This week in Medicare–08/03/2016
Recurring file updates Models 2 and 4 October 2016 updates for Affordable Care Act Bundled Payments for Care Improvement Initiative
On July 22, CMS released a change request to update the participating hospital files, episodes, and prospective bundled payment amounts associated with the Bundled Payments for Care Improvement initiative, Model 2 and Model 4. The number for this recurring update is R41662Q.
Effective date: October 1, 2016
Implementation date: October 3, 2016
View Transmittal R150DEMO.
Hospitals largely reported addressing requirements for EHR contingency plans
On July 25, the OIG posted a report discussing contingency plans hospitals could have in place in case there is a disruption that makes EHRs unavailable to hospital staff. Prior OIG work found, for example, that hospitals experienced substantial challenges responding to the effects of Superstorm Sandy, which included damage to health information systems and curtailed access to patient medical records. More recently, cyberattacks on hospitals have similarly prevented or limited access to EHRs. OCR enforces the HIPAA Security Rule, which requires all covered entities to have a contingency plan for responding to disruptions to electronic health information systems. Contingency plans specify processes to recover EHR systems and access backup copies of EHR data in the event of a disruption. This evaluation provides information about the status of hospitals' contingency plans in light of evolving threats to their electronic health information systems.
View the report.
Notice of proposed rulemaking for bundled payment models for high-quality, coordinated cardiac and hip fracture care
On July 25, HHS proposed new models that continue the Administration’s progress to shift Medicare payments from quantity to quality by creating strong incentives for hospitals to deliver better care at a lower cost. These models would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery.
View the fact sheet.
Cornerstone Hospital of southwest Louisiana incorrectly billed Medicare inpatient claims with Kwashiorkor
On July 27, the OIG posted a report stating that Cornerstone Hospital of Southwest Louisiana in Sulphur, Louisiana, did not comply with Medicare requirements for billing Kwashiorkor on any of the 52 claims reviewed. The hospital used diagnosis code 260 for Kwashiorkor but should have used codes for other forms of malnutrition. The 52 inpatient claims that were coded incorrectly resulted in overpayments of $343,000. Hospital officials believe that all claims identified by OIG were appropriately submitted for payment.
View the report.
First release of the Overall Hospital Quality Star Rating on Hospital Compare
On July 27, CMS posted a fact sheet stating it is updating the star ratings on the Hospital Compare website to help millions of patients and their families learn about the quality of hospitals, compare facilities in their area side-by-side, and ask important questions about care quality when visiting a hospital or other health care provider. Today’s update comes after substantive discussions with hospitals and other stakeholders to review the Overall Hospital Quality Star Rating’s methodology.
View the fact sheet.
Inpatient reviews update
On July 27, CMS updated its Inpatient Hospital Reviews webpage stating that temporary suspension remains effective, and the BFCC-QIO short-stay claim reviews will resume after the Beneficiary and Family Centered Care (BFCC)-QIOs have completed retraining on the inpatient admission policy, completed the re-review of previously formally denied claims, performed any needed provider outreach and education, and CMS validates the accuracy of the BFCC-QIOs’ performance of these activities. CMS is also announcing that reviews will be limited to a six-month look-back period from the date of admission which includes all claims that have been previously reviewed, reviewed and denied, or reviewed and approved, as appropriate. Claims outside that six-month look-back period will be paid under Part A even if they were initially denied. CMS will advise stakeholders when the suspension is lifted.
View the webpage.
Final FY 2017 payment and policy changes for Medicare SNF (CMS-1645-F)
On July 29, CMS posted the final rule for SNFs, which updates the payment rates used under the PPS for SNFs for FY 2017. In addition, it specifies a potentially preventable readmission measure for the Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP), and implements requirements for that program, including performance standards, a scoring methodology, and a review and correction process for performance information to be made public, aimed at implementing value-based purchasing for SNFs. Additionally, this final rule includes additional policies and measures in the Skilled Nursing Facility Quality Reporting Program (SNF QRP). This final rule also responds to comments on the SNF Payment Models Research project. It is effective October 1.
View the final rule.
View the fact sheet.
Final FY 2017 payment and policy changes for the Medicare hospice benefit (CMS-1652-F)
On July 29, CMS issued a notice outlining FY 2017 Medicare payment rates and wage index and the Hospice Quality Reporting Program (QRP) for hospices serving Medicare beneficiaries. This final rule updates the hospice wage index, payment rates, and cap amount for FY 2017. In addition, this rule finalizes changes to the hospice quality reporting program, including the addition of two new quality measures. The final rule also describes a potential future enhanced data collection instrument, as well as plans to publicly display quality measures and other hospice data beginning in calendar year 2017.
View the final rule.
View the fact sheet.
Final FY 2017 payment and policy changes for Medicare inpatient rehabilitation facilities (IRF) (CMS-1647-F)
On July 29, CMS issued a final rule outlining FY 2017 Medicare payment policies and rates for the IRF PPS and the IRF Quality Reporting Program. It updates the IRF PPS payments for FY 2017 to reflect an estimated 1.65% increase factor (reflecting an IRF-specific market basket estimate of 2.7%, reduced by a 0.3 percentage point multi-factor productivity adjustment and a 0.75 percentage point reduction required by law). An additional approximate 0.3% increase to aggregate payments due to updating the outlier threshold results in an overall estimated update of approximately 1.9% (or $145 million), relative to payments in FY 2016.
View the final rule.
View the fact sheet.
CMS extends, expands fraud-fighting enrollment moratoria efforts in six states
On July 29, CMS posted a press release announcing an extension and statewide expansion of fraud-fighting temporary provider enrollment moratoria efforts in six states, along with a new related demonstration project to allow for certain exceptions to the moratoria and heightened screening requirements for new providers. CMS also announced it is immediately lifting the current temporary moratoria on all Medicare Part B, Medicaid, and Children’s Health Insurance Program (CHIP) emergency ground ambulance suppliers.
View the press release.
FY 2017 rate update for inpatient psychiatric facilities (IPF) PPS
On August 1, CMS posted a notice in the Federal Register updating the prospective payment rates for Medicare inpatient hospital services provided by IPFs (which include freestanding IPFs and psychiatric units of an acute care hospital or critical access hospital). These changes are applicable to IPF discharges occurring during the FY beginning October 1, 2016, through September 30, 2017 (FY 2017).
View the notice in the Federal Register.
View the fact sheet.