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By Ginger - Site Admin on Wednesday, February 22, 2017 9:25 AM
Adverse drug events fell by 67,000 between 2010 and 2013 as the result of the federal “meaningful use” program that offered financial incentives to hospitals for using certified electronic health records (EHRs), according to a new Agency for Healthcare Research and Quality (AHRQ) study. Adverse drug events are harms experienced by a patient as a result of exposure to a medication. They affect nearly 5 percent of hospitalized patients and can be deadly. To minimize such harms, the Centers for Medicare and Medicaid Services (CMS) initiated the meaningful use program in 2010, awarding financial incentives to hospitals and physicians who adopted specific information technology (IT) capabilities, such as computerized prescriber order entry. The new AHRQ study in Journal of the American Informatics Association (JAMIA)...
By Ginger - Site Admin on Thursday, February 16, 2017 1:11 PM
On February 15, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule designed to stabilize the health insurance marketplace for 2018. The proposed rule would verify eligibility of individuals who newly enroll through special enrollment periods, which has been a concern of insurers with respect to individuals waiting until they need coverage to enroll. It will also allow an insurer to collect premiums for prior unpaid coverage before enrolling an individual in next year’s plan with the same insurer. This is designed to encourage patients to avoid coverage lapses. The rule would also move the assessment of network adequacy to states, and it would shorten the open enrollment for the 2018 coverage year to run from November 1, 2017, through December 15, 2017.

The proposed rule can be found at https://www.federalregister.gov/documents/2017/02/17/2017-03027/patient-protection-and-affordable-care-act-market-stabilization...
By Ginger - Site Admin on Tuesday, February 14, 2017 11:05 AM
The deadline for Eligible Professionals (EPs) to submit Reconsideration forms for the 2017 payment adjustment — based on the 2015 electronic health record (EHR) reporting period — is February 28, 2017. No applications will be accepted after the deadline.

Please visit the Centers for Medicare and Medicaid Services (CMS) website to find the EP Reconsideration Application . Complete this application if you received a letter from CMS that stated you are subject to the 2017 Medicare EHR payment adjustment and you believe this payment adjustment is in error....
By Ginger - Site Admin on Tuesday, February 07, 2017 9:15 AM
The Centers for Medicare and Medicaid Services (CMS) has extended the attestation deadline for providers participating in the Medicare Electronic Health Record (EHR) Incentive Program to Monday, March 13, 2017, at 11:59 p.m. (PT).

Providers participating in the Medicare EHR Incentive Program must attest to the 2016 program requirements by March 13, 2017, to avoid a 2018 payment adjustment.

If you are participating in the Medicaid EHR Incentive Program, please refer to http://chfs.ky.gov/dms/EHR.htm...
By Ginger - Site Admin on Wednesday, January 18, 2017 10:16 AM
The Centers for Medicare and Medicaid Services (CMS) Registration and Attestation System is now open. Providers participating in the Medicare Electronic Health Record (EHR) Incentive Program must attest to the ...
By Ginger - Site Admin on Friday, January 13, 2017 9:31 AM
CMS recently updated an FAQ to provide information about calculations for electronic health record (EHR) Incentive Programs objectives and measures requiring patient action.

...
By Ginger - Site Admin on Wednesday, October 26, 2016 8:40 AM

Kentucky's U.S. Congressmen Andy Barr, Thomas Massie and Hal Rogers signed the House of Representatives Dear Colleague letter and Senator Mitch McConnell wrote his own personal letter to the Centers for Medicare and Medicaid Services (CMS) urging the importance of flexibility during the proposal to implement part of the Bipartisan Budget Act (BiBA) of 2015 concerning the treatment of off-campus outpatient departments.

The letters expressed concern that implementation of the rule could seriously impact rural states, such as Kentucky, and would limit access to care in already underserved areas.

Please take the time to thank the Senator and your Congressman for their support of hospitals in Kentucky.

If you have any questions, contact Sarah S. Nicholson at KHA (snicholson@kyha.com).

By Ginger - Site Admin on Thursday, September 22, 2016 9:12 AM
After a request from KHA and its members, three U.S. Congressmen from Kentucky (Andy Barr, Thomas Massie and Hal Rogers) have signed onto the Tiberi-Kind “Dear Colleague” letter pertaining to CMS policies on alternative payment models (APMs). KHA is grateful for their support.

The Chairman Pat Tiberi and Congressman Kind Dear Colleague letter urges the Centers for Medicare and Medicaid Services (CMS) to provide health care providers more regulatory relief and flexibility under APMs like bundling, the “CJR” program for joint replacement, accountable care organizations and other models intended to move health care delivery away from site-specific, fee-for-service reimbursement. CMS has the authority to waive numerous rules and statutory provisions in these alternative care delivery and reimbursement models, yet with few exceptions it has not done so.

More waivers around site-specific acute and post-acute regulations are needed that were originally implemented for a purely fee-for-service reimbursement...
By Ginger - Site Admin on Thursday, September 15, 2016 8:24 AM
On September 14, KHA submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed Medicaid disproportionate share hospital (DSH) rule addressing the treatment of third-party payers in calculating uncompensated care costs.

KHA and Kentucky's hospitals disagree with the position of CMS to require counting payments from Medicare and other private insurers to calculate uncompensated care costs for retention of DSH payments. The proposed rule would redefine a hospital's cost of care and is not authorized by statute.

The law states clearly that the only costs counted are Medicaid payments and payments made by uninsured patients, not payments made by other programs or insurers.

This proposal would harm many safety net hospitals, and would have devastating consequences for Kentucky's rural hospitals.

For a full copy of the comments, visit the Policy page in the Advocacy section of www.kyha.com.

If you have any questions,...
By Ginger - Site Admin on Wednesday, September 07, 2016 8:38 AM

On September 6, KHA submitted comments to the Centers for Medicare and Medicaid Services on the calendar year (CY) 2017 hospital outpatient prospective payment system (OPPS) proposed rule that would implement site-neutral provisions of the Bipartisan Budget Act of 2015 (BiBA).

Kentucky's hospitals are opposed to CMS' site-neutral proposal because the rule would not only apply to new off-campus outpatient facilities but also to existing hospital outpatient departments (HOPDs) that expand services or relocate to benefit their communities by lowering payment.

For a full copy of KHA's comments, members may visit the Policy page of the Advocacy section of www.kyha.com.

If you have any questions, please contact Nancy Galvagni at KHA (ngalvagni@kyha.com).

By Ginger - Site Admin on Tuesday, September 06, 2016 9:09 AM
KEPRO, Kentucky's quality improvement organization (QIO), announced on Friday that the Short Stay reviews will be resuming soon. The organization hopes to receive further details from the Centers for Medicare and Medicaid Services (CMS) this week, and will provide more information at that time about upcoming informational webinars that will be held during the third week of September.
By Ginger - Site Admin on Wednesday, August 31, 2016 9:03 AM
CMS issued an invitation the public to comment on the Calendar Year (CY) 2017 Changes to the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule . Comments are due by 5:00 p.m. (ET) next Tuesday, September 6.

The CY 2017 OPPS ASC proposed rule includes the following changes to the Medicare and Medicaid EHR Incentive Programs:

Eliminates the Clinical Decision Support (CDS) and Computerized Provider Order Entry (CPOE) objectives and measures beginning in 2017 and reduces the...
By Ginger - Site Admin on Friday, August 19, 2016 8:29 AM
The Centers for Medicare and Medicaid Services (CMS) will host two webinars in August that highlight how to participate successfully in the Electronic Health Record (EHR) Incentive Programs in 2016 based on the criteria outlined in the October 2015 final rule. The first webinar will discuss criteria for eligible professionals (EPs) and the second will highlight requirements for eligible hospitals and critical access hospitals (CAHs). Please use the links below to register.

2016 EHR Incentive...
By Ginger - Site Admin on Tuesday, June 28, 2016 8:58 AM
The Medicare Electronic Health Record (EHR) Incentive Program 2017 hardship exception instructions and ...
By Ginger - Site Admin on Wednesday, June 15, 2016 7:35 AM
The Centers for Medicare & Medicaid Services yesterday awarded $32 million in grants to find and enroll eligible children in Medicaid and the Children's Health Insurance Program. The University of Kentucky Research Foundation is one of 38 recipients that include states, school districts and community organizations in 27 states who will target eligible populations that are less likely to be enrolled.

University of Kentucky Research Foundation, a first-time participant in the Connecting Kids to Coverage Outreach and Enrollment Program, will focus on enrolling uninsured children and parents from 40 counties in the rural mountainous Appalachian region of the state. The strategies include using an existing network of Community Health Workers to work with local community-based partners providing application and renewal assistance to enroll and retain eligible uninsured children and parents in Medicaid and CHIP. The targeted outreach approaches for these hard-to-reach individuals will be to go where they “work,...
By Ginger - Site Admin on Friday, June 10, 2016 7:39 AM
All Providers Must Take Action by July 1, 2016 to Avoid Payment Adjustments

Hardship exception applications are due by July 1 for eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs).

The Medicare EHR Incentive Program 2017 hardship exception instructions and ...
By Ginger - Site Admin on Tuesday, May 17, 2016 6:46 AM
The Centers for Medicare and Medicaid Services (CMS) is hosting listening sessions this week to share more information about the recently released Medicare Access and CHIP Reauthorization Act of 2015 Notice of Proposed Rulemaking (NPRM).

Overview of the MACRA NPRM

Date: Tuesday, May 17 Time: 12:00 - 1:30 p.m. (ET) Details: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)...
By Ginger - Site Admin on Friday, May 06, 2016 7:58 AM
Don’t forget to register for the May 10 MLN Connects® National Provider Call, MACRA Listening Session: Quality Payment Program Proposed Rule. This call will be an opportunity for stakeholders, specifically Part B Fee-For-Service clinicians, and state and national associations that represent health care providers, to provide the Centers for Medicare and Medicaid Services (CMS) with early feedback on the proposed policy for the Quality Payment Program. To participate, visit the MLN Connects Event Registration page. Space may be limited, so please register early.

CMS also encourages you to register for:

The...
By Ginger - Site Admin on Wednesday, April 20, 2016 9:13 AM

The Centers for Medicare and Medicaid Services (CMS) recently participated in the 2016 Healthcare Information and Management Systems Society (HIMSS) Annual Conference and Exhibition in Las Vegas. CMS' education session presentations from this year’s conference are now available online.

Visit the Events page for the EHR Incentive program to view all five presentations from the Exhibition.

By Ginger - Site Admin on Wednesday, April 20, 2016 9:06 AM
The Kentucky Medicaid Electronic Health Record (EHR) Incentive Program began accepting program year 2015 meaningful use attestations on Thursday, April 7. Please keep in mind all attestations must be submitted for program year 2015 by 11:59 p.m. (ET) on May 31, 2016.
By Ginger - Site Admin on Wednesday, April 13, 2016 8:07 AM
To help eligible professionals, eligible hospitals, and critical access hospitals (CAHs) successfully participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs in 2016, the Centers for Medicare and Medicaid Services (CMS) has posted new resources on the CMS EHR Incentive Programs website .

These resources include:

...
By Ginger - Site Admin on Tuesday, March 08, 2016 9:23 AM
Eligible professionals, eligible hospitals and critical access hospitals (CAHs) participating in the Medicare Electronic Health Record (EHR) Incentive Program must attest using the Medicare and Medicaid EHR Incentive Program Registration and Attestation System no later than Friday, March 11 at 11:59 p.m. (ET).

Medicaid EHR Incentive Program participants should refer to their respective ...
By Ginger - Site Admin on Friday, March 04, 2016 9:12 AM
Eligible professionals, eligible hospitals and critical access hospitals (CAHs) participating in the Medicare Electronic Health Record (EHR) Incentive Program must attest using the Medicare and Medicaid EHR Incentive Program Registration and Attestation System by Friday, March 11 at 11:59 p.m. ET.

Medicaid EHR Incentive Program participants should refer to their respective ...
By Ginger - Site Admin on Friday, February 26, 2016 8:09 AM
The Centers for Medicare and Medicaid Services (CMS) has submitted a 653-page finalized rule governing Medicaid managed care to the Office of Management and Budget (OMB) for review, according to Modern Healthcare. Reports indicate that the rule will take a step to reduce the institution for mental diseases (IMD) prohibition on treating adult Medicaid patients in freestanding psychiatric hospitals by permitting states to pay managed care organizations (MCOs) for behavioral care to beneficiaries who stay 15 days or less in an IMD. Additionally, the rule is reported to contain a medical loss ratio of at least 85%, which would allow 15% to be paid to MCOs for administration, marketing and profit. The rule also contains requirements for improving network adequacy through time and distance standards for certain types of providers, including hospitals and physicians.

OMB can take up to 90 days to review the rule, therefore, it could be published sometime in May. KHA’s comments were among the 900 comment letters CMS received on proposed rule....
By Ginger - Site Admin on Friday, February 12, 2016 9:54 AM
The Centers for Medicare and Medicaid Services (CMS) extended the attestation deadline for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs to Friday, March 11 at 11:59 p.m. ET, from the original deadline of Monday, February 29.

Eligible professionals, eligible hospitals and critical access hospitals (CAHs) participating in the Medicare EHR Incentive Program can attest through the CMS Registration and Attestation System. Providers participating in the Medicaid EHR Incentive Program should refer to their respective ...
By Ginger - Site Admin on Wednesday, February 10, 2016 9:28 AM
Broadband access is required to meet certain objectives outlined in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs final rule. Therefore, The Centers for Medicare and Medicaid Services (CMS) has maintained exclusions for providers in areas with limited broadband availability as identified by the Federal Communications Commission (FCC):

Objective 8, Patient Electronic Access - Eligible providers (EPs) and eligible hospitals/CAHs Measure 2 Only:...
By Ginger - Site Admin on Tuesday, February 02, 2016 9:53 AM
The Centers for Medicare and Medicaid Services (CMS) has launched important changes to the Medicare Electronic Health Record (EHR) Incentive Program hardship exception process that will reduce burdens on clinicians, hospitals and critical access hospitals (CAHs). These changes are a result of recent Medicare legislation – the Patient Access and Medicare Protection Act (PAMPA), Pub. L. No. 114-115 – and the agency’s ongoing efforts to improve the program.

CMS has released an FAQ outlining the documentation requirements for submitting the new hardship application to avoid the 2017 payment adjustment.

FAQ #14113 - On the new hardship application form for the 2017 payment adjustment there is nothing which says documentation is required to be submitted with the application form. Does this mean that CMS will only require the selection of a hardship category and the completion of the provider’s identifying information in order to approve a hardship exception? Or will CMS be reviewing the application...
By Ginger - Site Admin on Thursday, January 28, 2016 9:35 AM
Answers to many of the questions submitted by participants during the Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP) Provider Training offered in Baltimore, Maryland, in November have been posted and are available on the Centers for Medicare and Medicaid Services (CMS) website at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/LTCH-Quality-Reporting-Training.html, under ‘Downloads’.

Additionally, CMS will host a follow-up webinar on February 3. The primary focus will be on Sections GG (Functional Abilities and Goals) and M (Skin Conditions) of the LTCH Continuity Assessment Record and Evaluation (CARE) Data Set V 3.0. Information about Section O (Special Treatments, Procedures and Programs) and where to find additional assistance...
By Ginger - Site Admin on Tuesday, January 26, 2016 8:42 AM
On January 22, the Centers for Medicare and Medicaid Services (CMS) launched important changes to the Medicare Electronic Health Record (EHR) Incentive Program hardship exception process that will reduce burden on clinicians, hospitals and critical access hospitals (CAHs). These changes are a result of recent Medicare legislation – the Patient Access and Medicare Protection Act (PAMPA), Pub. L. No. 114-115 – and ongoing efforts to improve the program.

CMS has posted new, streamlined hardship applications, reducing the amount of information that eligible professionals (EPs), eligible hospitals and CAHs must submit to apply for an exception. The new applications and instructions for a hardship exception from the Medicare Electronic Health Records Incentive Program 2017 payment adjustment are available here....
By Ginger - Site Admin on Friday, January 08, 2016 9:38 AM
The Center for Medicare and Medicaid Services’ (CMS) Innovation Center has announced a new $157 million funding opportunity, the Accountable Health Community Model, that acknowledges the social determinants framework for health and the need for partnerships to link what happens in the clinical setting with what happens in the community. The five-year program is the first CMS Innovation Center model to focus on the health-related social needs of Medicare and Medicaid beneficiaries, including building alignment between clinical and community-based services at the local level.

CMS will award a total of 44 cooperative agreements, ranging from $1 million to $4.5 million, to successful applicants to implement the Accountable Health Communities model. Award recipients under this model, referred to as “bridge organizations,” will oversee the screening of Medicare and Medicaid beneficiaries for social and behavioral issues, such as housing instability, food insecurity, utility needs, interpersonal violence and...
By Ginger - Site Admin on Thursday, December 10, 2015 9:06 AM
The Centers for Medicare and Medicaid Services (CMS) on October 16 published a final rule with comment for the Electronic Health Record (EHR) Incentive Program that makes modifications to meaningful use requirements in 2015 through 2017 and sets the start date for Stage 3 of the program. For more details on the rule, see the AHA Regulatory Advisory.

CMS is accepting comments on the provisions of the meaningful use Stage 3 final rule through December 15. AHA will submit comments, and hospitals are strongly encouraged to submit their own comments to the agency. AHA has also provided a model comment letter to assist you. The model comment letter includes recommendations on how to improve the structure of the meaningful use program and increase flexibility to ensure program success by the greatest number of eligible providers. It also includes specific comments on the Stage 3 objectives.

...
By Ginger - Site Admin on Friday, December 04, 2015 8:41 AM
To help eligible professionals, eligible hospitals, and critical access hospitals (CAHs) successfully participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs in 2015, CMS has posted new resources on the CMS EHR Incentive Programs website.

Eligible Professionals and Eligible Hospitals/CAHs: What You Need to Know for 2015 Overview of the EHR Incentive Programs in 2015-2017 What’s Changed for the EHR Incentive Programs in 2015-2017 Eligible Professionals and Eligible Hospitals/CAHs Attestation Worksheets Alternate Exclusions and Specifications Fact Sheet Eligible Professionals and Eligible Hospitals/CAHs Objectives and Measures Tables Eligible Professionals and Eligible Hospitals/CAHs Specification Sheets CMS will continue to update the EHR Incentive Programs website to include additional information and resources for eligible professionals and...
By Ginger - Site Admin on Wednesday, November 18, 2015 8:56 AM
On October 6, the Centers for Medicare and Medicaid Services (CMS) released the final rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. To support provider participation in 2015, CMS has released two additional FAQs in response to inquiries about the public health reporting objective in 2015.

FAQ 13409 Question: For 2015, how should a provider report on the public health reporting objective if they had planned to be in Stage 1 meaningful use which required sending a test message and continued submission if successful, but did not require registration of intent?

Answer: We did not intend to require providers to engage in new activities during 2015, which may not be feasible after the publication of the final rule in order to successfully demonstrate meaningful use in 2015. Since providers in Stage 1 in 2015 were not previously required to submit a registration of intent to submit data to meet Objective 10 measures, providers may meet the measures by having...
By Ginger - Site Admin on Wednesday, November 11, 2015 8:37 AM
On October 6, the Centers for Medicare and Medicaid Services (CMS) released the final rule with comment for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. To keep providers informed of changes to the programs and how to participate in 2015, CMS has also released three new FAQs providing clarification on how to attest to certain measures for health information exchange, patient electronic access and other objectives that require patient action.

FAQ 12817 Question: For the Health Information Exchange objective for meaningful use in 2015 through 2017, may an eligible professional (EP), eligible hospital or critical access hospital (CAH) count a transition of care or referral in its numerator for the measure if they electronically create and send a summary of care document using their Certified Electronic Health Record Technology (CEHRT) to a third party organization that plays a role in determining the next provider of care and ultimately delivers the summary of care document?...
By Ginger - Site Admin on Tuesday, September 29, 2015 8:13 AM
The American Hospital Association (AHA) published a Member Advisory on September 28 providing guidance to hospitals on Thursday's transition to ICD-10:

Beginning October 1, health care claims must include ICD-10 codes for medical diagnoses and inpatient hospital procedures, marking a major change to billing transactions. The Centers for Medicare and Medicaid Services (CMS) will continue to pay claims and implement ICD-10 even if there is a government shutdown and Congress fails to act by October 1 on legislation to fund the government into fiscal year 2016.

Given the major changes that will occur with the move to ICD-10, hospital leaders are urged to pay close attention to their billing processes to ensure they identify issues quickly. AHA has distributed a chart, which outlines steps to monitor the transition and actions to address problems that could arise.

CMS has indicated...
By Ginger - Site Admin on Monday, September 28, 2015 8:48 AM
On September 25, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would revise the Medicare payment system for clinical diagnostic laboratory tests and implement other changes required by section 216 of the Protecting Access to Medicare Act of 2014. Under the proposed rule, certain “applicable” laboratories would be required to report private payer rate and volume data if they receive at least $50,000 in Medicare revenues from laboratory services and more than 50% of their Medicare revenues from laboratory and physician services. Laboratories would collect private payer data from July 1, 2015 through Dec. 31, 2015 and report it to CMS by March 31, 2016. CMS would post the new Medicare rates by Nov. 1, 2016 for lab tests beginning Jan. 1, 2017. In a factsheet...
By Ginger - Site Admin on Monday, September 28, 2015 8:23 AM
On September 24, HRET (the American Hospital Association’s Health Research and Education Trust) executed a contract with the Centers for Medicare and Medicaid Services (CMS) for the Hospital Engagement Network (HEN) 2.0 Project.

Two kickoff webinars will be held this week to get the project started. Both events will cover the same topic (details on how to join the AHA/HRET HEN 2.0 initiative):

AHA/HRET HEN 2.0 Hospital Kick Off Webinar September 29 1:00 p.m. - 3:00 p.m. (CT) Register at https://hret.adobeconnect.com/hospitalkickoff/event/registration.html.

October 1 (Repeat Webinar) 1:00 p.m. - 3:00 p.m. (CT) Register at https://hret.adobeconnect.com/hospitalkickoff/event/registration.html.

The Kentucky face-to-face...
By Ginger - Site Admin on Friday, September 25, 2015 8:22 AM
Important changes will go into effect on October 1, 2015, regarding the Two-Midnight Rule. The Centers for Medicare and Medicaid Services (CMS) is changing its approach with regard to educating providers and enforcing Two-Midnight Short-Stay reviews. Specifically, CMS has decided to use Beneficiary and Family-Centered Care Quality Improvement Organizations (BFCC-QIOs), rather than Medicare Administrative Contractors (MACs) or Recovery Auditors, to conduct the first line medical reviews of providers who submit claims for inpatient admissions.

Kentucky’s BFCC-QIO is KEPRO, which has more information on the changes and action hospitals should take on its website. KEPRO is hosting an informational webinar for hospitals on Wednesday, September 30 at 3:00 p.m. (ET). Each hospital should identify at least one person to participate. There are a limited number of lines available so please register TODAY!...
By Ginger - Site Admin on Thursday, August 20, 2015 8:09 AM
On August 18, the Centers for Medicare and Medicaid Services (CMS) held an Open Door Forum to discuss hospitals and hospital quality. During the forum, CMS addressed short stay policies.

Officials noted that, in conjunction with proposals in the calendar year (CY) 2016 Outpatient Prospective Payment System (OPPS) Proposed Rule, the Agency has extended its probe and educate review period through December 31.Beginning October 1, quality improvement organizations (QIOs) will take over initial reviews of claims for patient status based on current policies. As of January 1, QIOs and recovery audit contractors (RACs) will carry out reviews based on any policies adopted through the OPPS final rule.

CMS said QIOs will conduct reviews and education sessions in a collaborative manner with providers and will only refer cases to recovery audit contractors (RACs) for further review if there is evidence of a pattern of high levels of short stay claims denials, if a hospital does not respond to educational outreach or if there is some potential of fraud or abuse. The Agency acknowledged that there are questions about parameters for review and how referrals will be made and said more information will be forthcoming.

...
By Ginger - Site Admin on Friday, July 24, 2015 8:43 AM
While ICD-10 is almost here, you still have time to get ready, but you must get ready now. Each day this week the Centers for Medicare and Medicaid Services (CMS) has been highlighting 1 of the 5 recommendations to help you begin testing: 1) Why Test Now, 2) How to Get Started, 3) Testing with Trading Partners, 4) Types of Testing, and 5) Testing Tips. Yesterday's information on Types of Testing is shared below:

Acknowledgement Testing In acknowledgement testing, providers and other submitters, like clearinghouses, submit claims with ICD-10 codes and ICD-10 companion qualifiers. While claims are not adjudicated, submitters receive an acknowledgement that their claim was accepted or rejected.

Tip: Be sure to use ICD-10 qualifiers, which differ from ICD-9 qualifiers. Some providers have reported that ICD-10 qualifiers had to be manually set up in their systems.

Beyond testing with Medicare as described below, you can check with your commercial health plans, clearinghouses and billing...
By Ginger - Site Admin on Thursday, July 16, 2015 7:38 AM
KEPRO is the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for more than 30 states, including Kentucky. On July 28 from 10:00 – 11:00 a.m. (ET), KEPRO will host a webinar for Kentucky hospitals to discuss their role and answer any questions.

KEPRO will also briefly discuss the recent Centers for Medicare and Medicaid Services (CMS) Outpatient Proposed Rule which would expand their role on the Two-Midnight Rule policy. Specifically, CMS has decided to use QIOs, rather than Medicare Administrative Contractors (MACs) or Recovery Auditors, to conduct the first-line medical reviews of providers who submit claims for inpatient admissions.

For instructions on how to register, visit http://www.new-kyha.com/Portals/5/NewsDocs/KEPROMeetingRegistration.pdf.

If you have any questions, please contact Elizabeth Cobb at KHA (ecobb@kyha.com)....
By Ginger - Site Admin on Wednesday, July 15, 2015 8:35 AM
The proposed calendar year (CY) 2016 payment rule for the Medicare Outpatient Prospective Payment System (OPPS) was published in the July 8 Federal Register. The proposed rule includes annual updates to the Medicare fee-for-service (FFS) outpatient payment rates as well as proposed regulations that implement new policies.

The Healthcare Association of New York State (HANYS) has shared a high-level summary of the proposed rule.

A copy of the Federal Register (FR) and other resources related to the OPPS are available on the Centers for Medicare and Medicaid Services (CMS) website. Comments on all aspects of the proposed rule are due to CMS by August 31 and can be submitted electronically at http://www.regulations.gov...
By Ginger - Site Admin on Tuesday, July 14, 2015 7:45 AM

KEPRO is the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for more than 30 states, including Kentucky. On July 28 from 10:00 – 11:00 a.m. (ET), KEPRO will host a webinar for Kentucky hospitals to discuss their role and answer any questions.

KEPRO will also briefly discuss the recent Centers for Medicare and Medicaid Services (CMS) Outpatient Proposed Rule which would expand their role on the Two-Midnight Rule policy. Specifically, CMS has decided to use QIOs, rather than Medicare Administrative Contractors (MACs) or Recovery Auditors, to conduct the first-line medical reviews of providers who submit claims for inpatient admissions.

KHA will share dial-in information as soon as it becomes available. Please save the date.

If you have any questions, please contact Elizabeth Cobb at KHA (ecobb@kyha.com).

By Ginger - Site Admin on Wednesday, July 01, 2015 9:23 AM
To keep providers updated with information on the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, the Centers for Medicare and Medicaid Services (CMS) has recently updated an FAQ about the Stage 2 Summary of Care objective.

An important update was added regarding the NIST EHR-Randomizer Application:

Question: When reporting on the Summary of Care objective in the Medicare and Medicaid EHR Incentive Program, how can eligible professionals and eligible hospitals meet measure 3 if they are unable to complete a test with the CMS designated test EHR (Randomizer)?

...
By Ginger - Site Admin on Thursday, June 25, 2015 9:00 AM
Last week, KHA expressed serious concern with certain aspects of the Centers for Medicare and Medicaid Services’ (CMS) proposal for implementing a site-neutral payment component to the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for cost reporting periods beginning on or after October 1, 2015.

“KHA supports many of CMS’s proposals, such as the proposal to use a specific 15 Medicare-severity-LTC-diagnosis-related groups to identify the psychiatric and rehabilitation conditions that would be paid a site-neutral rate versus a standard LTCH PPS rate, and KHA supports the proposal to use the previously finalized pressure ulcer measure to meet IMPACT Act requirements,” wrote KHA Membership Services Director Pam Kirchem, commenting on LTCH provisions of the proposed inpatient and LTCH PPS rule for fiscal year 2016. “However, we believe that the proposed two outlier-related budget neutrality adjustments are unwarranted and result in inappropriately lower LTCH payments. We recommend CMS calculate...
By Ginger - Site Admin on Wednesday, May 27, 2015 8:07 AM
On Tuesday, May 26, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would update Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to better align them with existing commercial, Marketplace and Medicare Advantage regulations. The proposed rule, which is the first major update to Medicaid and CHIP managed care regulations in more than a decade, includes updates to managed care provider networks, quality measures, external quality review, and beneficiary rights and protections.

KHA staff is analyzing the rule for comments, which are due to CMS by July 27. KHA also submitted issues to CMS via AHA for their consideration in drafting the proposed rule to address problems experienced with managed care in Kentucky.

The regulation proposes a minimum medical loss ratio (MLR) of 85 percent beginning in 2017, standards around actuarial soundness of capitation rates, contracting standards and consumer protections. To read the entire rule, see...
By Ginger - Site Admin on Tuesday, May 12, 2015 7:58 AM
During the week of July 20 through 24, a final sample group of providers will have the opportunity to participate in ICD-10 end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. The Centers for Medicare and Medicaid Services (CMS) is accepting additional July volunteers from May 11 through 22. This is an excellent opportunity to participate in end-to-end testing with Medicare prior to the October 1, 2015, implementation date.

Approximately 850 volunteer submitters will be selected to participate in the July end-to-end testing. This nationwide sample will yield meaningful results, since CMS intends to select volunteers representing a broad cross-section of provider, claim and submitter types, including claims clearinghouses that submit claims for large numbers of providers. Note: Testers who are participating in the January and April end-to-end testing weeks are able to test again in July without re-applying.

To volunteer...
By Ginger - Site Admin on Wednesday, May 06, 2015 8:54 AM
The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) are inviting the public to submit comments on the recently released notices of proposed rulemaking (NPRMs).

Due May 29:

Stage 3 of Meaningful Use NPRM – Specifies the Stage 3 requirements for eligible professionals, eligible hospitals and critical access hospitals in the electronic health records...
By Ginger - Site Admin on Friday, April 10, 2015 8:56 AM

On April 7, the Centers for Medicare and Medicaid Services (CMS) held its regular Open Door Forum (ODF) devoted to hospital and hospital quality issues. The Agency reminded providers that it has extended its "Probe and Educate" program related to Recovery Audit Contractor (RAC) review of hospital inpatient claims through April 30. As of now, relevant claims with dates of service from October 1, 2013, through April 30, 2015 are not subject to formal review by RACs. Though that would lapse as of May 1, 2015, CMS noted that legislation before Congress would extend the period through fiscal year (FY) 2015.

Other topics included wage index appeals, open payments review and coverage of CT scans for lung cancer.

A summary of the Forum from Health Policy Source is available at http://www.new-kyha.com/Portals/5/NewsDocs/ODFSummary040715.pdf.

By Ginger - Site Admin on Friday, March 20, 2015 8:36 AM
During the week of July 20 through 24 a third sample group of providers will have the opportunity to participate in ICD-10 end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. Approximately 850 volunteer submitters will be selected to participate in the July end-to-end testing. This nationwide sample will yield meaningful results, since the Centers for Medicare and Medicaid Services (CMS) intends to select volunteers representing a broad cross-section of provider, claim and submitter types, including claims clearinghouses that submit claims for large numbers of providers. Note: Testers who are participating in the January and April end-to-end testing weeks are able to test again in July without re-applying.

To volunteer as a testing submitter:

Volunteer forms are available on your MAC website Completed volunteer forms are due April 17 CMS will review applications and select the group of testing...
By Ginger - Site Admin on Wednesday, March 04, 2015 9:00 AM
To help you prepare for the transition to ICD-10, the Centers for Medicare and Medicaid Services (CMS) offers acknowledgement testing for current direct submitters (providers and clearinghouses) to test with the Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor anytime up to the October 1 implementation date.

CMS previously conducted two successful acknowledgement testing weeks in March 2014 and November 2014. These acknowledgement testing weeks give submitters access to real-time help desk support and allow CMS to analyze testing data. Registration is not required for these virtual events.

The first event for 2015 is happening now: March 2-6. Mark your calendar for the next testing week: June 1-5.

How to participate Information is available on your MAC website or through your clearinghouse (if you use a clearinghouse to submit claims to Medicare). Any provider who submits claims electronically...
By Ginger - Site Admin on Thursday, January 08, 2015 11:40 AM
Centers for Medicare & Medicaid Services (CMS) has announced that the deadline for Critical Access Hospitals (CAHs), using Method II billing to report on the Physician Quality Reporting System (PQRS) is February 28.

While the deadline is urgent for CAHs, some Rural Health Clinics (RHCs) may also be required to submit data to PQRS by the same deadline.  Particularly, those RHCs owned and operated by CAHs should be increasingly aware of the PQRS regulations.  

Who else should report?

Eligible Providers (EPs) who submit claims and are paid under the Medicare Physician Fee Schedule (PFS) using the 1500 Claim Form and required to participate in PQRS and will be subject to the "payment adjustment" for those 1500 Claim Form submissions.

If the EPs submitted claims under the Medicare PFS using the UB-04 Claim Form, they are exempt from PQRS penalties.

Ask yourself: Did the Eligible Professional (physician, PA, NP, etc.) seek Medicare payment using a 1500 claim form in precious years,...
By Ginger - Site Admin on Thursday, October 16, 2014 3:11 PM
KHA/KHREF will offer two seminars on the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation:

December 1-2 for CMS Conditions of Participation for Prospective Payment System (PPS) Hospitals December 2-3 for CMS Conditions of Participation for Critical Access Hospitals (CAHs)

Each 1 1/2 day program will be lead by Sue Dill Calloway, MSN, JD, RN, CPHRM, CCMSCP, a nurse attorney and consultant who has conducted numerous seminars and webinars for KHA and other states.  

The program and registration details are provided in the the links above.  If you have any questions, please contact Carol Walters at KHA (502-426-6220 or 800-945-4542 or via email at cwalters@kyha.com).

...
By Ginger - Site Admin on Tuesday, October 14, 2014 3:53 PM
KHA congratulates Norton Healthcare System Associate Vice President Ben Yandell, PhD, CQE for his appointment to the Technical Expert Panel (TEP) for the Hospital Quality Star Ratings on Hospital Compare. The TEP is a group of stakeholders and experts who provide technical input to the measure contractor on the development, selection, and maintenance of measures for which the Centers for Medicare and Medicaid Services (CMS) contractors are responsible. The TEP is one important step in the measure development or reevaluation process that CMS contractors use to ensure transparency and it provides an opportunity to receive multi-stakeholder input early in the process. Dr. Yandell will participate in teleconference meetings between now and September of 2015 convened by Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation (YNHHSC/CORE). YNHHSC/CORE was contracted by CMS to reevaluate and potentially revise the scoring methodology for the Hospital-Acquired Condition (HAC) Reduction...
By Ginger - Site Admin on Friday, October 03, 2014 9:57 AM
Medicare has announced the list of hospitals that will receive payment penalties under the Hospital Readmissions Reduction Program. Medicare will apply the penalties to payments for patient stays between October 1, 2014, and September 30, 2015. This is the third year of the penalty program where the maximum penalty will be a 3 percent reduction in Medicare payments.

There will be 2,610 hospitals receiving a readmissions penalty, but only 39 hospitals will receive the full 3 percent penalty. In Kentucky, 66 percent of all hospitals will receive a penalty, with the average penalty being a 1.21 percent reduction in payment. However, Kentucky has a disproportionate share of hospitals receiving the maximum penalty, with nine hospitals, representing 23 percent of the total. As expected, these facilities are located in some of the most impoverished areas in the nation where many factors associated with poverty and poor health influence hospital readmission rates, which are not accounted for in Medicare’s...
By Ginger - Site Admin on Monday, September 29, 2014 10:27 AM

Reminder: the U.S. Department of Health and Human Services (HHS) issued a rule finalizing October 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on October 1, 2015.

The rule requires the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.

For resources on transitioning to ICD-10, visit the ICD-10 website.


By Ginger - Site Admin on Monday, September 29, 2014 9:58 AM
The stakes are increasing for hospitals under the growing Medicare quality reporting and incentive programs. Hospitals that only felt a “pinch” in payment cuts may now feel a true “bite.” This webinar series will take hospital leaders through the “nuts and bolts” of the federal incentive programs and provide guidance on understanding impact modeling reports distributed by KHA on each of the programs.

Information will also be provided on how to use performance knowledge and hospital resources to improve results in the CMS incentive programs. During the webinar, you will hear case studies from hospitals on initiatives and activities used to reverse poor performance trends.

Webinar 1: Value Based Purchasing: Understanding Your Performance and How the Program is Evolving - October 8 at 11:00 a.m. (ET)/10:00 (CT) Webinar 2: Hospital Readmission Penalty Program: Impact to Your Hospital and Avoiding Common Mistakes in Achieving Improvement - October 15 at 11:30 a.m. (ET)/10:30 (CT) Webinar...
By Ginger - Site Admin on Tuesday, September 23, 2014 8:34 AM
Health care providers can volunteer through October 3 to participate in an ICD-10 end-to-end testing opportunity with Medicare Administrative Contractors and the Common Electronic Data Interchange contractor, the Centers for Medicare & Medicaid Services (CMS) announced Friday. About 850 volunteers representing a cross section of provider, claim and submitter types will be selected to participate in the testing, scheduled for January 26-30, 2015. Volunteer forms are available on the MAC websites, CMS said. The Department of Health and Human Services in July issued a final rule establishing October 1, 2015 as the date on which health care providers must begin including ICD-10 diagnosis and procedure codes on Medicare and other health care claims. AHA members can access an updated Executive Action Guide...
By Ginger - Site Admin on Monday, September 22, 2014 11:16 AM
On August 29, the Centers for Medicare & Medicaid Services (CMS) issued a notice offering a settlement of hospital appeals of short stay denials. CMS’s intent in offering the settlement is to address the significant backlog of Medicare appeals at the administrative law judge (ALJ) level, which resulted in the Office of Medicare Hearings and Appeals suspending assignment of appeals to ALJs for at least two years.

Each hospital should evaluate carefully the terms of the offer and the hospital’s own situation in making a decision about whether to pursue the settlement offer. To assist with this analysis, the AHA commissioned a national accounting firm to develop the attached tool to help hospitals compare the settlement they might expect to receive under CMS’s offer with what they might recover if they choose to continue the appeals process for claims eligible for the settlement. The tool includes an overview and instructions pertaining to the checklist....
By Ginger - Site Admin on Thursday, September 18, 2014 9:10 AM
Immediate action is required for groups with 10 or more eligible professionals (EPs) who would like to register as a physician quality reporting system (PQRS) Group Practice Reporting Option (GPRO) in order to avoid the automatic calendar year (CY) 2016 Value-Based Payment Modifier downward payment adjustment. 

The Centers for Medicare & Medicaid Services (CMS) describes the steps that physician provider groups may need to take before 11:59 p.m. (EDT) on September 30 to avoid negative payment adjustments from Medicare in 2016.  

Failing to take action could result in a negative payment adjustment of as much as -4 percent on allowed Medicare charges. 

Please contact the atom Alliance representative for Kentucky if you have any questions. 

Kentucky Margie Banse margie.banse@hcqis.org atom Alliance is a multi-state alliance for powerful change composed of three nonprofit, healthcare quality...
By Ginger - Site Admin on Wednesday, September 10, 2014 3:00 PM
The Centers for Medicare and Medicaid Services (CMS) is aiming to improve the salience and usability of comparative quality information for consumers by incorporating a Star Rating system in its Compare websites. Currently, Nursing Home Compare features an overall star rating for each facility and star ratings for other important categories of health care quality. Earlier this year, CMS introduced star ratings to Physician Compare, which uses them to rate a limited number of measures for group practices. In April 2015, CMS plans to introduce star ratings on Hospital Compare for the HCAHPS measures.

There will be a "dry run" of Star Ratings for HCAHPS measures in preparation for the April 2015 public reporting beginning on September 15, 2014 and ending on October 14, 2014. The dry run corresponds with the Hospital Inpatient Quality Reporting (IQR) Program preview period for the December 2014 public reporting of HCAHPS measures.

CMS is using the IQR preview period as an opportunity to dry run star ratings for HCAHPS measures (HCAHPS Star Ratings). Therefore, your preview report will include the standard data you receive for HCAHPS measures and will also include star ratings data for HCAHPS measures. Please note that the HCAHPS Star Ratings included in your preview report will not be publicly reported in December 2014. All other data besides the HCAHPS Star Ratings in your preview report will be publicly reported on Hospital Compare in December.

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By Ginger - Site Admin on Wednesday, September 10, 2014 10:34 AM
On September 9, the Centers for Medicare and Medicaid (CMS) held a National Provider Call to discuss its recent offer to settle outstanding Medicare hospital claims that were denied because of patient status issues. Slides for the call are available at http://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2014-09-09-Hospital-Settlement-Presentation.pdf. The slides also include links to documents and instructions that will be needed by eligible hospitals, predominately Inpatient Prospective Payment System (IPPS) and Critical Access Hospital (CAH) providers, that decide to pursue the claims settlement. Settlement requests are due to CMS by...
By Ginger - Site Admin on Tuesday, September 09, 2014 2:37 PM
The Joint Commission and Centers for Medicare and Medicaid Services (CMS) are now focusing on some specific standards that continue to be problematic. These standards make it necessary and timely to present a program on the essentials of Joint Commission readiness. This two-day program, offered by the Kentucky Hospital Research and Education Foundation (KHREF) on November 13-14, will provide a comprehensive review of the accreditation manual for hospitals focusing on such specific problematic topics as National Patient Safety Goals, infection control and leadership/human resources. Attendees will gain a better understanding of how The Joint Commission and CMS are interrelated; where the problematic areas are; and how to have a flawless survey through proper front-end preparation.

For a complete overview of the conference, and to learn how to register, please see the brochure.

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By Ginger - Site Admin on Friday, September 05, 2014 9:48 AM

The Kentucky Hospital Research and Education Foundation (KHREF) is hosting a workshop on October 21 to focus on the new Centers for Medicare and Medicaid Services (CMS) two-midnight rule. While full implementation of this new rule has been delayed by Congress, some form of this rule will be implemented. The main objective of this new rule is to address the challenge of proper inpatient admissions versus placing the patient into outpatient observation.

The target audience for the webinar includes chief executive officers, chief financial officers, chief operating officers, chief medical officers, chief nursing officers, Chargemaster coordinators, coding staff, billing and claims personnel.

For a complete overview of the workshop and a registration form, please view the brochure.

  

By Ginger - Site Admin on Tuesday, September 02, 2014 11:41 AM
On Friday, August 29, the Department of Health and Human Services (HHS) published a final rule that would provide physicians, hospitals and critical access hospitals (CAHs) more flexibility in implementing certified electronic health record technology (CEHRT) in 2014 to meet the meaningful use standards of the Medicare and Medicaid Electronic Health Record Incentive Programs. The final rule, jointly issued by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC), will allow providers to use the 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT for the reporting period in 2014 for the Incentive Programs. Beginning in 2015, all eligible physicians and hospitals would be required to attest using the 2014 Edition CEHRT. In addition, the rule finalizes a provision that would formalize CMS’ and the ONC’s previously stated intention to extend Stage 2 of the program one additional year through 2016, and to begin Stage 3 in 2017. The rule is available...
By Ginger - Site Admin on Tuesday, September 02, 2014 11:30 AM
According to a bulletin released by the Centers for Medicare and Medicaid Services (CMS) on August 29, to more quickly reduce the volume of patient status claim denials pending in the appeals process, CMS is offering an administrative agreement to any acute care hospital or critical access hospital (CAH) willing to resolve their pending appeals (or waive their right to request an appeal) in exchange for timely partial payment (68 percent of the net payable amount). CMS encourages hospitals with patient status claim denials currently in the appeals process to make use of this administrative agreement to alleviate the burden of current appeals on both the hospital and Medicare system.

More details about the providers and claims eligible for an administrative agreement, as well as the documents needed to request such an agreement, can be found on the CMS Inpatient Hospital Reviews web page.

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By Ginger - Site Admin on Thursday, August 28, 2014 9:23 AM
On August 27, AHA submitted the comment letter to the Centers for Medicare and Medicaid Services (CMS) on its proposed rule for the calendar year (CY) 2015 outpatient and ambulatory surgery center (ASC) prospective payment systems (PPS). The letter urges the agency to carefully reconsider its proposed methodology of creating a Healthcare Common Procedure Coding System modifier to track services furnished in off-campus, provider-based hospital outpatient departments. It also recommends changes to the implementation of its new set of claims-level comprehensive ambulatory payment classifications to ensure that it does not negatively and disproportionately impact certain types of hospitals that have specialized case mixes. In addition, AHA opposes CMS’ proposal to require a physician order for all inpatient admissions as a condition of payment under the agency’s general...
By Ginger - Site Admin on Thursday, August 28, 2014 8:56 AM
On August 27, AHA submitted a comment letter to the Centers for Medicare and Medicaid Services (CMS) on its proposed rule for the calendar year (CY) 2015 physician fee schedule. In the letter, AHA expresses its support for CMS’ proposal to add seven new codes to its list of approved Medicare telehealth services and encourages the agency to consider adding other services in future rulemaking. AHA also commends CMS for recognizing the need to pay for services related to chronic care management, but suggests the agency re-examine whether the rate of $41.92 adequately reimburses providers for the full scope of services. In addition, AHA urges the agency to carefully reconsider its proposed methodology of creating a Healthcare Common Procedure Coding System modifier to track services furnished in off-campus, provider-based hospital outpatient...
By Ginger - Site Admin on Wednesday, August 27, 2014 9:14 AM
To keep providers updated with information on the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, the Centers for Medicare and Medicaid Services (CMS) has recently added three new FAQs to the CMS FAQ system.

New FAQs:

For the certification criteria that providers must have in place to meet the Clinical Decision Support (CDS) objective, what type of interventions must the EHR technology trigger to meet the criteria? For this and for the Eligible Provider and Eligible Hospital Core Measures related to the Objective “use clinical decision support to improve performance on high-priority health conditions,” are “pop-up” alerts the only type of intervention that a provider can use to meet the CDS objective? Read the answer. I am an eligible professional. What should I do if my patients...
By Ginger - Site Admin on Thursday, August 14, 2014 8:30 AM
The Kentucky Hospital Research and Education Foundation (KHREF) will host three webinars in September regarding topics related to the Centers for Medicare and Medicaid Services' (CMS) Conditions of Participation (CoP):

CMS’s New Hospital CoP MedicationAdministration and Safe Opioid Use - September 3 CMS Quality Assessment and Performance Improvement (QAPI) Hospital CoP Standards and CMS QAPI Worksheet - September 17 CMS Hospital CoPs: The Final 2014 Regulations for Hospitals - September 24 Visit the corresponding links above from program details and registration information.

If you have any further questions, contact Carol Walters at KHA (502-426-6220 or 800-945-4542 or via email...
By Ginger - Site Admin on Monday, August 04, 2014 8:54 AM
The Centers for Medicare and Medicaid Services (CMS) has issued a final rule that will update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2015.

The document is currently on display at the Federal Register office. Publication is scheduled for Aug 5. A copy is currently available at http://www.ofr.gov/OFRUpload/OFRData/2014-18335_PI.pdf. This link will be superseded after publication.

In addition, CMS has issued a final rule to update the Medicare Inpatient Psychiatric Facilities (IPFs) PPS for FY 2015. The rule is scheduled to be published in the August 6 Federal Register. A copy can currently be downloaded at http://www.ofr.gov/OFRUpload/OFRData/2014-18329_PI.pdf.This link will change upon publication later this week.

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By Ginger - Site Admin on Friday, July 25, 2014 8:15 AM

On July 23, the Centers for Medicare and Medicaid Services (CMS) conducted a webinar to explain changes in the Quality Improvement Organization (QIO) program, as KHA briefly outlined (see article). Many hospitals were unable to join the webinar, so the slides are available at http://www.new-kyha.com/Portals/5/NewsDocs/ProviderCallSlides%2007232014.pdf for your information.

CMS plans to conduct additional webinars/conference calls to repeat the information. KHA will notify you when they are scheduled.

By Ginger - Site Admin on Tuesday, July 22, 2014 9:31 AM
The Centers for Medicare and Medicaid Services (CMS) has awarded new quality improvement organization (QIO) contracts. For the first time, CMS restructured the QIO program by separating the QIO’s case review work from the quality improvement work, and issued separate requests for proposals (RFPs) and contracts for each. Two contracts were awarded to Beneficiary and Family Centered Care QIOs (BFCC-QIO) to perform case reviews, quality of care reviews, diagnosis-related group (DRG) reviews, EMTALA reviews, appropriateness of setting reviews, medical necessity reviews, readmission reviews, Physician Acknowledgment Statement monitoring, appeals and sanctions. KePRO (which previously held the QIO contract for Ohio), was awarded the BFCC-QIO contract for Kentucky as well as 32 other states and the District of Columbia. Kentucky hospitals should have received a letter from KePRO indicating they will begin this work August 1, and advising that hospitals should download, sign and return a Memorandum of Agreement (MOA)...
By Ginger - Site Admin on Friday, July 18, 2014 2:13 PM
On July 18, the Centers for Medicare and Medicaid Services (CMS) awarded additional contracts as part of a restructuring of the Quality Improvement Organization (QIO) Program to create a new approach to improve care for beneficiaries, families and caregivers. QIOs are private, mostly not-for-profit organizations staffed by doctors and other health care professionals trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care.

The new contracts being awarded to fourteen organizations represent the second phase of QIO restructuring. The awardees will work with providers and communities across the country on data-driven quality initiatives. These QIOs will be known as Quality Innovation Network (QIN)-QIOs.

QIN-QIO projects will be based in communities, health care facilities and clinical practices. They will drive quality by providing technical assistance, convening learning and action networks for sharing best practices, and collecting and analyzing data for improvement. The U.S. Department of Health and Human Services’ (HHS) National Quality Strategy (NQS) and the CMS Quality Strategy provide the framework for the contracts along with the companion, recommendations and priorities....
By Ginger - Site Admin on Wednesday, July 09, 2014 11:08 AM

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule to update the Hospital outpatient prospective payment system (OPPS) and the ambulatory surgical center (ASC) payment system for calendar year (CY) 2015. CMS states that the proposed rule, which contains a 60-day comment period ending September 2, would update the payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments and ASCs beginning January 1, 2015.

KHA's Washington liaison Larry Goldberg has prepared an analysis and commentary on the proposal, which is available at http://www.new-kyha.com/Portals/5/NewsDocs/03Jul2014OPPSProposed.pdf.

By Ginger - Site Admin on Thursday, July 03, 2014 7:20 AM

The Centers for Medicare and Medicaid Services (CMS) have issued a proposed calendar year (CY) 2015 update to the home health prospective payment system (HH PPS). The changes would be effective January 1, 2015.

The 166-page rule is currently on display at the Federal Register at: http://www.ofr.gov/OFRUpload/OFRData/2014-15736_PI.pdf. Publication is scheduled for July 7. Please note that after this date, the Federal Register web address will change. A 60-day comment period ending September 2 is provided.

KHA Washington liaison Larry Goldberg has provided an analysis of the proposed update for KHA members. It is available at http://www.new-kyha.com/Portals/5/NewsDocs/1Jul2014HHAProposed.pdf.

By Ginger - Site Admin on Wednesday, June 11, 2014 7:50 AM
Congressional support for reforming the Centers for Medicare and Medicaid Services’ (CMS) Recovery Audit Contractor (RAC) program continues to grow. Currently, 221 representatives – a majority of the House – have signed on to support the AHA-backed Medicare Audit Improvement Act (H.R.1250/S.1012). Kentucky Congressmen Andy Barr, Brett Guthrie, Thomas Massie, Hal Rogers and Ed Whitfield have all lent their support to the legislation.

Now is a great time to thank those Congressmen who have joined this effort and to reach out to those who have yet to sponsor the Act. Senators Mitch McConnell and Rand Paul and Congressman John Yarmuth are not currently sponsors.

For further information, please contact Sarah S. Nicholson at KHA (502-426-6220 or 800-945-4542 or via e-mail at snicholson@kyha.com).

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By Ginger - Site Admin on Tuesday, June 03, 2014 7:56 AM
The Department of Health and Human Services (HHS) is releasing new data and launching new initiatives at the annual Health Datapalooza conference in Washington, D.C.

On June 2, the Centers for Medicare and Medicaid Services (CMS) released its first annual update to the Medicare hospital charge data, or information comparing the average amount a hospital bills for services that may be provided in connection with a similar inpatient stay or outpatient visit. CMS is also releasing a suite of other data products and tools aimed to increase transparency about Medicare payments. The data on CMS’s website now includes inpatient and outpatient hospital charge data for 2012, and new interactive dashboards for the CMS Chronic Conditions Data Warehouse and geographic variation data. Also, the Food and Drug Administration (FDA) has launched a new open data initiative. Before the end of the conference, the Office of the National Coordinator for Health Information Technology (ONC) will announce the winners of two data...
By Ginger - Site Admin on Friday, May 23, 2014 8:04 AM
The Centers for Medicare and Medicaid Services (CMS) made the following announcement on Thursday, May 22. Please note, prior authorization is expanding in Kentucky for more durable medical equipment for Medicare patients. Links for additional information are available at the bottom of the announcement from CMS.

CMS has announced plans to expand a successful demonstration for prior authorization for power mobility devices, test prior authorization in additional services in two new demonstration programs, and propose regulation for prior authorization for certain durable medical equipment, prosthetics, orthotics and supplies. Prior authorization supports the administration’s ongoing efforts to safeguard beneficiaries’ access to medically necessary items and services, while reducing improper Medicare billing and payments. The proposed rule is estimated to reduce Medicare spending by $100 to $740 million over the next ten years.

“With prior authorization, Medicare beneficiaries will have greater confidence...
By Ginger - Site Admin on Friday, March 28, 2014 2:38 PM
On March 27, KHA submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding the proposed Conditions of Participation (CoP) rule regarding emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers.

A copy of KHA's comment letter is available at http://www.kyha.com/wp-content/uploads/2014/03/KHAResponsetoCMSCOPEPRules.pdf.

The AHA released a Regulatory Advisory on this topic. It is available at http://www.kyha.com/wp-content/uploads/2014/03/EmergencyPreparednessCOP_ProposedRule_RegulatoryAdv.pdf.

For further information, please contact Richard Bartlett at KHA (502-426-6220 or 800-945-4542 or via e-mail at rbartlett@kyha.com)....
By Ginger - Site Admin on Thursday, March 20, 2014 3:47 PM
From the Centers for Medicare and Medicaid Services (CMS):

Payment adjustments for eligible hospitals that have not successfully participated in the Medicare Electronic Health Record (EHR) Incentive Program will begin on October 1. Hospitals can avoid the payment adjustment by taking action by April 1.

Hospitals that have never participated in the Medicare EHR Incentive Program can:

Submit a hardship exception application for experiencing circumstances that posted a significant barrier to achieving meaningful use Begin 90 days of meaningful use for the 2014 reporting year...
By Ginger - Site Admin on Wednesday, March 19, 2014 9:34 AM
On Friday, March 14, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule implementing a six-month extension of both the low-volume (LoVol) payment adjustment and the Medicare-dependent Hospital (MDH) program, as required by legislation passed in December (the Pathway for SGR Reform Act of 2013). The interim final rule is applicable for discharges under the inpatient prospective payment system (PPS) on or after October 1, 2013, and on or before March 31, 2014. CMS will accept comments on the interim final rule for a period of 60 days.

To qualify for the extension of the LoVol adjustment, hospitals must notify/make requests to their Medicare Administrative Contractor (MAC) no later than March 31.

On March 18, AHA released a Special Bulletin which provided details of the rule. A copy of the interim final rule is available on the CMS website at http://www.ofr.gov/OFRUpload/OFRData/2014-05922_PI.pdf.

By Ginger - Site Admin on Friday, March 14, 2014 9:38 AM
On March 12, the Centers for Medicare and Medicaid Services (CMS) updated its instructions to Medicare Administrative Contractors (MACs) on the two-midnight benchmark policy and cancelled surgical procedures. A copy of the revised instructions and a question and answer sheet, with revisions noted in red, are available here.

Also, on its website (http://cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/InpatientHospitalReviews.html), CMS indicates it will waive the 120-day time frame for filing redetermination requests received before September 30, 2014 for claim denials under the Probe and Educate...
By Ginger - Site Admin on Friday, January 24, 2014 4:35 PM

According to an AHA "Newsflash," on January 24, the Centers for Medicare and Medicaid Services (CMS) clarified that hospitals can continue to use service vendors to assist them in making Medicaid presumptive eligibility determinations under the Patient Protection and Affordable Care Act.

Many hospitals use outside vendors to help with eligibility assessments and enrollment. CMS's announcement, which was welcomed by AHA, would still hold hospitals accountable for accurate presumptive eligibility determinations.

CMS issued the clarification in a series of FAQs on hospital presumptive eligibility. The FAQ on this issue can be found on page six.

By Ginger - Site Admin on Friday, January 17, 2014 12:22 PM
The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule in the Federal Register that establishes national emergency preparedness requirements for Medicare and Medicaid providers and suppliers to ensure that they adequately plan for both natural and man-made disasters.

The proposed rule addresses emergency preparedness requirements that 17 provider and supplier types must meet in order to participate in the Medicare and Medicaid programs.

This proposed rule could have a significant impact on hospitals. For example, the rule includes language that relates to the behavior of the new electronic health record (EHR) systems during a disaster or emergency, and a requirement that EHR systems be redundantly backed up both in region and out of region.

KHA Emergency Preparedness Director Richard Bartlett has prepared resources for hospitals to educate themselves regarding the proposed changes and to prepare in case the rule is approved. Visit http://www.kyha.com/proposed-rule-change-on-cop-related-to-emergency-preparedness/...
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