Riverbend

ListServ Messages 04/18/2008

April 15, 2008

Information from The CMS - This message is being resent due to a problem with the URLs.

The CMS Online Manual System: A Web-based Manual System for Medicare Contractors, Providers and State Agencies brochure has been updated and is now available to order print copies or to download as a PDF file. This brochure explains how to navigate the CMS Online Manual System. To view the PDF file, go to http://www.cms.hhs.gov/MLNProducts/downloads/on-linebrochure.pdf. Print copies may be ordered by visiting the MLN Product Ordering Page at http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5 on the CMS website.

CMS PROPOSES TO EXPAND QUALITY PROGRAM FOR HOSPITAL INPATIENT SERVICES IN FY 2009

The Centers for Medicare & Medicaid Services (CMS) today proposed additional steps to strengthen the tie between the quality of care provided to Medicare beneficiaries and payment for the services provided when they are in the hospital.

CMS is proposing to expand the list of conditions which are reasonably preventable through proper care and for which Medicare will no longer pay at a higher rate if the patient acquires them during a hospital stay. In addition, CMS is adding 43 new quality measures for which hospitals will have to report data in order to receive the full annual payment update for their services.

The proposed regulation builds on efforts across Medicare to transform the program to a prudent purchaser of health care services, paying based on quality of care, not just quantity of services. CMS is also making hospital quality and cost information available to help consumers make more informed choices.

The proposed rule would apply to services provided to patients who are discharged from the hospital during fiscal year (FY) 2009, which begins on October 1, 2008. The proposed rule would apply to more than 3,500 acute care hospitals paid under the Inpatient Prospective Payment System (IPPS).

The IPPS was intended to reward hospitals for being efficient by making a single payment to the hospital based on the average costs of treating a patient with a particular diagnosis, rather than paying for the actual costs of each case. However, until recently, Medicare did not have the legal authority to use its payment system to encourage hospitals to improve the quality of care they furnish.

The proposed rule also includes proposals to update Medicare payment rates and policies for inpatient hospitals for FY 2009. Overall, the proposed rule is estimated to increase Medicare payments to acute care hospitals by nearly $4.0 billion.

Comments on the proposed rule will be accepted through June 13. CMS will respond to comments in a final rule to be issued on or before August 1, 2008.

Important Dates:

Display Date: 4/14/08
Publication Date: 4/30/08
Public comment period will close: 6/13/08
Weblinks:
Press Release: http://www.cms.hhs.gov/apps/media/press_releases.asp

3 Quality Fact Sheets and Exec Summary Fact Sheet 4/14/08-: http://www.cms.hhs.gov/apps/media/fact_sheets.asp

The rule is posted at: http://www.cms.hhs.gov/AcuteInpatientPPS/IPPS/list.asp?listpage=4

Backgrounder- (Under downloads) - http://www.cms.hhs.gov/AcuteInpatientPPS/IPPS/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=4&sortOrder=ascending&itemID=CMS1209719&intNumPerPage=10

April 16, 2008

Information from The CMS.

New:

MM5994 – April 2008 Update to the Ambulatory Surgical Center (ASC) Payment System; Summary of Payment Policy Changes
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5994.pdf

MM5971 – CR 5550 Clarification - Signature Requirements
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5971.pdf

MM5999 – April 2008 Update of the Hospital Outpatient Prospective Payment System (OPPS) http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5999.pdf

SE0812 – Use of Professional Society Practice Parameters in Properly Providing Allergen Immunotherapy to Medicare Beneficiaries
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0812.pdf

April 16, 2008

Important Information from Riverbend GBA

Please be aware that your facility will continue to receive a remittance advice with the legacy number in the heading for claims that were adjudicated without the NPI number.Claims that were adjudicated with the NPI number will be indicated on a separate remittance advice with the NPI number in the heading.

Due to this change your facility may have two remittance advices for a specific paid date, one with the legacy number in the heading and one with the NPI number in the heading.