AHA, hospitals lawsuit responds to revised rebilling policy   04/22/2013
The AHA and five hospital systems Friday amended the lawsuit they filed last November against the Centers for Medicare & Medicaid Services to challenge the agency’s continuing refusal to pay for certain claims denied by Recovery Audit Contractors, despite the agency’s recent concession that the previous payment denial policy was unlawful. The amended lawsuit responds directly to CMS’ limited but helpful Ruling, in effect until a permanent rule is published, that permits hospitals to rebill only for certain claims that are newly denied or already in the appeals pipeline. “[CMS’] refusal to make the hospitals whole [for claims that were not previously appealed and for which the time to appeal has passed] is both unlawful and fundamentally unfair,” the amended lawsuit in American Hospital Association v. Sebelius states. “[H]ospitals reasonably took CMS at its word and never sought payment [and now] CMS will refuse to pay those claims, taking shelter under the theory that the time limit for filing Part B claims – the very Part B claims CMS told hospitals they could not file – has expired. [That is the] quintessential example of unlawful arbitrary and capricious agency action.” The AHA and its hospital co-plaintiffs – Missouri Baptist Sullivan Hospital, Munson Medical Center, Lancaster General Hospital, Trinity Health Corp. and Dignity Health – ask the federal district court in Washington, D.C., to declare that CMS must accept and process such claims, and that the agency may not treat hospitals’ attempts to rebill them as untimely.
Senate committee seeks feedback on drug supply safety proposal   04/22/2013
Leaders of the Senate Health, Education, Labor and Pensions Committee have released for stakeholder feedback through Friday a discussion draft of a bill, commonly referred to as “track and trace” legislation, to improve the safety and security of the nation’s drug distribution system. Committee Chairman Tom Harkin (D-IA), Ranking Member Lamar Alexander (R-TN) and Sens. Michael Bennet (D-CO) and Richard Burr (R-NC) said the bipartisan proposal would replace the “patchwork of state product tracing laws with a strong, uniform standard that would ultimately result in electronic, interoperable unit level product tracing for the entire country.” They said the committee will release a separate proposal next week to address safety issues at compounding pharmacies.
AHA urges CMS/ONC to fully implement existing health IT efforts   04/22/2013
Rather than engage in additional regulation to advance health information exchange and interoperability, the Centers for Medicare & Medicaid Services should fully implement both meaningful use and the new payment and delivery models and other programs already underway that provide incentives for information exchange and monitor their results, AHA said in comments submitted Friday to CMS and the Office of the National Coordinator for Health Information Technology. In addition, AHA urged ONC to “re-double its efforts to remove barriers to interoperability and support the development of a robust infrastructure for health information exchange.” Responding to the agencies’ March 7 public request for information on a wide range of possible new regulatory mechanisms, AHA Vice President and Deputy Director of Policy Ashley Thompson said AHA “greatly appreciates the intention behind the RFI and is committed to development of a health care system where the best information is available to support the best possible care and engage patients. However, by asking a series of questions about regulatory levers, the RFI wrongly suggests that additional regulatory requirements are necessary to advance interoperability and the electronic exchange of health information.”
CMS finalizes operating rules for EFT, remittance advice without changes   04/22/2013
The Centers for Medicare & Medicaid Services Friday announced it has finalized without changes an interim final rule adopting operating rules for electronic transfer of health care funds and remittance advice under the Health Insurance Portability and Accountability Act. Issued last August with a comment period, the AHA-supported rule adopts operating rules developed by the Council for Affordable Quality Healthcare's Committee on Operating Rules for Information Exchange, which link the remittance advice with the fund transfer so health care providers can match the transactions when they arrive separately. “After careful review and consideration of all the comments, we have decided not to change any of the policies established in the EFT & ERA Operating Rule Set,” CMS said in an email update Friday. Health plans and other HIPAA-covered entities, including hospitals, must comply with the operating rules by Jan. 1, 2014. CMS said it will issue a separate notice to clarify covered entities’ obligations under the rule in light of CORE’s ongoing maintenance of certain code combinations.
Hospitals recognized for slashing energy consumption   04/22/2013
The AHA’s American Society for Healthcare Engineering today recognized 14 hospitals that reduced their energy consumption by 10% or more over a 12-month period as part of its Energy Efficiency Commitment (E2C) program, which supports the goals of the Environmental Protection Agency's ENERGY STAR Challenge. Several facilities previously recognized through the program also were recognized again today, Earth Day, for saving even more energy.  “These hospitals should be celebrated for making energy efficiency commitments that have shown real results,” said ASHE Executive Director Dale Woodin. “Hospitals across the country may face different energy challenges, depending on their location, age and other factors. But the E2C program shows that health care facilities can significantly cut energy use regardless of their situation, and the first step is making a commitment to do so.”
AMA initiative targets cardiovascular disease, diabetes   04/22/2013
The American Medical Association today announced an initiative to focus physicians and patients on preventing and controlling cardiovascular disease and diabetes. In support of the Department of Health and Human Services’ Million Hearts initiative to reduce high blood pressure, AMA will work with the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine to better understand the reasons for uncontrolled blood pressure, find clinically meaningful solutions and share lessons learned. The initiative also will work with YMCA of the USA to increase physician referrals of patients with prediabetes to evidence-based diabetes prevention programs, in support of the Center for Disease Control and Prevention’s National Diabetes Prevention Program.