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08
May 2013
Posted by Shaka Scott
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CMS Publishes Medicare Provider Charge Data

The Centers for Medicare & Medicaid Services has finally made  publicly available  hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments. The data represents almost 7 million discharges or 60 percent of total Medicare IPPS discharges. Hospitals have protected their price lists or “charge masters”  from public disclosure and by means of contractual confidentiality restrictions. CMS’s disclosure of this data were inspired in part by a March 2013 Time magazine investigative report on hospital charges authored by Steven Brill, which attracted extensive media attention and discussion.

CMS hopes that users of the data will be able to make comparisons between the amount charged by individual hospitals within local markets, and nationwide, for services that might be furnished in connection with a particular inpatient stay. CMS shared the data in advance with media outlets such as The Huffington Post, The New York Times and The Washington Post. Each of these outlets have published stories based on their analysis.   Entities such as ACO’s may find this data useful as they seek to deliver better patient care on limited budgets in order to produce shared savings.

Links:

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html

Posted in: 2013 Physician Fee Schedule, Accountable Care Organizations, CMS, Patient Protection and Affordable Care Act

25
Jul 2012
Posted by Shaka Scott
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Revisions to Payment Policies Under the Physician Fee Schedule for CY 2013

On July 30, 2012 CMS will publish a major proposed rule addressing changes to the physician fee schedule, payments for Part B drugs, and other Medicare Part B payment policies to ensure that the payment systems are updated to reflect changes in medical practice and the relative value of services. The proposed rule would also implement provisions of the Affordable Care Act by establishing a faceto-face encounter as a condition of payment for certain durable medical equipment (DME) items. In addition, it would implement statutory changes regarding the termination of non-random prepayment review under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Finally, this proposed rule also includes a discussion regarding the Chiropractic Services Demonstration program.

The proposed rule also addresses new claims-based data reporting requirements for therapy services to implement a provision in the Middle Class Tax Relief and Jobs Creation Act (MCTRCA). In addition, this rule proposes:

● Potentially Misvalued Codes to be Evaluated.

● Additional Multiple Procedure Payment Reductions (MPPR).

● Expanding Medicare Telehealth Services.

● Regulatory Changes regarding Payment for Technical Component of Certain Physician Pathology Services to Conform to Statute.

● Primary Care and Care Coordination Service.

● Payment rates for Newly Covered Preventive Services.

● Definition of Anesthesia and Related Care in the Certified Registered Nurse Anesthetists Benefit.

● Ordering Requirements for Portable X-ray Services.

● Updates to the Ambulance Fee Schedule.

● Part B Drug Payment Rates.

● Ambulance Coverage-Physician Certification Statement.

●Updating the–

  • Physician Compare Website.
  • Physician Quality Reporting System.
  • Electronic Prescribing (eRx) Incentive Program.
  • Medicare Shared Savings Program.

● Providing Budget Neutrality Discussion on the Chiropractic Demonstration.

● Physician Value-Based Payment Modifier and the Physician Feedback Reporting Program.

● Medicare Coverage of Hepatitis B Vaccine.

● Updating Existing Standards for e-prescribing under Medicare Part D and Lifting the LTC Exemption.

Several proposed changes would affect the specialty distribution of Medicare expenditures. This proposed rule reflects the priority on improving payment for primary care services. Overall, payments for primary care specialties would increase and payments to select other specialties would decrease due to several changes in how CMS proposes to calculate payments for CY 2013.

Link: https://federalregister.gov/a/2012-16814

Posted in: 2013 Physician Fee Schedule, Patient Protection and Affordable Care Act