for reimbursement without receiving your CREATE grant approval.
· Each application must start with the pre-application and requires a new application code.
· Again, you must apply at least 45 days prior to the beginning of the course for which you are applying.
Thank you for all you do for all our Colorado communities! We are here to support you, so please do not hesitate to contact us with questions or concerns.
If you have any questions about the CREATE Grant process, please contact Megan Lyda at ml@coruralhealth.org.
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