The Centers for Medicare & Medicaid Services (CMS) intends to implement the nationwide Recovery Audit Contractor (RAC) program in phases beginning in March 2008. Medicare providers should become informed about the RAC program and begin planning for its implementation. In this post, aspects of the RAC program are highlighted to assist providers and others in understanding CMS's plans for the nationwide RAC program.
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On May 6, 2008, the House Ways and Means Subcommittee on Health held a hearing on the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) competitive bidding program.
During the hearing, the Subcommittee on Health entertained testimony from a number of witnesses, including Kerry Weems, the Centers for Medicare & Medicaid Services (CMS) Acting Administrator and Tom Ryan on behalf of the American Association for Homecare.
In testimony before the Subcommittee, the Acting CMS Administrator states that the "success story of DMEPOS competitive bidding is the amount of money that beneficiaries will save as a result of lower coinsurance..." and reports that, when fully implemented in 2010, the DMEPOS competitive bidding program is projected to save the Medicare program and taxpayers $1 billion annually. In fact, CMS claims that, across the first 10 metropolitan statistical areas and in each product category of the DMEPOS competitive bidding program, beneficiaries will see an average savings of 26 percent when the new payment rates take effect on July 1, 2008.
However, in testimony before the Subcommittee, the American Association for Homecare (AAHomecare) depicts the DMEPOS competitive bidding program as "poorly conceived and fundamentally flawed." In fact, AAHomecare points out that nearly 63 percent of the accredited, qualified homecare providers that submitted bids were disqualified in the first round of bidding because they were unable to navigate the bidding process. AAHomecare also raises a number of concerns about the DMEPOS competitive bidding program adversely impacting Medicare beneficiaries access to quality care.
AAHomecare also believes that the savings projected by CMS for the first round of competitive bidding is misleading. According to AAHomecare, small suppliers (concerned about larger suppliers having a competitive advantage) may have bid extraordinarily low to remain viable. AAHomecare reports that the small suppliers may have assumed that the larger suppliers' bids would reflect accurate (higher) pricing and increase the final Medicare single payment amounts. However, AAHomecare believes that the number of small suppliers with extraordinarily low bids may have prevented many larger firms' bids from being considered. Therefore, AAHomecare questions whether the extraordinary low bid rates in the first round of the DMEPOS competitive bidding program will be sustainable over the 3 year contracting period.
Consequently, AAHomecare urges Congress to immediately halt the implementation of the DMEPOS competitive bidding program and reports that it supports the implementation of a rational, alternative process to determine Medicare pricing for DMEPOS items and services.
On May 14, 2008, the House Small Business Committee's Subcommittee on Regulations, Health Care and Trade held a hearing on "The Impact of CMS Regulations and Programs on Small Health Care Providers."
During the hearing, the Subcommittee entertained testimony on the Medicare recovery audit contractor (RAC) program from the Centers for Medicare & Medicaid Services (CMS), American Medical Association (AMA), American Academy of Family Physicians, and The Alliance of Specialty Medicine.
In testimony, CMS pointed out the apparent cost-effectiveness of the RAC demonstration. CMS also highlighted some of the improvements made to the permanent RAC program (e.g., requiring medical directors and certified coders) based on the feedback and experience during the RAC demonstration.
CMS testimony also indicates that CMS intends to place a much greater emphasis on provider education and training in the permanent RAC program and require permanent RACs to identify and publish vulnerability analyses so that providers can make corrections before audits begin. Further, CMS reports that once the permanent RACs are selected, CMS and the RACs intend to conduct extensive provider outreach. According to testimony, CMS "hopes to have selections of the national RAC contractors made later this spring so that claim review can begin this calendar year."
In testimony before the Subcommittee, the AMA stated that it "believes that the RAC program is seriously flawed" and expressed its support for the Medicare Recovery Audit Contractor Program Moratorium Act (H.R.4105), which would impose a one-year moratorium on the RAC program so that policymakers can reevaluate the program. The AMA also expressed some comments and suggestions regarding the RAC program. In brief, those comments and suggestions included the following:
On May 15, 2008, Lewis Morris, Chief Counsel to the Inspector General, presented testimony entitled "In the Hands of Strangers: Are Nursing Home Safeguards Working?" before the House Energy and Commerce Committee's Subcommittee on Oversight and Investigations.
In his testimony, the Chief Counsel describes the studies, enforcement actions, initiatives and government-industry collaboration that the Department of Health and Human Services' Office of Inspector General (OIG) has undertaken to identify ways to improve the quality of nursing home care. The Chief Counsel also offers some suggestions for consideration, including:
On May 9, 2008, the U.S. Government Accountability Office (GAO) also released a report entitled "Federal Monitoring Surveys Demonstrate Continued Understatement of Serious Care Problems and CMS Oversight Weaknesses." According to the report, during fiscal years 2002 through 2007, about 15 percent of federal comparative surveys nationwide identified state surveys that failed to cite at least 1 deficiency at the most serious levels of nursing home noncompliance - actual harm and immediate jeopardy. In the report, the GAO recommends that the Centers for Medicare & Medicaid Services (CMS):
The GAO reports that it provided a draft of the report to CMS through the Department of Health and Human Services (HHS) and that HHS endorsed and indicated that it would implement the GAO recommendations.
The Centers for Medicare & Medicaid Services (CMS) recently announced that it will host a national provider conference call on the 2008 Physician Quality Reporting Initiative (PQRI). The conference call will take place from 3:30 p.m. - 5:00 p.m. (EDT) on May 28, 2008.
During the conference call, CMS will provide an overview of the alternative reporting periods and alternative criteria for satisfactorily reporting quality measures for the 2008 PQRI as authorized by the Medicare, Medicaid and SCHIP Extension Act of 2007. Prior to the call, CMS will post a PowerPoint slide presentation in the Educational Resources section on the PQRI webpage. Following the presentation, callers will have an opportunity to ask questions.
To participate in the conference call, registration is required. Registration will close at 3:30 p.m. (EDT) on May 27, 2008 or when available space has been filled. For those unable to participate in the conference call, a replay of the call will be accessible from 5:30 p.m. (EDT) on May 28, 2008 until 11:59 p.m. (EDT) on June 5, 2008. To access the replay, one must call 1-800-642-1687 and use passcode 46870023.
On May 9, 2008, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 1502 adding a new Chapter 36 to the Medicare Claims Processing Manual (CMS Pub. 100-04).
In the new Chapter 36, CMS provides Medicare contractors with instructions regarding the Medicare durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding program, including CMS policy on grandfathered suppliers and items, and the transfer of title of capped rental DME items, oxygen and oxygen equipment. CMS reports that subsequent installments of Chapter 36 will contain additional instructions, information about the DMEPOS competitive bidding program, and possibly revisions to clarify language or add additional information on policy. CMS has also posted sample notification letters on the Competitive Bidding Implementation Contractor website, which suppliers may use to notify Medicare beneficiaries whether or not they elect to become a grandfathered supplier.
On May 9, 2008, the Centers for Medicare & Medicaid Services (CMS) published a Final Rule in the Federal Register establishing rate year (RY) 2009 payment rates and policies for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCH).
According to CMS, the Final Rule will increase the standard Federal rate for LTCHs by 2.7 percent and establish a standard Federal rate for the 2009 LTCH PPS rate year of $39,114.36 for discharges occurring during the 15 month period from July 1, 2008 through September 30. 2009. Under the Final Rule, CMS estimates that aggregate LTCH PPS payments for RY 2009 to be approximately $4.47 billion. CMS reports that this is an increase of approximately $110 million (or 2.5 percent) over estimated payments in RY 2008.
The Centers for Medicare & Medicaid Services (CMS) recently announced that it will hold the next Skilled Nursing Facility/Long-Term Care Open Door Forum at 2:00 p.m. (EDT) on May 22, 2008.
To participate by telephone, one must dial 1-800-837-1935 and reference conference ID 41865584. To participate in person, one must RSVP by 2:00 p.m. (EDT) on May 20, 2008 to SNF_LTCODF-L@cms.hhs.gov, and include your name, organization, phone number, and “SNF/LTC” in the subject line. The Open Door Forum will take place at the Hubert H. Humphrey Building, 200 Independence Avenue S.W., Washington, D.C. CMS asks that attendees arrive no later than 1:30 p.m.
Beginning May 26, 2008, CMS will also make an audio recording of the Open Door Forum available. To access the audio recording, one must dial 1-800-642-1687 and enter the conference ID. The recording will expire after 3 business days.
On May 8, 2008, the Centers for Medicare & Medicaid Services (CMS) announced that it will host a national conference call on the implementation of the Medicare durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding program, which is scheduled to begin on July 1, 2008.
The national conference call will take place from 12:30 p.m. - 2:00 p.m. (EDT) on May 13, 2008. During the conference call, CMS is expected to give a general overview of the DMEPOS competitive bidding program and address some exceptions and situations suppliers may encounter in the program's implementation. CMS also reports that a presentation will be made by the Competitive Bidding Implementation Contractor. CMS expects to post a PowerPoint presentation on the CMS website prior to the call.
To participate in the conference call, registration is required. Registration will close at 12:30 p.m. (EDT) on May 12, 2008 or when available space has been filled. CMS will also make an audio recording of the conference call available from 2:30 p.m. (EDT) on May 13, 2008 until 11:59 p.m. (EDT) on May 17, 2008. The audio recording may be accessed by calling 1-800-642-1687 and using passcode 45744159.
The Centers for Medicare & Medicaid Services (CMS) recently released a display copy of a Proposed Rule that would enhance the marketing standards for Medicare Advantage (MA) health plans and Medicare Part D prescription drug plans. In the Proposed Rule, CMS incorporates some of the requirements that CMS previously imposed through operational guidance and introduces new MA and Medicare Part D prescription drug plan requirements. According to the CMS Press Release, the marketing standards would:
The Proposed Rule also contains provisions for enhancing the protections afforded to Medicare beneficiaries receiving the low income subsidy and those enrolled in special needs plans. The Proposed Rule is expected to appear in the Federal Register on May 16, 2008. CMS reports that it will be accepting comments on the Proposed Rule until July 15, 2008.
The Centers for Medicare & Medicaid Services (CMS) recently announced that it is seeking self-nominations from clinical data registries interested in becoming part of the submission process for the 2008 Physician Quality Reporting Initiative (PQRI). CMS has posted the selection criteria and process on the CMS website and is accepting self-nominations from registries through May 31, 2008.
The Medicare, Medicaid and SCHIP Extension Act of 2007 authorizes CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries. CMS has posted a document on the CMS website establishing the new alternative reporting criteria and periods.
