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CMS to Release a CBR on Subsequent Nursing Facility E/M Services in April

Policy Snapshot
Payment, Current Procedural Terminology (CPT) codes
March 25, 2016

The Centers for Medicare & Medicaid Services (CMS) will issue a national provider Comparative Billing Report (CBR) on Subsequent Nursing Facility Evaluation and Management (E/M) Services in April 2016. The CBR, produced by CMS contractor eGlobalTech, will focus on providers of all specialties who bill Current Procedural Terminology codes 99307 through 99310 to report subsequent nursing facility E/M services. CBRs contain data-driven tables with an explanation of findings that compare providers’ billing and payment patterns to those of their peers in their state and across the nation....

Medicare Skilled Nursing Facility (SNF) Transparency Data (CY2013)

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Federal Regulations, Payment, Current Procedural Terminology (CPT) codes
March 25, 2016

On March 9, 2016, the Centers for Medicare & Medicaid Services (CMS) released a new dataset, the Skilled Nursing Facility Utilization and Payment Public Use File (SNF PUF).  This data set, which is part of CMS’s Medicare Provider Utilization and Payment Data sets, details information on services provided to Medicare beneficiaries by skilled nursing facilities.  The new data include information on 15,055 skilled nursing facilities, over 2.5 million stays, and almost $27 billion in Medicare payments for 2013.  The data is posted on the CMS website...

Join a Virtual Office Hour Session Focused on 2016 PQRS Reporting Measures Series, Session 1: Introduction to Quality Measures Reporting

Policy Snapshot
Physician Quality Reporting System (PQRS), Quality, Measures
March 25, 2016

 The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the first session of a three-part Virtual Office Hours series regarding 2016 Physician Quality Reporting System (PQRS) quality measures. The series includes three separate sessions that cover topics related to PQRS measures, such as explaining what a quality measure is, measures-related resources, and next steps for participation in 2016 PQRS.

The first session, titled "2016 PQRS Reporting: Introduction to Quality Measures Reporting (session 1 of 3)", will take place on Tuesday, March...

EHR Incentive Program Hardship Application Deadline Extended to July 1

Policy Snapshot
Electronic Health Records (EHR), Health Information Technology (HIT), Meaningful Use, Attending Physician
March 4, 2016

The Centers for Medicare & Medicaid Services (CMS) extended the hardship application deadline for the Medicare Electronic Health Record (EHR) Incentive Program to July 1, 2016. Eligible professionals, eligible hospitals, and critical access hospitals will have time to submit their applications to avoid adjustments to their Medicare payments in 2017. In January, CMS posted new, streamlined hardship exception application forms on the Payment Adjustments and Hardship Information...

Antipsychotic Drug use in Nursing Homes: Trend Update

Policy Snapshot
Dementia, Antipsychotics
March 4, 2016

The Centers for Medicare & Medicaid Services (CMS) extended the hardship application deadline for the Medicare Electronic Health Record (EHR) Incentive Program to July 1, 2016. Eligible professionals, eligible hospitals, and critical access hospitals will have time to submit their applications to avoid adjustments to their Medicare payments in 2017. In January, CMS posted new, streamlined hardship exception application forms on the PaThe Centers for Medicare & Medicaid Services (CMS) is tracking the progress of the National Partnership to Improve Dementia Care in Nursing Homes by...

HHS Announces EHR Commitment from Healthcare Industry; House Energy and Commerce Committee Discusses Future of LTC Delivery

Policy Snapshot
Electronic Health Records (EHR), Health Information Technology (HIT), Attending Physician, Certified Medical Director, Certified Nursing Assistant (CNA), Interdisciplinary/Interprofessional Team, Non-Physician Practitioners, Nurse Practitioner (NP)
March 4, 2016

U.S. Department of Health and Human Services (HHS) Secretary Sylvia Matthews Burwell announced a commitment made by companies that provide 90 percent of nation’s electronic health records (EHRs) used in hospitals and the five largest private health care systems to make EHRs work better for patients and health care providers.
 
The companies and health care systems committed to three principles, including allowing consumers to easily and securely access their electronic health information, helping providers...

Mandatory Payment Reduction of 2% Continues until Further Notice for the Medicare FFS Program – “Sequestration”

Policy Snapshot
Payment, Physician Fee Schedule (PFS), Attending Physician
March 4, 2016

Medicare Fee-For-Service (FFS) claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will continue to incur a 2 percent reduction in Medicare payment until further notice. Claims for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), including claims under the DMEPOS Competitive Bidding Program, will continue to be reduced by 2 percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013. The claims payment adjustment will continue to be applied to all claims after...

AMDA’s Dr. Karl Steinberg Appointed to NQF Palliative and End-of-Life Care Committee

Policy Snapshot
End-of-Life, Palliative Care
March 4, 2016

AMDA Board of Directors member, Public Policy Committee Chair, and Caring for the Ages Editor in Chief Karl Steinberg, MD, CMD, was recently appointed to the National Quality Forum’s (NQF’s) Palliative and End-of-Life Care Standing Committee for the Palliative and End-of-Life Endorsement Maintenance Project. The goals of the project are to identify and endorse performance measures for accountability and quality improvement that address palliative and end-of-life care.
Dr. Steinberg’s selection is pending a NQF member and public comment period on the proposed roster. For more details...

Alignment and Simplification of Quality Measures

Policy Snapshot
Centers for Medicare and Medicaid (CMS), Gastrointestinal Disorders, Accountable Care Organization (ACO), Quality, Measures
February 26, 2016

On February 16, the Centers for Medicare & Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP), as part of a broad Core Quality Measures Collaborative of health care system participants, released seven sets of clinical quality measures. These measures support multi-payer alignment, for the first time, on core measures primarily for physician quality programs. Partners in the Collaborative recognize that physicians and other clinicians must...

Ask your members of Congress to support the Improving Access to Medicare Coverage Act!

Policy Snapshot
Skilled Nursing Care, Medicare
February 25, 2016

Many Medicare residents entering into a skilled nursing facility (SNF) are coming from the acute hospital setting. In order to receive the paid Medicare SNF benefit they must have received inpatient status for three consecutive days during their hospital stay. Those not classified as inpatient but rather as observation are consequently charged for SNF services. The Improving Access to Medicare Coverage Act of 2015 would count all time (inpatient or observation) spent in the hospital towards the required three day stay.

AMDA has long supported this legislation and has had...