CMS posts additional guidance on two-midnight policy, audits   02/25/2014
The Centers for Medicare & Medicaid Services today posted additional guidance regarding its two-midnight policy and related Probe & Educate audits. Specifically, CMS said it will require Medicare Administrative Contractors to re-review all claims denied to date under the Probe & Educate process to ensure that the decisions and subsequent education were consistent with the agency’s clarifications on Jan. 30. In addition, CMS released preliminary data related to the Probe & Educate audit process, including examples of common claim denials during the process. The agency also has updated its website to include instructions for how the two-midnight policy will apply to hospital transfers and off-campus emergency departments. Watch for an AHA Special Bulletin with additional information later this week.
Senate bill introduced to remove 96-hour certification requirement for CAHs   02/25/2014
Sens. Pat Roberts (R-KS) and Jon Tester (D-MT) yesterday introduced a Senate companion (S. 2037) to the Critical Access Hospital Relief Act, AHA-supported legislation that would remove the 96-hour physician certification requirement as a condition of payment for critical access hospitals. Medicare requires physicians to certify that patients admitted to a CAH will be discharged or transferred to another hospital within 96 hours for the CAH to receive payment for the patient’s services under Medicare Part A. The Centers for Medicare & Medicaid Services has not historically enforced the requirement, but in recent guidance related to its two-midnight admissions policy implied that it will, a situation that would threaten patients’ access to longer care when needed. The legislation would not remove the requirement that CAHs maintain an average annual length of stay of 96 hours, nor affect other certification requirements for hospitals. The House bill (H.R. 3991) was introduced earlier this month by Reps. Adrian Smith (R-NE), Greg Walden (R-OR), Lynn Jenkins (R-KS) and David Loebsack (D-IA).
AHA supports CMS proposals to enhance QHP provider networks   02/25/2014
The Centers for Medicare & Medicaid Services should ensure that enrollees in federally-facilitated health insurance exchanges have access to an adequate selection of hospitals and essential community providers, without inhibiting care coordination and the growth of integrated care systems, AHA said in comments submitted yesterday. Responding to the agency’s recent draft 2014 Letter to Issuers regarding the requirements for plans to be offered in Federally-facilitated Marketplaces in 2015, Linda Fishman, AHA senior vice president for public policy analysis and development, commended CMS for proposing to require QHP applicants for 2015 and beyond to submit for review a list of all in-network providers and facilities. She recommended that CMS also define more specifically its criteria for “reasonable” network coverage, and limit significant changes to the network during the annual enrollment period and plan year. In addition, AHA voiced support for proposals and rulemaking to ensure greater participation by ECPs, and for continuing the alternate ECP standard when a majority of covered professional services are provided by employed physicians or a single contracted medical group.
Groups issue geriatric ED guidelines   02/25/2014
The American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association and Society for Academic Emergency Medicine yesterday issued guidelines for treating older emergency department patients, noting that geriatric patients on average stay longer in the ED, use more resources and are significantly more likely to require social services. “It is important that the special needs of these vulnerable patients are met appropriately in the emergency setting,” said ACEP President Alex Rosenau. “As of 2010, there were 40 million people in this age group, and many of them will be emergency patients at some point.” The guidelines cover staffing; follow-up care; education; quality improvement; equipment and supplies; policies, procedures and protocols; the use of urinary catheters; medication management; fall assessment; delirium and dementia; and palliative care. The groups said similar programs designed for other age groups (pediatrics) and specific diseases (heart attack, stroke and trauma) have resulted in better, more cost-effective care and better patient outcomes.
AHA members-only webinar March 4 on Medicaid enrollment, presumptive eligibility   02/25/2014
Officials from the Centers for Medicare & Medicaid Services will update hospitals on the latest Medicaid enrollment news during an AHA members-only webinar Tuesday, March 4 at 12 p.m. Eastern Time. Participants also will hear from outside experts on Medicaid presumptive eligibility and tools that help hospitals enroll patients in coverage at the point of service under this Affordable Care Act provision. To register for the webinar, at 12 p.m. Eastern Time, click here.
Infographic: CMS timeline for 2014 EHR upgrade 'too much, too soon'   02/25/2014
Hospitals face many challenges upgrading their electronic health records to meet new certification criteria by Sept. 30 to avoid a penalty under the Medicare EHR Incentive Program, according to an AHA infographic released today. While EHRs must integrate information from many diverse sources, a complicated process that can take up to 19 months, many EHR vendors have yet to upgrade their products to the 2014 Edition criteria, making the Sept. 30 deadline “unrealistic,” the infographic notes. On Friday, 48 health care provider organizations, including the AHA, urged the Department of Health and Human Services to extend the certification timeline through 2015 and add flexibility to help hospitals, physicians and other eligible professionals meet the higher threshold for EHR meaningful use.