CMS: Medicare prepayment review demonstration to begin in August   07/30/2012
The Centers for Medicare & Medicaid Services plans to launch its Recovery Audit Prepayment Review Demonstration on Aug. 27, according to a notice at The three-year demonstration, announced last November, will audit medical records for claims after the claims are submitted but before they are paid. As with other medical necessity audits, the outcome for this demo will be based on the reviewer's clinical judgment about whether an item or service was eligible for Medicare coverage and was medically reasonable and necessary. "These reviews will focus on seven states with high populations of fraud- and error-prone providers (FL, CA, MI, TX, NY, LA, IL) and four states with high claims volumes of short inpatient hospital stays (PA, OH, NC, MO) for a total of 11 states," CMS said "…A special Open Door Forum will be held in August to discuss this demonstration and details will be posted here when available." The project's original Jan. 1 start date was delayed, as advocated by the AHA.
CMS selects hospitals for ACA advance practice nursing project   07/30/2012
The Centers for Medicare & Medicaid Services has selected five hospitals to participate in the Medicare Graduate Nurse Education Demonstration, the agency announced today. The Patient Protection and Affordable Care Act provides up to $200 million for the Medicare demonstration to expand the primary care workforce. Under the four-year project, the Hospital of the University of Pennsylvania in Philadelphia; Duke University Hospital in Durham, NC; Scottsdale (AZ) Healthcare Medical Center; Rush University Medical Center in Chicago; and Memorial Hermann-Texas Medical Center Hospital in Houston will receive reasonable cost reimbursement to provide qualified clinical training to clinical nurse specialists, nurse practitioners, certified registered nurse anesthetists and certified nurse-midwives.
CMS announces SNF payment update for FY 2013   07/30/2012
Skilled nursing facilities will receive a net Medicare prospective payment system increase of 1.8% ($670 million) in fiscal year 2013, the Centers for Medicare & Medicaid Services announced Friday. The increase reflects a 2.5% market basket update minus a 0.7% productivity adjustment, as required by the Patient Protection and Affordable Care Act. The federal rate also incorporates adjustments to account for facility case mix. Under the RUG-IV case-mix classification system, urban facilities will receive a 1.9% update and rural facilities will receive a 1.5% update. Unlike traditional rulemaking, the 2013 payment update includes no policy changes.
Court's invalidation of expedited union elections rule stands   07/30/2012
A federal trial court in Washington, D.C. Friday rejected a request to alter or amend its decision invalidating a National Labor Relations Board rule aimed at expediting union elections. In May, the Court ruled that the Board lacked the required quorum when it adopted the rule. The Board later submitted a motion asking the court to reconsider, which included an affidavit about what went on in its electronic voting room Dec. 13-16 with respect to the rule. According to the Court, the affidavit sets forth facts that "somewhat strengthen the agency's position that Hayes was present for but abstained from the pivotal vote." However, it said the Board "has neither adequately explained why it could not have presented this evidence at the summary judgment stage nor established that the Court's contrary finding was 'clear error.'"
Reminder: AHA to host members-only webinar Aug. 2 on EHR meaningful use    07/30/2012
A Centers for Medicare & Medicaid Services representative will review meaningful use requirements for physicians and the registration/attestation processes for hospitals supporting employed or affiliated physicians during an AHA members-only webinar Aug. 2 at 3 p.m. Eastern Time. AHA staff will moderate the session, intended for technical and clinical staff responsible for implementing meaningful use. To register and suggest specific topics for the session, click here. For more information, contact AHA Member Relations at (800) 424-4301.