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CMS Finalizes Prior Authorization Program for Certain DMEPOS Items Print E-mail
Written by FHI's Week in Review   
Tuesday, 12 January 2016 18:15

In a January 7, 2016 post by MWE.com, the authors report:

On December 30, 2015, the Centers for Medicare & Medicaid Services (CMS) published its final rule establishing a prior authorization program for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) items frequently subject to unnecessary utilization (the Final Rule). As noted in our commentary on the proposed rule the Final Rule creates a "Master List" of items that could require prior authorization as a condition of Medicare payment as well as a subset list of items for which prior authorization is required. The provisions of the Final Rule are effective on February 29, 2016.

Read more in the current issue of Week in Review>>
 
CMS finalizes hip, knee bundled payment program: 10 things to know Print E-mail
Written by Ayla Ellison | Becker's Hospital Review   
Tuesday, 17 November 2015 00:00

CMS has finalized a new payment model that holds acute care hospitals accountable for the quality of care they deliver to Medicare beneficiaries for hip and knee replacement from surgery through recovery.

Here are 10 things to know about the new Comprehensive Care for Joint Replacement Model.

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Medicare Approves Payment for End-of-Life Counseling Print E-mail
Written by Robert Lowes | Medscape Medical News   
Friday, 30 October 2015 00:00

A proposal too hot to handle in the nascent days of the Affordable Care Act (ACA) became a reality today <October 30, 2015> when the Centers for Medicare and Medicaid Services (CMS) approved payment for voluntary end-of-life counseling as part of its 2016 Medicare physician fee schedule.

The new policy will help seniors "make important decisions that give them control over the type of care they receive and when they receive it," CMS said in a news release.

Last Updated on Friday, 06 November 2015 17:31
 
Congress Take Step Toward Site-Neutral Medicare Payments in Bipartisan Budget Act of 2015 Print E-mail
Written by MWE.com   
Thursday, 29 October 2015 00:00

On October 28, 2015, the U.S. House of Representatives approved legislation that, if enacted, would, among other things, substantially alter how and how much Medicare pays for outpatient services furnished by hospitals. The legislation, known as the Bipartisan Budget Act of 2015, principally reflects and implements a two-year federal budget and debt limit compromise negotiated between President Obama and congressional Republicans that diminishes many of the harshest spending reductions wrought by sequestration, and avoids a potential default on U.S. debt obligations. Nonetheless, the legislation is drawing heightened scrutiny by, and concern within, the health care community- not because of the central purposes of the bill, but rather because of a handful of Medicare and Medicaid related provisions also included in the legislation.
 
Of perhaps greatest significance to the health care community is a provision (Section 603) that would provide that effective January 1, 2017, Medicare payments for most items and services furnished at an off-campus department of a hospital that was not billing as a hospital service prior to the date of enactment would be made under the applicable non-hospital payment system. This "site neutrality" provision begins to address concerns raised by certain policymakers in recent years that Medicare should not..
 
Last Updated on Friday, 13 November 2015 16:28
 
OIG Calls for CMS to Reform Payment for Skilled Nursing Facility Services Print E-mail
Written by MWE.com   
Wednesday, 07 October 2015 15:55

The Office of Inspector General of the U.S. Department of Health and Human Services (OIG) issued a report on September 30, 2015, that calls for the Centers for Medicare and Medicaid Services (CMS) to reform payment for skilled nursing facility (SNF) services. The OIG focused on billing for therapy (e.g., speech, occupational, physical) as a driver increasing SNF revenue and noted that SNFs' margin on Medicare reimbursement for therapy was 29 percent. 

Medicare pays SNFs a daily rate for therapy that is primarily based on the level of therapy provided to the beneficiary. The OIG's review of therapy billings indicated that a disproportionate number of beneficiaries received 720 minutes of therapy during the relevant seven-day assessment period-exactly the number of minutes required for "ultra-high" categorization, which results in a higher level of resource utilization group, which in turn results in higher reimbursement.

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