CMS Releases Proposed Rules for Accountable Care Organizations

April 1, 2011 By

On March 31, 2011, CMS released its proposed rules for public review and comment relating to Medicare payments for health care providers participating in Accountable Care Organizations (ACOs).  Under the proposed rules, health care providers participating in ACOs would be eligible to receive additional Medicare payments based on meeting certain specified quality and savings requirements in addition to receiving traditional Medicare fee-for-service payments under Medicare Parts A and B.

The proposed rules are available here and will be published in the Federal Register on April 7, 2011.  A fact sheet published by CMS which provides a summary of proposed rules is available here.  If you would like further information about ACOs, please contact Dave Schoolcraft or Elana Zana.

Filed Under: Accountable Care Organizations, Health Reform, Medicare

Registration for Medicare EHR Incentive Payments Starts January 3rd

December 28, 2010 By

Starting on January 3rd, 2011, registration for the HITECH Electronic Health Record Medicare Incentive Payments will open.  This registration is available for both eligible professionals and eligible hospitals, including Critical Access Hospitals.  The registration link will be available starting on January 3rd and can be accessed here.  Registration for the Medicaid EHR Incentive Payments will be available for the following states:  Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee, and Texas.  In February, registration will likely open in California, Missouri, and North Dakota.  It is anticipated that other states, including Washington, will  launch their Medicaid EHR Incentive Programs during the spring and summer of 2011.

For mor information regarding the Medicare Incentive Payments see the CMS press release.  For a general overview of the HITECH incentive payments please read our previous blog posts for physicians and hospitals.  As a disclaimer, these blog posts were written prior to the issuance of the Final Rules but provide a good overview of the statutory requirements.

CMS has also issued tip sheet regarding Stage 1 Meaningful Use for hospitals, and Critical Access Hospitals, click here to access the tip sheet.  The tip sheet for eligible professionals can be accessed here.  Additional information may be obtained by contacting CMS or your State directly (CMS and State Medicaid Contact List & Information).

If you would like further information regarding achieving Meaningful Use, registering for the Medicare Incentive Payments, or assistance calculating the Medicare or Medicaid incentive payments please contact Dave Schoolcraft or Elana Zana.

Filed Under: Critical Access Hospital, HITECH, Incentive Payments, Medicare

New CMS Rules Require Equal Visitation Rights

November 18, 2010 By

The Center for Medicare & Medicaid Services (CMS) issued new rules today that require participating hospitals to have policies that allow patients to choose the visitors who are allowed by their bedside, including same-sex domestic partners. 

 According to the White House’s press release, the new rules will:

  • Require hospitals to explain to all patients their right to choose who may visit them during their inpatient stay, regardless of whether the visitor is a family member, a spouse, a domestic partner (including a same-sex domestic partner), or other type of visitor, as well as their right to withdraw such consent to visitation at any time. 
  • Require hospitals have written policies and procedures detailing patients’ visitation rights, as well as the circumstances under which the hospitals may restrict patient access to visitors based on reasonable clinical needs.
  • Specify that all visitors chosen by the patient must be able to enjoy “full and equal” visitation privileges consistent with the wishes of the patient.
  • Update the Conditions of Participation (CoPs), which are the health and safety standards all Medicare- and Medicaid-participating hospitals and critical access hospitals must meet, and are applicable to all patients of those hospitals regardless of payer source.

The rules will take effect 60 days after publication.  The new rules can be found here.

Filed Under: Health Reform, Medicare

CMS Releases Self-Referral Disclosure Protocol

September 23, 2010 By

On September 23, 2010, the Centers for Medicare and Medicaid Services (CMS) posted on its web site the long awaited voluntary “Self-Referral Disclosure Protocol” which it refers to as the “SRDP.”  Information about the SRDP is available on the CMS website, and the SRDP is available here.

In March 2010, Congress enacted the Patient Protection and Affordable Care Act (sometimes referred to as the “PPACA” or “ACA”).  Section 6409 of the ACA required CMS to promulgate a Stark law self-disclosure program by September 23, 2010, which it has now done.  CMS intentionally decided to establish the SRDP without going through rule making.  While it is good news that there exists a formal mechanism for resolving Stark law violations, the SRDP raises as many questions as it answers.  Important aspects of the SRDP include the following:

  • The SRDP is separate from the advisory opinion process and cannot be used to obtain a CMS determination about an actual or potential violation;
  • CMS makes no guaranty about the treatment a disclosing party will receive, i.e., that overpayment amounts will be compromised in any particular manner or at all;
  • CMS will coordinate disclosures it receives with the DHHS Office of Inspector General (OIG) and Dept. of Justice (DOJ) as appropriate;
  • The disclosure must be comprehensive, address all of the elements set forth in SRDP, and include a comprehensive financial analysis;
  • Disclosures made within 60 days of the overpayment being identified will suspend the obligation to return any overpayment until a settlement agreement is entered or the disclosure is removed from the SRDP;
  • The disclosing party or an appropriate officer of the disclosing party must certify that the submission is truthful and based on a good faith effort to resolve any potential liabilities under the Stark law;
  • CMS will verify the submission, including requesting additional information and requiring cooperation from the disclosing party to provide information that may be subject to the attorney-client or attorney work product privileges; and
  • Repayment of any overpayment will not be accepted prior to CMS’s completion of its verification and inquiry.

Throughout the process, CMS will require the diligent and good faith cooperation of a disclosing party.  Failure to provide cooperation will be considered by CMS as it assesses appropriate resolutions.  If a disclosing party provides false or misleading information, or intentionally omits relevant information, CMS may refer the matter to the DOJ or other appropriate agencies.  Disclosures must be made within 60 days of the date the original overpayment was identified, or the date any corresponding cost report is due, if applicable.  Finally, CMS has set forth factors that it will consider in determining whether to reduce the amounts that would otherwise be owed.  Again, CMS provides no guarantees, or even guidelines, for how it will determine appropriate resolutions.  The factors CMS will consider include

  • The nature and extent of the illegal or improper practice;
  • The timeliness of the self-disclosure;
  • The cooperation of the disclosing party in providing additional information;
  • The litigation risk associated with the disclosure; and
  • The financial position of the disclosing party.

Despite the request of various industry groups, CMS has made no explicit statements about how it will consider or treat disclosures of technical violations (e.g., missing signature, expired agreements, etc.).  Ultimately, CMS states that it has “no obligation to reduce any amounts due and owing,” and that it will make determinations on an individual, facts and circumstances basis for each disclosure.

Having this avenue to attempt to resolve Stark law violations is indeed an improvement that has been needed for a long time.  However, providers cannot take much comfort from CMS’s statement that it has no obligation under the SRDP to compromise amounts due.  Only time and experience will tell how CMS treats these disclosures.  Ultimately, if a disclosing party does not believe that it is receiving appropriate treatment, it appears that the party can remove itself from the SRDP;  however, that is cold comfort after it has brought the matter to CMS’s attention and now has the obligation under the ACA to return overpayments.

For more information on the SRDP or the Stark law in general, please contact Don Black, Dave Schoolcraft or any one of OMW’s Healthcare Team members.  

Filed Under: Medicare, Stark

CMS Launches EHR Incentive Payment Website

August 18, 2010 By

To help answer questions regarding meaningful use and the EHR incentive payments, CMS has launched an EHR Incentive Program website.  The website provides FAQ’s, CMS presentations, fact sheets, and more.  To view the site click here.

Filed Under: HITECH, Incentive Payments, Medicare

CMS Presentation on Meaningful Use & EHR Incentives Final Rules

July 22, 2010 By

On July 13, CMS issued the Medicare and Medicaid Programs Electronic Health Record Incentive Program Final Rules.  These final rules were published in the Federal Register on July 28th. 

On July 22nd, CMS hosted a conference call to explain the changes in the Final Rules as compared to the Proposed Rules.  Some key changes include:

  • Inclusion of Critical Access Hospitals in the definition of eligible hospital for Medicaid incentives.
  • A revised definition of hospital based eligible professionals to exclude only those physicians that provide 90% or more of their services in either an inpatient or emergency department.
  • Eligible Professionals and Eligible Hospitals may defer 5 optional “menu set” Meaningful Use reporting objectives.
  • Reduction in measure thresholds for Meaningful Use reporting objectives.

To view the CMS slide presentation click here.  ONC has also published a slide deck entitled “Supporting Meaningful Use” that provides helpful guidance.  CMS has also launched an EHR Incentives website which has fact sheets, press releases, general information, and instructions on how to participate, also on the website will be the transcript of the CMS conference call.

In addition, CMS has published the Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for EHR Technology.  For more information on these Standards click here.

If you have questions regarding how these final rules will affect your practice please contact Elana Zana.

Filed Under: Critical Access Hospital, HITECH, Incentive Payments, Medicare

249 Members of Congress Urge CMS to Revise Meaningful Use and Incentive Eligibility

March 18, 2010 By

In a letter submitted to CMS on March 15th, Members of Congress encouraged CMS to revise its proposed definition of meaningful use and the restrictions on the EHR incentive payments.  The letter covered three topics:

1) the definition of Meaningful Use;

2) the definition of Hospital-Based Physician; and

3) the limitation on payments to Multi-Campus hospitals.

Specifically, the letter discussed the application of the meaningful use requirements for both Medicare and Medicaid and urged CMS to relax the restrictions and the broad scope of the definition.  The letter recommends that CMS modify the hospital-based definition to allow incentive payments for physicians that furnish services in hospital-owned ambulatory settings by excluding those physicians from the definition of hospital-based.  Lastly, the letter requests that CMS identify hospitals as discrete facilities regardless of whether the hospital is part of a multi-hospital system operating under the same Medicare provider number.

Filed Under: HITECH, Incentive Payments, Medicare

Final Physician Supervision Rules for Hospital Outpatient Therapeutic and Diagnostic Services for CY 2010

December 2, 2009 By

CMS recently released the CY 2010 Outpatient Prospective Payment System Final Rule.  The Final Rule finalized, among many other items, several provisions concerning physician supervision of hospital outpatient therapeutic and diagnostic services which CMS had previously proposed.  The physician supervision provisions finalized for CY 2010 were in response to industry concerns raised regarding the “clarifications” to the physician supervision requirements issued in CMS’s CY 2009 OPPS Final Rule.  The new physician supervision requirements for hospital outpatient therapeutic and diagnostic services include the following:

  • CMS expanded the direct supervision of hospital outpatient therapeutic services to licensed clinical social workers, physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse-midwives.  These non-physician practitioners may directly supervise all hospital outpatient therapeutic services that they may perform themselves within their scope of practice under State law and hospital privileges, provided that they meet all additional requirements, including any other collaboration or supervision requirements.  However, CMS did not extend the direct supervision by non-physician practitioners to pulmonary rehabilitation, cardiac rehabilitation, or intensive cardiac rehabilitation.  Direct physician supervision for these services must be furnished by a doctor of medicine or osteopathy.  CMS also did not extend direct supervision by non-physician practitioners to hospital outpatient diagnostic services – only physicians may directly supervise these services, when required. 
  • All hospital outpatient diagnostic services provided directly or under arrangement, whether provided in the main hospital buildings, in a provider-based department, or other nonhospital location, must follow the physician supervision requirements for the individual tests as listed in the Medicare Physician Fee Schedule (MPFS) Relative Value File.
  • For services furnished on a hospital’s main campus (i.e., in the hospital or in an on-campus outpatient department), the supervising physician or non-physician practitioner may be located anywhere on the hospital campus, including a physician’s office or other nonhospital space, so long as he/she is on the same campus and immediately available to furnish assistance and direction throughout the procedure.  This standard applies to all hospital outpatient therapeutic services, and to the subset of hospital outpatient diagnostic services requiring direct physician supervision as specified in the MPFS Relative Value File.
  • For services furnished in off-campus provider based departments of hospitals, the physician or non-physician practitioner must be physically present in the off-campus provider-based department (versus the previous requirement to be “present and on the premises of the location”) and be immediately available to furnish assistance and direction throughout the procedure.  Again, this standard applies to all hospital outpatient therapeutic services, and to the subset of hospital outpatient diagnostic services requiring direct physician supervision as specified in the MPFS Relative Value File.

The Final Rule also made “technical corrections” to the regulation concerning therapeutic services to clarify that the supervision (and other) requirements required for payment of outpatient therapeutic services applies to both hospitals and critical access hospitals (CAHs).  CMS explained that the prior absence of specific reference to CAHs was simply a drafting oversight, but that it has always applied the requirements to CAHs.

The Final Rules offer increased flexibility to hospitals in meeting the physician supervision requirements for hospital outpatient therapeutic and diagnostic services, and are applicable to services furnished on or after January 1, 2010.  A full copy of the CY 2010 OPPS Final Rule is available here.  (For a PDF version, click here (this will take awhile to download).)

Filed Under: Critical Access Hospital, Medicare
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