Medicare Update

Comment Period Extended for Rule Proposing New ESRD Prospective Payment System

On September 29, 2009, the Centers for Medicare & Medicaid Services (CMS) published a Proposed Rule that would implement a case-mix adjusted bundled prospective payment system for Medicare outpatient end stage renal disease (ESRD) dialysis facilities beginning January 1, 2011.

Today, CMS published a Notice extending the comment period for the Proposed Rule. CMS will now be accepting comments until 5:00 p.m. on December 16, 2009. The original comment period would have ended on November 16, 2009.

Subscribe to Medicare Update, follow me on Twitter @MedicareUpdate, and become a fan on Facebook.

Top Ten Medicare Update Blog Posts in October 2009

Below are the top ten Medicare Update posts during October 2009 (based on the number of views):

1)   CMS Announces 2010 Medicare Premiums and Deductibles

2)   OIG Work Plan Reveals Possible Risk Areas for Medicare Providers and Suppliers

3)   Senator Stabenow Introduces Medicare Physician Fairness Act of 2009

4)   OIG Work Plan Identifies Possible Areas of Concern for Home Health Agencies and DMEPOS Suppliers

5)   CMS Directs Medicare Contractors to Take Action on OIG Reports

6)   CMS Posts FAQ on Code 432 and Medicare Recovery Audit Contractors

7)   The Changing Dynamics of Medicare Fraud Schemes?

8)   Medicare Fraud and Recovery Audit Contractor Program

9)   CMS to Shelve Medicare Medical Home Demonstration

10) Region D Recovery Audit Contractor Updates CMS Approved Audit Issues

Subscribe to Medicare Update, follow me on Twitter @MedicareUpdate, and become a fan on Facebook.

MedPAC Releases Updated Medicare Payment Basics Documents

On October 14, 2009, the Medicare Payment Advisory Commission (MedPAC) released updated documents for its Medicare Payment Basics series, which provide an overview of 18 Medicare payment systems. 

To view the updated documents, visit the Medicare Payment Basics page of the MedPAC website or click on any of the following links:

• Oxygen and oxygen equipment payment system
• Skilled nursing facility services payment system
• Physician services payment system
• Psychiatric hospital services payment system
• Rehabilitation facilities (inpatient) payment system
• Part D payment system
• Outpatient therapy services payment system
• Medicare Advantage program payment system
• Outpatient dialysis services payment system
• Outpatient hospital services payment system
• Home health care services payment system
• Hospice services payment system
• Hospital acute inpatient services payment system
• Long-term care hospitals payment system
• Clinical laboratory services payment system
• Critical access hospitals payment system
• Durable medical equipment payment system
• Ambulatory surgical centers payment system

MedPAC is an independent Federal body established by the Balanced Budget Act of 1997 to advise Congress on issues affecting the Medicare program.

Subscribe to Medicare Update, follow me on Twitter @MedicareUpdate, and become a fan on Facebook.

Top Ten Medicare Update Blog Posts in September 2009

Below are the top ten Medicare Update posts during September 2009 (based on the number of views):

1.  Senate Finance Committee Releases Framework for Comprehensive Health Reform

2.  CMS Proposes New Prospective Payment System for Renal Dialysis Facilities

3.  CMS Publishes Final Rule on Overpayments and Recoupment Limitations

4.  OIG Reports on Medicare Coverage and Hospice Care for Nursing Facility Residents

5.  CMS Investigates Humana Regarding Health Care Reform Mailings

6.  Region C Recovery Audit Contractor Adds States to CMS Approved Audit Issues

7.  OIG Releases Report on Power Wheelchair Acquisition Costs and Services

8.  CMS Approved Audit Issues Posted for Region A Recovery Audit Contractor

9.  CMS Announces Additional Recovery Audit Contractor Outreach Sessions

10. Region C Recovery Audit Contractor Adds New State to CMS Approved Audit Issues

Subscribe to Medicare Update, follow me on Twitter @MedicareUpdate, and become a fan on Facebook.

Medicare Update on Facebook

CMS to Host Open Door Forum on Proposed ESRD Prospective Payment System

The Centers for Medicare & Medicaid Services (CMS) recently announced that it will host a Special Open Door Forum to discuss the Proposed Rule outlining a proposed End Stage Renal Disease (ESRD) Prospective Payment System (PPS). 

This Special Open Door Forum (ODF) will take place from 3:30 p.m. - 5:00 p.m. (EDT) on October 15, 2009. During this Special ODF, CMS will highlight the key features of the proposed ESRD-PPS including the:

• Composition of the bundle and basis for the proposed unit of payment;
• Data sources used in developing the system;
• Proposed patient-level and facility-level case mix adjusters;
• Proposed outlier policy; and
• Proposed market basket.

CMS reports that it will also discuss implementation issues, highlight key findings reflected in the impact analysis, provide a brief overview of a quality incentive program, and summarize issues that have been identified for further analysis within any final rule. Participants will be given an opportunity to ask questions.

To participate in the Special ODF, one must dial 1-800-837-1935 and reference conference ID 26811397.

By October 14, 2009, CMS will make the discussion materials for this Special ODF available here.

Beginning October 25, 2009, CMS will also post an audio recording of the Special ODF on the Special Open Door Forum webpage. The audio recording will be available for 30 days.

Subscribe to Medicare Update, follow me on Twitter @MedicareUpdate, and become a fan on Facebook.

Related Posts:

• CMS Proposes New Prospective Payment System for Renal Dialysis Facilities
• CMS to Host Town Hall Meeting on Proposed ESRD Prospective Payment System

CMS to Host Town Hall Meeting on Proposed ESRD Prospective Payment System

The Centers for Medicare & Medicaid Services (CMS) recently released a display copy of a Notice announcing a town hall meeting to discuss the Proposed Rule for the Medicare end-stage renal disease (ESRD) prospective payment system (PPS).

According to the Notice, the town hall meeting will be held from 9:00 a.m. - 12:00 p.m. (EDT) on October 23, 2009. The meeting will take place in the main auditorium at CMS, 7500 Security Boulevard, Baltimore, MD. Individuals interested in attending the meeting must register on-line.  Individuals interested in making oral presentations must register as attendees and speakers on the CMS website.

Registrations must be received by 5:00 p.m. (EDT) on October 2, 2009.

CMS reports that the meeting will begin with a brief overview of the ESRD PPS proposed rule. However, the majority of the time allotted will be reserved for oral presentations from registered speakers.

For more information regarding the town hall meeting (including information about speaker and attendee registration), see the display copy of the Notice.

The Notice is scheduled to appear in the Federal Register on September 29, 2009.

UPDATE: The Notice as it appears in the Federal Register can be found here.

Subscribe to Medicare Update, follow me on Twitter @MedicareUpdate, and become a fan on Facebook.

Related Post: CMS Proposes New Prospective Payment System for Renal Dialysis Facilities

CMS Proposes New Prospective Payment System for Renal Dialysis Facilities

On September 15, 2009, the Centers for Medicare & Medicaid Services (CMS) released a display copy of a Proposed Rule that would implement a case-mix adjusted bundled prospective payment system (PPS) for Medicare outpatient end stage renal disease (ESRD) dialysis facilities beginning January 1, 2011.

According to Proposed Rule, CMS would establish a base bundled payment rate of $198.64 for all services related to a dialysis session.  The base rate would be adjusted for case mix factors (such as a patient's age, gender, body size, and time on dialysis) and include a special case mix adjustment for pediatric patients. Adjustments would be made for specific conditions or co-morbidities that have a significant impact on a course of treatment. There would also be adjustments to the base rate to reflect geographic differences in labor costs, adjustments for low volume facilities, and an outlier policy for expensive cases.

Further, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires that CMS create a quality improvement program (QIP) that results in payment reductions for providers and dialysis facilities that do not meet or exceed minimum performance standards. Therefore, under the Proposed Rule, the QIP would have payment consequences for services furnished on or after January 1, 2012 with respect to various measures including hemodialysis adequacy and anemia management.

Generally, the new payment system would apply to dialysis services furnished to Medicare beneficiaries on or after January 1, 2011. The Proposed Rule is scheduled to appear in the Federal Register on September 29, 2009. CMS reports that it will be accepting comments on the Proposed Rule through November 16, 2009. See the Proposed Rule for instructions regarding the submission of comments.

UPDATE: The Proposed Rule as it appears in the Federal Register can be found here.

Subscribe to Medicare Update and follow me on Twitter @MedicareUpdate.

OIG Releases Compendium of Unimplemented Recommendations

On May 29, 2009, the Department of Health and Human Services' (HHS) Office of Inspector General (OIG) released its Compendium of Unimplemented Office of Inspector General Recommendations (May 2009).

The Compendium includes information about OIG recommendations that had not been fully implemented as of December 31, 2008.  The Compendium also includes a list of "priority recommendations," which the OIG believes represent the most significant opportunities to positively impact HHS programs.

The list of "priority recommendations" includes a number of recommendations for the Medicare program. In brief, those recommendations (and any estimated savings) include:

• Ensure accurate Medicare Part D sponsors bids and prospective payments
• Implement safeguards to prevent and detect fraud and abuse in Medicare prescription drug plans
• Ensure durable medical equipment suppliers' compliance with Medicare standards
• Modify payment policy for Medicare hospital bad debts (estimated savings $340 million)
• Reduce the rental period for Medicare home oxygen equipment (estimated savings $3.2 billion)
• Modify payments to managed care organizations (estimated savings $1.97 billion)
• Place a ceiling on administration costs included in managed care organizations' rate proposals
• Improve Centers for Medicare & Medicaid Services performance evaluation process for program safeguard contractors
• Ensure the appropriate processing of denial of Medicare payment remedies for noncompliant nursing homes
• Improve oversight of Medicare hospices

The Compendium also includes other unimplemented OIG recommendations pertaining to the Medicare program, including (but not limited to):

• Identify duplicate Medicaid and Medicare home health payments
• Require physician examination before ordering home health services
• Revise graduate medical education payment methodology
• Reduce Medicare end stage renal disease payment rates
• Improve quality oversight of ambulatory surgical centers in the Medicare program

See the Compendium for more detailed information (including background information, OIG findings, recommendations, status and any estimated savings). 

Ways and Means Health Subcommittee Schedules Hearing on MedPAC Report to Congress

The House Ways and Means Health Subcommittee has scheduled a hearing on the Medicare Payment Advisory Commission's (MedPAC) annual March 2009 Report to Congress on Medicare payment policy.  The hearing will take place at 10:00 a.m. on March 17, 2009.

MedPAC is an independent Congressional agency established by the Balanced Budget Act of 1997 to advise Congress on issues affecting the Medicare program.  The March 2009 Report to Congress contains a number of Medicare payment recommendations for 2010 that could impact providers and suppliers, including hospitals, physicians, ambulatory surgical centers, skilled nursing facilities, home health agencies, inpatient rehabilitation facilities and long-term care hospitals.

According to an Advisory issued by the Health Subcommittee, the Health Subcommittee will be accepting written comments for the hearing record. The Advisory contains instructions and the deadline for submitting written comments.

Related Post: MedPAC Makes Medicare Payment Recommendations for 2010

MedPAC Makes Medicare Payment Recommendations for 2010

The Medicare Payment Advisory Commission (MedPAC) recently released its Report To The Congress: Medicare Payment Policy (March 2009) in which MedPAC makes certain Medicare payment recommendations for 2010.  In brief, the MedPAC payment recommendations include the following:

Hospital Inpatient and Outpatient Services

• Congress should increase payment rates for the acute inpatient and outpatient prospective payment systems in 2010 by the projected rate of increase in the hospital market basket index, concurrent with implementation of a quality incentive payment program.
• Congress should reduce the indirect medical education (IME) adjustment in 2010 by 1 percentage point to 4.5 percent per 10 percent increment in the resident-to- bed ratio. The funds obtained by reducing the IME adjustment should be used to fund a quality incentive payment program.

Physician Services and Ambulatory Surgical Centers

• Congress should update payments for physician services in 2010 by 1.1 percent.
• Congress should establish a budget neutral payment adjustment for primary care services billed under the physician fee schedule and furnished by primary care focused practitioners. Primary care focused practitioners are those whose specialty designation is defined as primary care and/or those whose pattern of claims meets a minimum threshold of furnishing primary care services. The Secretary of the Department of Health and Human Services (Secretary) would use rulemaking to establish criteria for determining a primary care focused practitioner.
• Congress should direct the Secretary to increase the equipment use standard for expensive imaging machines from 25 hours to 45 hours per week.  This change should redistribute relative value units from expensive imagining to other physician services.
• Congress should increase payments for ambulatory surgical centers (ASC) services in calendar year 2010 by 0.6 percent. In addition, Congress should require ASCs to submit to the Secretary cost and quality data that will allow for an effective evaluation of the adequacy of ASC payment rates.

Outpatient Dialysis Services

• Congress should maintain current law and update the composite rate in calendar year 2010 by 1 percent.

Skilled Nursing Facility Services

• Congress should eliminate the update to payment rates for skilled nursing facility services for fiscal year 2010.

Home Health Services

• Congress should eliminate the market basket increase for 2010 and advance the planned reductions for coding adjustments in 2011 to 2010, so that payments in 2010 are reduced by 5.5 percent from 2009 levels.
• Congress should direct the Secretary to rebase rates for home health care services in 2011 to reflect the average cost of providing care.
• Congress should direct the Secretary to assess measures that protect the quality of care and ensure incentives for the efficient delivery of home health care. The study should include alternative payment strategies such as blended payments, risk corridors and outcome based quality incentives.

Inpatient Rehabilitation Facility Services

• The update to the payment rates for inpatient rehabilitation facility services should be eliminated for fiscal year 2010.

Long-Term Care Hospital Services

• The Secretary should update payment rates for long term care hospitals for fiscal year 2010 by the projected rate of increase in the rehabilitation, psychiatric, and long term care hospital market basket index less the Commissioner's adjustment for productivity growth.

MedPAC is an independent Congressional agency established by the Balanced Budget Act of 1997 to advise Congress on issues affecting the Medicare program.  MedPAC meets publicly to discuss policy issues and formulate its recommendations to Congress.  Two reports, issued in March and June each year, are the primary outlets for MedPAC's recommendations.