CMS announces provider calls on 'two-midnight' policy, rural issues   11/07/2013
The Centers for Medicare & Medicaid Services will answer questions about its new “two-midnight” policy for inpatient hospital admissions during a Special Open Door Forum on Tuesday, Nov. 12, at 1 p.m. Eastern Time. On Nov. 13, CMS will host an Open Door Forum on rural health issues. Topics will include clarifying guidance on the “96-hour rule” for Critical Access Hospitals and a recent report by the Department of Health and Human Services’ Office of Inspector General that recommended dramatic changes to the CAH program.
CMS to implement ordering and referring denial edits Jan. 6   11/07/2013
Beginning Jan. 6, the Centers for Medicare & Medicaid Services will automatically deny certain Medicare claims for clinical laboratory tests, imaging procedures, and durable medical equipment and supplies if they do not contain a valid National Provider Identifier for the ordering or certifying physician or eligible professional, the agency announced yesterday. The requirement was included in an April 2012 final rule implementing several program integrity provisions of the Patient Protection and Affordable Care Act, but delayed to give physicians and EPs more time to enroll in the Medicare program or to revalidate their Medicare enrollment. The provision generally only impacts hospitals with home health agencies or enrolled as durable medical equipment suppliers. For more information, see the Medicare Learning Network article and June 2012 AHA member advisory.
CMS announces additional chance for IPFs to correct FY 2014 quality data   11/07/2013
Inpatient psychiatric facilities that were unable to review and correct quality reporting data for fiscal year 2014 due to technical difficulties with the QualityNet application will have one more opportunity to do so between Nov. 11 and 22, the Centers for Medicare & Medicaid Services announced yesterday. Any data corrections will not affect the facility’s annual payment update, which is based on whether the facility submitted data. This one-time review and correction period does not replace the 30-day period IPFs will have in early 2014 to review and correct measure data that will be publicly displayed. IPFs and distinct-part psychiatric units in acute care hospitals are eligible to participate in the IPF quality reporting program.
AHA to host members-only webinar on Medicaid presumptive eligibility   11/07/2013
Tune in Nov. 21 at 3 p.m. Eastern Time for an AHA members-only webinar on hospital-based Medicaid presumptive eligibility and enrollment. Medicaid officials from the Centers for Medicare & Medicaid Services will present the latest information on presumptive eligibility determination, a Patient Protection and Affordable Care Act provision that allows hospitals to temporarily enroll patients in Medicaid coverage at the point of service. To register for the 60-minute webinar, click here.
AMA study lists states where one private health insurer rules   11/07/2013
The American Medical Association today announced its annual list of 10 states with the least competitive commercial health insurance markets, based on a common measure of market concentration used by the U.S. Department of Justice and Federal Trade Commission. They are among 15 states in which a single company had a majority share of the market in 2011, based on the AMA’s latest study of competition in U.S. health insurance. Forty-five states had two health insurers with a combined commercial market share of 50% or more. Nearly three-quarters of the 386 metropolitan areas studied were “highly concentrated,” based on 2010 Horizontal Merger Guidelines issued by the DOJ and FTC. “In far too many states, one or two insurance companies dominate the market, which can hurt patients, physicians and employers,” said AMA President Ardis Dee Hoven, M.D. “Without rivals to compete against, a large health insurance company can take advantage of patients by raising premiums and dictating important aspects of patient care.”
AHA launches health IT survey   11/07/2013
The AHA encourages all hospitals to complete the sixth annual Information Technology Supplement to the AHA Annual Survey, which was mailed to CEOs today. Recipients should forward the survey to their chief information officer to complete on paper or online by Dec. 6. "Even if your hospital has not adopted any or all of the specific technologies in the survey, your answers are extremely important," AHA President and CEO Rich Umbdenstock said in the survey cover letter. "This is particularly true at a time when we are carefully monitoring the Centers for Medicare & Medicaid Services’ implementation of incentive programs on meaningful use of  electronic health records, which will be followed by penalties in 2015 and later." For more information, contact AHA survey support at (800) 530-9092 or