CMS: Health plans must comply with new electronic payment standard   03/31/2014
Health plans must comply with health care provider requests to use the Automated Clearing House Network to receive electronic fund transfers and remittance advice, the Centers for Medicare & Medicaid Services said Friday in response to a Frequently Asked Question. The ACH Network is the standard format for EFT and ERA transactions under administrative simplification operating rules that took effect Jan. 1, and therefore allows providers to fill out a single enrollment form to receive EFT and ERA transactions from different health plans. Health plans may not delay or reject an EFT or ERA transaction for using the ACH Network, or provide incentives such as excessive fees for providers to use an alternative payment method, CMS said. The agency recommends that providers review payment method agreements for any added fees.
AHA offers guiding principles for CMS emergency preparedness proposal   03/31/2014
The Centers for Medicare & Medicaid Services has generally chosen the correct framework for its proposed emergency preparedness Conditions of Participation and Conditions for Coverage for Medicare and Medicaid providers, but should ensure that the proposed requirements enhance readiness without adding confusion or administrative burden, AHA told the agency in comments submitted Friday. Specifically, AHA Executive Vice President Rick Pollack encouraged CMS to consider five guiding principles as it finalizes the requirements: align policies with existing standards; define leadership roles for community planning; accept an integrated approach to emergency planning; collaborate to develop interpretive guidance; and balance implementation and compliance with education. In addition, AHA urged CMS to re-evaluate its associated burden and cost estimates, including implementation timeframes.
AHA guide offers integrated approach to supporting population health   03/31/2014
A new guide from the AHA's Hospitals in Pursuit of Excellence initiative offers hospitals and care systems an integrated approach to supporting population health in an era of health care transformation. “Though the rate and extent to which hospitals and care systems engage in population health may vary, a significant shift toward population health is anticipated in the next three to five years,” the authors note. “The tactics described in this guide provide a framework for initiatives that hospitals and care systems could pursue to develop an institutional infrastructure that supports population health.” The tactics are: value-based reimbursement; seamless care across all settings; proactive and systematic patient education; workplace competencies and education on population health; integrated, comprehensive health information technology that supports risk stratification of patients with real-time accessibility; and mature community partnerships to collaborate on community-based solutions. The guide, the latest in an HPOE series on population health, includes metrics for monitoring progress as well as case examples. For more information, visit
CA report examines hospitals' allied health workforce needs   03/31/2014
California’s education and training programs for allied health professionals must evolve and innovate to meet the current skill demands of hospitals and other health employers, according to a report released this week by the California Hospital Association. “Evolving care models resulting from implementation of the [Affordable Care Act] will drive demand for health professionals in new ways,” the report states. “…With significantly diminishing funding from all sources, yet an increasing demand for services, it is now more important than ever that workforce development resources are targeted toward occupations that are in high demand by health employers, as opposed to simply focusing resources on occupations with minimal requirements or shorter investments of time.” In a CHA survey last year, California hospitals reported the highest average allied health vacancy rates for medical coders (5.3%) and ultrasound technologists (4.9%), but said vacancies for pharmacists and physical therapists (3.3% each) had the greatest impact on access to care. Among other findings, 40% of the hospitals’ clinical laboratory scientists, who conduct a wide range of diagnostic assessments for physicians, were age 56 or older.