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Policy Snapshot
January 29, 2016

A revised Skilled Nursing Facility (SNF) Billing Reference Fact Sheet is available. Learn about SNF:

  • Coverage
  • Payment
  • Billing requirements
  • ...
Policy Snapshot
January 22, 2016

In a recent speech by Center for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt, he noted that CMS is trying to make the electronic health records (EHR) programs more physician friendly and tweeted that “in 2016, MU (meaningful use) as it had existed—with MACRA—will now be effectively over and replaced with something better.”

In a follow-up blog post to the CMS website Administrator Slavitt provided a more detailed update on CMS’ plans stating, “We have been working side...

Policy Snapshot
January 22, 2016

On January 19, the Centers for Medicare &Medicaid Services (CMS) updated the Open Payments dataset, consistent with the values we published on June 30, 2015. The total value before this update was $9.9 billion. The updated Open Payments dataset reflects:

  • Changes made to records
  • Changes to delays in publication flags
  • Changes to disputed records
  • Records that were deleted

This financial data was submitted by applicable manufacturers and applicable group purchasing organizations. Every year, CMS will update the Open Payments data...

Policy Snapshot
January 22, 2016

All Quality Improvement and Evaluation System (QIES) systems will be unavailable from Wednesday, March 16 after 8 pm ET through Monday, March 21, 2016. This downtime will affect all QIES connectivity and systems. The national database, Certification and Survey Provider Enhanced Reporting (CASPER) reports, and quick reference (QW) will not be available during this time. In addition, the following submission systems will be unavailable:

  • Hospice Item Set
  • Inpatient Rehabilitation Facility (IRF) -Patient Assessment Instrument (PAI)
  • Long-term Care Hospital (
  • ...
Policy Snapshot
January 15, 2016

This week, the Health Care Payment Learning and Action Network (LAN) released their Alternative Payment Model (APM) Framework White Paper. The paper defines payment model categories and establishes a common framework and a set of conventions for measuring progress in the adoption of APMs, which are methods of rewarding health care providers based on the quality and coordination of the care they provide.

APMs are important mechanisms for delivering high-quality, cost-effective, person-centered health care. In the APM Framework, all payments to health care providers fall within one...

Policy Snapshot
January 15, 2016

On January 11, the Centers for Medicare & Medicaid Services (CMS) announced 121 new participants in Medicare Accountable Care Organization (ACO) initiatives designed to improve the care patients receive in the health care system and lower costs. CMS also announced that providers and hospitals have signed up to join new types of ACOs, which in addition to being paid for positive patient outcomes will also receive penalties for negative ones. With new participants in the Medicare Shared Savings Program, the Next Generation ACO Model, Pioneer ACO Model, and the Comprehensive End-Stage...

Policy Snapshot
January 15, 2016

CMS has revised guidelines on Reviewing Short Stay Hospital Claims for Patient Status: Admissions On or After January 1, 2016. Starting October 1, 2015 Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs) began conducting initial patient status reviews of claims for inpatient admissions. Under the revised exceptions policy (CMS-1633-F), which became effective...

Policy Snapshot
January 15, 2016

In this MLN Connects video, Dr. Patrick Conway, the Principle Deputy Administrator and Chief Medical Officer for CMS, provides an overview of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. This important legislation requires that patient assessment data used in post-acute care settings (Skilled Nursing Facilities, Home Health Agencies, Inpatient Rehabilitation Facilities, and Long-Term Care Hospitals...

Policy Snapshot
January 15, 2016

The 2015 White House Conference on Aging released their final report which summarizes the work of 2015 year as well as the feedback they have received in the course of carrying out the conference.

In a year that marked the 50th anniversary of Medicare, Medicaid, and the Older Americans Act, as well as the 80th anniversary of Social Security, the White House Conference on Aging provided an opportunity to reflect on the importance of these programs, highlight new actions to support aging Americans,...

Policy Snapshot
January 8, 2016

On November 3, 2015, the Centers for Medicare & Medicaid Services (CMS), published in the Federal Register (80 Fed. Reg. 68126), proposed revisions to requirements for discharge planning for hospitals, Critical Access Hospitals (CAHs), and Home Health Agencies (HHAs). The proposed rule is designed to reduce avoidable hospital readmissions and improve patient care with a focus on improvements for psychiatric and behavioral health patients, including those with substance abuse disorders. It calls for coordination, consultation, and use of information from community-based service...