CMS Proposed Rule Could Scale Back Mandatory Bundled Payment Programs
CMS released a proposed rule earlier this month that could cancel two bundled payment programs, and significantly limit a third.nnTwo bundled payment programs could be canceled before they begin, and the scope of a third will be significantly limited if a proposed rule released by CMS August 17 is finalized.nnThe agency proposes cancellation of Episode Payment Models (EPM) and the Cardiac Rehabilitation (CR) incentive payment model in the rule. In addition, CMS proposes to make participation in the Comprehensive Care for Joint Replacement model (CJR) voluntary in 33 of the 67 geographic areas where participation is currently mandatory. The agency also suggests making participation in the CJR voluntary for low-volume and rural hospitals in all areas.nnThe EPM and CR models were mandatory programs for certain providers that were originally scheduled to begin months ago, but multiple delays pushed that start date back to January 1, 2018. The models were created to institute bundled payments for episodes of care for treatment of acute myocardial infarctions, coronary artery bypass grafts, surgical hip and femur fractures, and cardiac rehabilitation by linking payment to quality outcomes.nnParticipation in the CJR model began in April 2016, and therefore CMS will not cancel that program but proposes to substantially reduce the number of providers who must participate.nnWhile cutting these programs may seem like a shift away from value-based care, CMS said in a press release that it hopes canceling these programs would allow stakeholders to devote time and resources toward creating other episode-based models.n
nThis article originally posted on RevenueCycleAdvisor.com.
Welter Healthcare Partners is excited to present our helpful career advancing tips and strategies to sharpen the skills prospective employers look for in a coder!nnTeamwork – Ever heard of the expression – “Team Work Makes the Dream Work”? This idea serves as the foundation for many successful movements, companies and organizations. One person can only do so much and when we allow others to contribute their talents and ideas, extraordinary things can happen! There is no “I” in team and there are no lone rangers. Think about Julius Caesar, Napoleon, Gandhi, Steve Jobs, and many other life-changing leaders – they never could have influenced the world without millions of people working alongside them and supporting their efforts. Teams come in all shapes and sizes and it is important to be a team player. Group effort is always more effective than individual effort!
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is leading to changes in the realm of clinical and operational demands in health care. Read more, below, to learn about balancing reporting requirements while simultaneously ensuring optimum patient care.nnConcerns over the cost of health care and apparent lower health outcomes in the United States compared to other developed countries have significantly influenced program development by the Centers for Medicare and Medicaid Services (CMS). New reimbursement strategies intended to address cost and drive quality—specifically the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)—are placing new clinical and operational demands on the health care industry.nnSo in the era of MACRA, providers need to balance reporting requirements (which can be time-consuming) while continuing to put patients first. One of the best ways to do this is to ensure patient care is well coordinated.nnMoving Forward with MACRAnnMACRA made fundamental changes in the way health care providers are paid for Medicare patients. MACRA included the repeal of the Sustainable Growth Rate (SGR) and moved toward rewarding providers for performance through the Merit-based Incentive Payments System (MIPS) and, ultimately, the Advanced Alternative Payment Model (AAPM).n
Welter Healthcare Partners is excited to present our monthly Code Spotlight! Each month, Welter Healthcare Partners will spotlight a unique CPT or ICD-10 code to profile and discuss practice applications of the code, as well as pertinent guideline reminders.nnICD-10 Code – E11.65 – Type 2 Diabetes Mellitus with HyperglycemiannICD-10 code E11.65 represents the appropriate diagnosis code for uncontrolled type 2 diabetes without complications.nnClinical documentation must support the following: Elevated glucose (sugar) levels, length of condition, severity of illness, if insulin use is required, and any associated manifestations or underlying chronic diseases. High blood glucose levels in diabetes mellitus are indicative of inadequate or poorly controlled diabetes. Reporting specificity is increasingly important if you participate in an HCC risk adjustment payment model. Clinical documentation must support the complexity of the diagnosis code(s) reported.
In a final rule published Wednesday, the Centers for Medicare and Medicaid Services have established new requirements for the use of electronic health records. Check out the article, below, for more information! nn”We are establishing new requirements or revising existing requirements for eligible professionals, eligible hospitals, and critical access hospitals participating in the Medicare and Medicaid Electronic Health Record Incentive Programs,” stated the rule, which goes into effect October 1, 2017.nnFor 2018, CMS will allow a 90-day reporting period. This is a significant difference from the complete year that CMS had aimed for under the Obama administration. This change applies to hospitals and physicians in the Medicare and Medicaid meaningful use programs.nnAlso in 2018, CMS will allow healthcare providers to use 2014-certified EHRs, 2015-certified EHRs, or a combination. Initially, CMS was requiring 2015-edition EHRs beginning in January 2018. However, healthcare organizations had raised concerns that the 2015-certified EHRs were more sophisticated and that they would not have enough time to install and test the systems.nnIn a statement, CMS administrator Seema Verma said this final rule will provide flexibility for acute and long-term care hospitals as they treat Medicare’s sickest patients.n