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Payment Matters
April 28, 2011
CMS Capitulates, Issues Ruling Granting Relief in Hospice Cap Challenges
By: Carel T. Hedlund and Lisa D. Stevenson
In the face of losing multiple court challenges to the validity of the beneficiary counting methodology in the hospice cap regulation (42 C.F.R. § 418.309(b)), CMS has now acquiesced by issuing Ruling CMS-1355-R [PDF] on April 14, 2011. Under the Ruling, CMS will grant relief to any hospice provider that has a properly pending administrative appeal on this issue. The relief involves recalculating the hospice cap by prorating beneficiaries among the years in which they received hospice care, instead of counting them only in one year. CMS will also presumably seek to remand pending court cases for a similar recalculation.
Click to continue...CMS Releases Proposed FFY 2012 IPPS Rule
By: Mark A. Stanley
CMS has released its proposed federal fiscal year (FFY) 2012 prospective payment system (PPS) rule for inpatient stays in acute care and long-term care hospitals (LTCHs). The rule projects a decrease in operating payments to acute care hospitals in the amount of $498 million dollars for FFY 2012, a 0.5% decrease in comparison with FFY 2011 payments. The proposed rule can be viewed here [PDF].
Click to continue...Federal Health IT Strategic Plan Available for Comment
Though many providers are currently focused on achieving “Meaningful Use” of certified electronic health record technology, the federal government, in conjunction with private partners and the HIT Policy Committee, is planning for the next five years of electronic health record technology and implementation. The government’s explanation of its strategy is published as the Health IT Strategic Plan. The HITECH Act requires that the plan be revised, and the revised plan, describing government goals and strategies through 2015, is available for public comment through May 6, 2011. Providers who wish to review or comment on the Plan or its associated materials may do so through this website.
Click to continue...CMS Sign-Off - No Enforcement of Physician Signature Requirement on Lab Requisitions
By: Robert E. Mazer
As part of the Medicare Physician Fee Schedule final rule for calendar year 2011, the Centers for Medicare & Medicaid Services (CMS) required a physician or a qualified non-physician practitioner (NPP) to sign the requisition for a clinical diagnostic laboratory test effective January 1, 2011. This followed a controversy that started as part of the previous year’s rule making when the agency referred to its “longstanding policy” that required a written order for a clinical laboratory test to be signed by the ordering physician or NPP.
Click to continue...Primary Care Providers and General Surgeons Benefit from Increased Medicare Reimbursement
Effective January 1, 2011, and continuing to December 31, 2015, qualifying primary care providers and general surgeons in health professional shortage areas will benefit from a 10% increase in their reimbursement for certain services from Medicare Part B. This increased reimbursement from the Patient Protection and Affordable Care Act (PPACA) creates incentives to general practitioners to provide much needed primary care and general surgery services. PPACA, Pub. L. No. 111-148, § 5501 [PDF]; 2011 Physician Fee Schedule, Final Rule, Fed. Reg. 73170, 73431-43 (Nov. 29, 2010) [PDF]).
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