Aug 27, 2012 | Uncategorized
On Friday, August 24th, the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced a final rule that will save time and money for physicians and other health care providers by establishing a unique health plan identifier (HPID). The rule is one of a series of changes required by the Affordable Care Act to cut red tape in the health care system and will save up to $6 billion over ten years.nn“These new standards are a part of our efforts to 
elp providers and health plans spend less time filling out paperwork and more time seeing their patients,” Secretary Sebelius said.nnCurrently, when a health care provider bills a health plan, that plan may use a wide range of different identifiers that do not have a standard format. As a result, health care providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility. The change announced today will greatly simplify these processes.nnThe rule also makes final a one-year proposed delay – from Oct. 1, 2013, to Oct. 1, 2014– in the compliance date for use of new codes that classify diseases and health problems. These code sets, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include codes for new procedures and diagnoses that improve the quality of information available for quality improvement and payment purposes.nnThe rule announced Friday is the fourth administrative simplification regulation issued by HHS under the health reform law:n
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- On July 8, 2011, HHS adopted operating rules for two electronic health care transactions to make it easier for health care providers to determine whether a patient is eligible for coverage and the status of a health care claim submitted to a health insurer. The rules will save up to $12 billion over ten years.
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- On Jan. 10, 2012, HHS adopted standards for the health care electronic funds transfers (EFT) and remittance advice transaction between health plans and health care providers. The standards will save up to $4.6 billion over ten years.
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- On Aug. 10, 2012, HHS published an IFC that adopted operating rules for the health care EFT and electronic remittance advice transaction. The operating rules will save up to $4.5 billion over ten years.
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nClick here for more information on the final rule.nnSource: www.cms.gov; August 24, 2012.
Aug 22, 2012 | Uncategorized
HHS, on August 14, issued a final “blueprint” that states can use to operate their own health insurance exchanges. The blueprint details the functions that state-based exchanges will perform, how exchanges operated as partnerships between the federal government and states will perform, and what actions states may take in “federal facilitated” exchanges.nnFor example, a state-based exchange may opt to use the federal government to determine the advance premium tax credit (APTC) and cost-sharing reduction, the individual responsibility requirement and payment exemptions, reinsurance, and risk adjustment. States seeking to operate a state-based exchange or electing to participate in a state partnership exchange must submit a complete exchange blueprint no later than 30 business days prior to the required approval date of January 1 (November 16, 2012, for plan year 2014). The blueprint is available here.nnSource: www.polsinelli.com; August 5, 2012.
Aug 15, 2012 | Uncategorized
The rising tide of electronic health records (EHRs) in hospitals is lifting many other boats, ranging from clinical analytics apps to private health information exchanges. Another beneficiary is medical device integration (MDI) software, which connects medical device data output to EHRs.nnAccording to a new Capsite survey, 44% of the nearly 300 responding hospitals said they had purchased an MDI application in recent years. The majority of those purchases were made in 2011 and 2012. 
nnBlain Newton, CEO of Capsite, a research and consulting firm, told InformationWeek Healthcare that the big increase in MDI purchases in those two years is “symptomatic of the surge in EHR purchases and EHR implementation. You have these EHRs that can accept data in, and you have all these devices out there, so the race is on to gather that data as efficiently as possible to improve clinical outcomes.”nnFar more small and midsized hospitals than large institutions bought MDI software in the past two years. Newton explained that this is because the smaller facilities were more likely to have implemented EHRs during that time period.nn”The Sharp HealthCares of the world have been in the EHR game for a long time and recognized the need to integrate these devices [earlier on]. Whereas some of the smaller shops are just getting on that train now.”nnThose facilities have a long way to go. Just 33% of hospitals with less than 200 beds have recently purchased MDI software, vs. 75% of the midsized hospitals (200-400 beds) and 63% of the big institutions (greater than 400 beds).nnMost of the respondents that bought MDI systems were in the process of implementing the software or planned to do so in the next year. Newton believes that many of the hospitals that have not yet moved in this direction will do so after they finish rolling out their EHRs.nn”Most hospitals have either purchased EHRs and installed them or are on their way to installing them. That’s why we foresee an acceleration in the next couple of years in the MDI space. As those hospitals come online with the newly certified EHRs, they’ll think about connecting their devices to them.”nnThe MDI purchasers said they’d acquired their systems to improve clinical outcomes (40%), to improve efficiency (37%), to show Meaningful Use and get government EHR incentives (17%), or for some other reason (6%).nnSource: www.informationweek.com; Ken Terry; August 15, 2012.
Aug 8, 2012 | Uncategorized
Colorado Providers:nnWe are getting a new Medicare Administrative Contractor (MAC). No longer will Trailblazer be our Medicare contractor. The new company, Novitas Solutions, Inc.nnIf you receive payments through EFT (and you probably do) you must update your information.nnIf you need assistance please e-mail us at info@WHPelter.comnnDO NOT leave this to chance. Payment disruptions (you have heard the horror stories) can be avoided by being proactive.nn
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Medicare Electronic Funds Transfer (EFT) – JH Implementation Alertn IMMEDIATE ACTION REQUIRED TO AVOID PAYMENT DISRUPTION
nDear Provider:nnWelcome to Novitas Solutions, Inc., the Jurisdiction H (JH) Medicare Administrative Contractor (MAC). Our goal is to ensure a smooth transition of your services from your current contractor, TrailBlazer Health Enterprises (TrailBlazer), to Novitas Solutions as the JH MAC. As part of this transition, the Centers for Medicare & Medicaid Services (CMS) requires each active provider/supplier currently enrolled for EFT with TrailBlazer to continue receiving electronic payments from Novitas Solutions.nnTo ensure continued receipt of your electronic payments, the CMS requires you have a 05/10 version of the CMS-588 EFT Authorization Agreement (Agreement) on file with Novitas Solutions. Failure to have a 05/10 version of the Agreement on file with Novitas Solutions may result in a delay or interruption of your Medicare payments post-transition.nnPlease review the below information to determine the type of action you need to take in response to this letter:n
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- If you completed and submitted a 05/10 version of the Agreement to TrailBlazer prior to May 29, 2012 for Part B providers and May 30, 2012 for Part A providers, you are permitted to submit a copy of that Agreement to Novitas Solutions at the address provided on the second page of this letter.
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- If you have never completed the 05/10 version of the Agreement, or you did not maintain a copy of a previously submitted 05/10 version, you are required to submit a new 05/10 version of the Agreement to Novitas Solutions at the address provided on the second page of this letter.
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- The requested 05/10 version of the Agreement is for the continuation of existing EFT payments. Novitas Solutions cannot accept EFT changes (i.e., changes in bank routing information or authorized representative changes) prior to the planned implementation date of October 29, 2012 for Part A providers and November 19, 2012 for Part B providers. If you wish to change your existing information, please submit those changes to TrailBlazer in advance of the cutover.
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nChanges to EFT information submitted to TrailBlazer on or after May 29, 2012 for Part B providers and May 30, 2012 for Part A providers will be forwarded to Novitas Solutions as part of the transition, no further action is needed on your part.nnNOTE: You are not required to complete a CMS-855 Enrollment application as part of this process. For your convenience we have enclosed a hard copy 05/10 version of the Agreement for you to complete.nnThe “Instructions for Completing the EFT Authorization Agreement” on page 3 of the CMS-588 form provides specific instructions for completion of the agreement. The following are additional tips for completing the CMS-588 form:n
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- CMS-588 Part I – Check the New EFT Authorization box as the reason for the submission (already checked on the attached copy).
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- CMS-588 Part II – Ensure that you complete the Medicare Identification Number (your Medicare provider transaction access number (PTAN) or CMS certification number (CCN) that you currently use as issued by the outgoing contractor) as well as the National Provider Identifier (NPI).
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- CMS-588 Part III – Ensure banking information is provided including financial institution name, routing number,account number and type of account.
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- CMS-588 Part IV – Enter the name and telephone number of a contact person who can answer questions about theinformation submitted.
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- CMS-588 Part V – Ensure that your organization’s authorized or delegated official signs the CMS-588 form.
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nIn the event that you need another copy of this form, you may also download a blank agreement from the CMS Website at www.cms.hhs.gov. Please write “JH Transition” at the top of the form for easier identification.nnSubmit a copy or newly completed 05/10 version of the Agreement within 30 days from the date of this letter to the address below:n
Novitas Solutions, Inc.nProvider Enrollment ServicesnJH TransitionnPO Box 890095nCamp Hill, PA 17089-0095nAttention: Shelley Kuhn
nYou will receive a letter notifying you when your application has been processed. Should you have questions or need assistance, see our JH transition website at www.novitas-solutions.com or call us at 1-877-235-8073. Please be sure to identify yourself as a JH provider to expedite the handling of your call.nnThank you for your cooperation. We look forward to serving you.nnSincerely,nProvider Enrollment ServicesnNovitas Solutions, Inc.
Aug 1, 2012 | Uncategorized
CMS announce
d on July 13 that it has not imposed a deadline on states to determine whether to expand their Medicaid programs. The Supreme Court recently ruled that states are not required to participate in the Affordable Care Act’s expansion of the Medicaid program, which expands eligibility to people with incomes up to 133 percent of the federal poverty level. In response to a letter from 10 Republican governors, CMS Acting Administrator Marilyn Tavenner responded that “there will be no deadline for a state to tell [the Department of Health and Human Services] its plans on the Medicaid eligibility expansion.” In addition, states that do not expand Medicaid or establish a health insurance exchange will not have to pay back any federal funding that it has received already.nnIn related news, the National Association of Public Hospitals and Health Systems (NAPH) is concerned that up to 30 states may decline to expand Medicaid. The NAPH President and CEO, Bruce Siegel, said that up to 13 million people would remain uninsured if 30 states, including the 26 that filed suit against the federal government to challenge the ACA and the Medicaid expansion, do not expand Medicaid. NAPH is concerned that hospitals will not be able to provide services if states do not expand Medicaid, particularly in light of the ACA’s reduction in Disproportionate Share Hospital (DSH) payments.nnSource: www.polsinelli.com; Polsinelli Shughart PC; July 18, 2012.
