Today, as part of the Obama administration’s work to make our health care system more transparent, affordable, and accountable, Health and Human Services (HHS) Secretary Kathleen Sebelius announced the release of new, privacy-protected data on services and procedures provided to Medicare beneficiaries by physicians and other health care professionals. The new data also show payment and submitted charges, or bills, for those services and procedures by provider. Please click here for more information.
Category: Medicare
President Obama Signs Medicare Physician Fee Schedule/SGR Patch with Numerous Health Policy Provisions
ReedSmith reported today that on April 1, 2014, President Obama signed into law H.R. 4302, the “Protecting Access to Medicare Act of 2014” (“the Act”). The Act includes a one-year Medicare physician fee schedule fix that averts a nearly 24 percent payment cut set for April 1, 2014, but which falls far short of earlier hopes for full repeal of the current sustainable growth rate (SGR) formula. The Act also includes numerous other Medicare payment and policy changes, including skilled nursing facility value-based purchasing provisions, reforms to the physician fee schedule relative valuation process, a new framework for clinical laboratory payments, a variety of changes impacting imaging services, changes in the exceptions for long term care hospitals, and extension of certain expiring provisions. In other areas, the bill includes a one-year delay in the transition to ICD-10, changes to the timetable for Medicaid disproportionate share hospital cuts, and “front-loading” of the 2024 Medicare sequestration reduction.
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Senate Approves ICD-10 Delay
The Senate approved a bill yesterday evening that prevents cuts to Medicare physician payments from going into effect for one year and delays the conversion to ICD-10 diagnostic and procedure codes for at least one year. The Senate voted 64-35 in favor of the Protecting Access to Medicare Act of 2014, which the House approved last Thursday. If President Obama signs the legislation, it will be the 17th such patch that Congress has enacted since the Medicare sustainable growth-rate formula became law in 1997. The bill passed Monday would also delay enforcement of a controversial inpatient payment rule for hospitals, the “two-midnight rule,” for six months. Please click here for more information ICD-10
Correct Coding – Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) – Revised
As part of the 2014 HCPCS update codes were created describing certain off-the-shelf (OTS) orthotics. Some of these codes parallel codes for custom fitted versions of the same items. Refer to the appropriate Local Coverage Determination (LCD) for a list of codes.
When providing these items suppliers must:
• Provide the product that is specified by the ordering physician, i.e. (1) type of orthosis and (2) method of fitting (OTS or custom fitted)
• Be sure that the medical record justifies the need for the type of product and method of fitting
• Be sure only to use the code that accurately reflects both the type of orthosis and the appropriate level of fitting
• Have detailed documentation that justifies the code selected for custom fitted versus OTS codes)
The following definitions will be used for correct coding of these items. Please click here for more information
CMS is in the procurement process for the next round of Recovery Audit Program contracts
CMS is in the procurement process for the next round of Recovery Audit Program contracts. It is important that CMS transition down the current contracts so that the Recovery Auditors can complete all outstanding claim reviews and other processes by the end date of the current contracts. In addition, a pause in operations will allow CMS to continue to refine and improve the Medicare Recovery Audit Program. Several years ago, CMS made substantial changes to improve the Medicare Recovery Audit program. CMS will continue to review and refine the process as necessary. For example, CMS is reviewing the Additional Documentation Request (ADR) limits, timeframes for review and communications between Recovery Auditors and providers. CMS has proven it is committed to constantly improving the program and listening to feedback from providers and other stakeholders. For additional information please click here Recovery Audit Program.
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