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Payment Matters
February 22, 2011
D.C. Circuit Wage Index Decision Highlights Importance of Comments Made During Rulemaking
By: Carel T. Hedlund
In an important decision affecting the 2007 and 2008 wage indices for hospitals, the U.S. Court of Appeals for the District of Columbia Circuit ruled in favor of the hospitals on the ground that CMS had not adequately responded to comments, and remanded the case to CMS for further proceedings. Cape Cod Hospital et al. v. Sebelius, No. 09-5447 (D.C. Cir. January 14, 2011) [PDF]. The issue before the Court involved the provision of the law that requires that the wage index for any urban hospital in a state cannot be lower than the rural hospital wage index for the state (the so-called “rural floor”). The statute provides that this rural floor provision be implemented in a budget neutral fashion. The hospitals challenged the methodology used by CMS to calculate the rural floor budget neutrality adjustment.
Click to continue...OIG Releases Recovery Act Work Plan Including Plans for Meaningful Use, ONC, and REC Monitoring
By: James B. Wieland and Joshua J. Freemire
The Office of the Inspector General (OIG) recently released its Recovery Act Implementation Overview and Work Plan (Plan) for 2011. Unsurprisingly, while the Plan covers multiple subject areas, a significant portion of the work plan items relate to health care information technology (HIT). HIT items include review plans for the Electronic Health Record Incentive Program (Meaningful Use), Regional Extension Centers (RECs), HIPAA compliance, and the Office of the National Coordinator for Health Information Technology (ONC). With regard to HIT, the OIG seems especially concerned with information security.
Click to continue...CMS Begins Reprocessing of Claims Required by the Affordable Care Act and the 2010 Medicare Physician Fee Schedule Changes
The Affordable Care Act and the 2010 Medicare Physician Fee Schedule Changes were adopted with retroactive dates for some provisions. Accordingly, a large volume of Medicare fee-for-service claims need to be reprocessed. This may affect physicians, other practitioners, ambulance suppliers, inpatient/outpatient hospitals, long term care hospitals, inpatient rehabilitation faculties, and home health agencies. CMS recently issued a notice [PDF] that it will begin to reprocess these claims in the next several weeks. CMS is also taking steps to ensure that new claims are accurately processed going forward.
Click to continue...CMS Open Door Forum to Address Home Health Value-Based Purchasing Set for February 24
CMS recently announced that it would hold an open door forum conference call on February 24, 2011, at 1:30 PM ET, to address value-based purchasing for home health agencies. CMS is seeking input from all interested parties. CMS’s announcement, with more information, can be found at www.cms.gov/OpenDoorForums/Downloads/022411HHVBPSODF.pdf.
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