This week in Medicare updates
Transcatheter aortic valve replacement (TAVR) hospital program volume requirements
On June 1, CMS released a special edition MLN Matters article regarding coverage criteria for individual hospitals that want to perform TAVR. Before a TAVR procedure is eligible for Medicare coverage individual hospitals must meet the volume requirements specified in the TAVR NCD. Hospitals that do not meet these volume requirements are not eligible for waivers or exceptions.
View special edition MLN Matters article SE1515.
Announcement of request for applications for the Million Hearts® Cardiovascular Risk Reduction model
On June 1, CMS posted a notice in the Federal Register informing interested parties of an opportunity to apply for participation in the Million Hearts® Cardiovascular Risk Reduction Model. The primary goal of this model is to test whether encouraging physician practices to calculate risk for all of the practice’s eligible Medicare beneficiaries, using the American College of Cardiology/American Heart Association (ACC/AHA) Atherosclerotic Cardiovascular Disease (ASCVD) risk calculator will prevent the occurrence of first-time heart attacks and strokes. Applications are due September 4.
View the notice in the Federal Register.
Spring Semiannual Report to Congress
On June 1, the OIG posted its Semiannual Report to Congress. This report covers the period between October 1, 2014, and March 31, 2015.
View the report.
New Medicare data available to increase transparency on physician utilization
On June 1, CMS posted a fact sheet regarding the first annual update on the medical services physicians provide and how much they are paid under Medicare Part B Fee-For-Service for 2013. The Physician and Other Supplier Public Use File, now available for 2012 and 2013, has information on the number and type of health care services individual physicians and certain other health care providers furnished under the Medicare Part B fee-for-service program, as well as information on the amount that Medicare paid them for those services.
View the fact sheet.
View the press release.
New Medicare data available to increase transparency on hospital utilization
On June 1, CMS posted a fact sheet regarding the third annual update to the Medicare hospital inpatient and outpatient charge data. The data now includes inpatient and outpatient hospital charge data for 2013, as well as data released for years 2011 and 2012, and shows what different hospitals in all 50 states and Washington, D.C. charge for similar services.
View the fact sheet.
View the press release.
CMS announces entrepreneurs and innovators to access Medicare data
On June 2, CMS posted a press release a new policy that for the first time will allow innovators and entrepreneurs to access CMS data, such as Medicare claims. CMS will allow innovators and entrepreneurs to conduct approved research that will ultimately improve care and provide better tools that should benefit healthcare consumers through a greater understanding of what the data says works best in healthcare. The data will not allow the patient’s identity to be determined, but will provide the identity of the providers of care. CMS will begin accepting innovator research requests in September 2015.
View the press release.
OIG Advisory Opinion No. 15-06
On June 4, the OIG posted an advisory opinion regarding a nonprofit, tax-exempt, charitable organization’s proposal to provide financial assistance to individuals with chronic diseases, including cancer, to assist with the costs of health insurance and drug and device therapies
View the document.
OIG Advisory Opinion No. 15-07
On June 4, the OIG posted an advisory opinion regarding subsidies a medical device manufacturer provides to certain patients participating in a clinical research study.
View the document.
Finalized changes to the Medicare Shared Savings Program regulations
On June 4, CMS posted a fact sheet regarding a final rule that will update and improve policies governing the Medicare Shared Savings Program (Shared Savings Program). CMS is making these modifications to the program regulations after considering the over 270 comments received on a wide range of issues specified in the December 2014 notice of proposed rulemaking.
View the fact sheet.
View the press release.
CGS Administrators, LLC, did not always refer Medicare Cost Reports and reconcile outlier payments
On June 5, the OIG posted a report stating that, of 18 Medicare-participating hospital cost reports with outlier payments that qualified for reconciliation, CGS Administrators, LLC (CGS), referred 15 cost reports to CMS in accordance with Federal guidelines. However, CGS did not refer three cost reports that should have been referred to CMS for reconciliation, and one of those cost report had not been settled.
View the report.