CMS: April 1 deadline for eligible hospitals to avoid EHR payment penalty in 2015   03/10/2014
The Centers for Medicare & Medicaid Services announced today the availability of a revised hardship exception for hospitals eligible to participate in the Medicare Electronic Health Records Incentive Program. In order to avoid a payment penalty in fiscal year 2015, hospitals must apply for a hardship exception by midnight April 1, 2014. Hardship categories include vendor delays in 2014 EHR certification. Applications should be emailed to ehrhardship@provider-resources.com or faxed. CMS decisions on hardship exceptions will be final and cannot be appealed. Approved exceptions will be valid for one year. For more information, visit www.cms.gov.
Concerns with CMS rebilling policy remain, AHA and hospitals tell court   03/10/2014
In a supplemental brief filed Friday in federal court, AHA and five hospital systems deny that policy changes last March or in the final inpatient prospective payment system rule for fiscal year 2014 make their legal challenge to the Centers for Medicare & Medicaid Service’s rebilling policy moot. The lawsuit challenges CMS’s decision to impose a time limit for hospitals to rebill Medicare under Part B for inpatient claims denied by Recovery Audit Contractors, “a policy that leaves providers with no way to obtain payment for medically necessary care to beneficiaries because of the delinquent timing of RAC clawbacks,” the brief states, responding to specific inquiries from the court. Some of the claims included in the litigation “have not been paid, have no prospect of being paid and have reached a dead end in the administrative process,” all of which support waiving the legal requirement for administrative exhaustion of the claims before court review, the groups said. The brief offers to file an amended complaint if the court finds it necessary and renews the plaintiffs’ request for oral argument.
AHA submits comments on price transparency challenge for FTC workshop   03/10/2014
AHA today submitted comments to the Federal Trade Commission in advance of the agency’s March 20-21 workshop on health care competition issues, including price transparency in health care services. “AHA and its members are committed to ensuring that consumers get helpful information about the price and quality of their hospital care,” the letter notes. “…Price transparency has been a longstanding issue for uninsured patients, but growing enrollment in plans with higher levels of deductibles and coinsurance is creating a greater need for meaningful price information for insured patients as well.” The letter provides background on the various dimensions of the price transparency challenge, as well as the hospital field’s initiatives to tackle it. These include the AHA’s principles for price transparency and for helping patients with payment for hospital care, and AHA-supported legislation supporting state-based efforts regarding price transparency. The association expects to submit further comments at the conclusion of the workshop.
CMS issues final rule for ACA Basic Health Program   03/10/2014
The Centers for Medicare & Medicaid Services issued a final rule late Friday establishing standards for the Basic Health Program created by the Affordable Care Act. States may choose to offer the program to low-income citizens and lawfully present non-citizens who do not qualify for Medicaid, the Children’s Health Insurance Program or other minimum essential coverage offered through a health insurance exchange. According to CMS, the final rule sets forth a framework for program eligibility and enrollment, benefits, delivery of health care services, transfer of funds to participating states and federal oversight, among other provisions. CMS also issued a final methodology for determining the federal payment amounts made to states that elect to establish a certified Basic Health Program in program year 2015.
CMS extends comment period for ESRD care model quality measures   03/10/2014
Centers for Medicare & Medicaid Services contractor IMPAQ Intl. will accept comments through March 31 on proposed quality measures for the Comprehensive ESRD Care Initiative, a service delivery and payment model for Medicare patients with end-stage renal disease. The original comment deadline was March 14. Launched last year by the CMS Innovation Center, the project will test whether organizations comprised of dialysis facilities, nephrologists and other Medicare providers and suppliers can reduce costs and improve care coordination and quality for Medicare fee-for-service beneficiaries with end-stage renal disease. Participants will share in Medicare savings and loss amounts based in part on the organization's performance on the final quality measures.
CMS to withdraw certain proposed changes to Medicare Part D rule   03/10/2014
The Centers for Medicare & Medicaid Services does not plan to finalize certain elements of its proposed rule for Medicare Part D prescription drug plans, according to news reports. “In particular, we heard concerns about the proposals to lift the protected class definition on three drug classes, to set standards on Medicare Part D plans’ requirements to participate in preferred pharmacy networks, to reduce the number of Part D plans a sponsor may offer, and clarifications to the noninterference provisions,” CMS Administrator Marilyn Tavenner said in a letter to lawmakers. “Given the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time.”