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Payment Matters
February 9, 2011
Increased Scrutiny to Obtain and Maintain Medicare and Medicaid Enrollment – Final Regulations Published
By: Donna J. Senft
Providers and suppliers face significant changes in Medicare and Medicaid enrollment with the implementation of regulations responding to aspects of the health care reform legislation designed to enhance enrollment procedures to protect against fraud. The intent of the legislation was to prohibit unqualified individuals and entities from obtaining or maintaining enrollment; however, legitimate providers and suppliers will need to understand the new requirements so that billing privileges are not affected by a failure to comply with the rules. The final regulations, which become effective March 25, 2011, “Medicare, Medicaid, and Children’s Health Insurance Programs: Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers" [PDF] were published on February 2, 2011. Many of the proposed rules [PDF] were adopted as final with little to no change; however, there were some notable changes.
Click to continue...Rewarding Quality? Not Exactly - CMS Proposes Value-Based Purchasing Rule
After years of hinting that the Medicare payment practices would be modified so that the Centers for Medicare and Medicaid Services (CMS) would no longer be a passive purchaser of health care services, CMS released a proposed rule to implement a hospital value-based purchasing program under which a portion of hospital payment for inpatient services would be based on quality of care. The proposed rule [PDF] was published in the Federal Register on January 13, 2011, and implements Section 3001(a) of the Patient Protection and Affordable Care Act (Pub. L. 111-148) (ACA), which requires CMS to establish a value-based purchasing program applicable to hospital discharges occurring on or after October 1, 2012. Beginning in fiscal year (FY) 2013, CMS proposes that hospitals will receive value-based incentive payments that are based on the hospital meeting specified performance standards. In accordance with the statute, the program must be budget neutral and, thus, will be funded by a 1% reduction in base operating hospital DRG payments for each discharge in FY 2013, which will incrementally increase to a 2% reduction by FY 2017.
Click to continue...Can We Use 340B Drugs for…? New Answers on the Horizon
The issue of who can be included under the definition of “patient” for purposes of dispensing 340B drugs is a critical one for many covered entities enrolled in the 340B Drug Discount Program, particularly disproportional share hospitals (DSHs). Four years after publishing proposed guidance on the definition of “patient” in January 2007, the Health Resources and Services Administration (HRSA), the agency tasked with administering the popular, and often controversial, 340B Drug Discount Program, has now forwarded new guidance to the Office of Management and Budget for approval. The content of the new guidance is not yet known and many covered entities are anxious to learn whether the new guidance will expand the definition of patient in a manner that will permit them to provide more discounted drugs to the indigent and under insured population that they service.
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