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Rep. Boustany Introduces PHR Legislation
Rep. Charles W. Boustany, Jr. (R-LA) has introduced legislation to establish a demonstration program to provide financial incentives to encourage the adoption and use of interactive personal health records (PHR) and to encourage health information exchange networks to link clinical data to the personal health records. HR 6345, the “Patient-Controlled Health IT Act,” was referred to the House Energy and Commerce Committee and the House Ways and Means Committee upon its introduction on June 23. The legislation establishes a PHR incentive fund to pay qualified providers that furnish services to a qualified patient. Each qualified health information exchange network would also receive an incentive payment for each qualifying patient facilitated by the network. Additional incentive payments would be provided to qualified physicians who treat qualified patients with a defined set of chronic health conditions that includes a major mental disorder, diabetes, heart disease, asthma, hypertension, and cancer. For further information on this legislation you can visit the Action Center of the Advocacy Assistant.
CMS Publishes 2009 OPPS Proposed Rule
The Centers for Medicare & Medicaid Services (CMS) projects that proposed CY 2009 payment rates under the outpatient prospective payment system (OPPS) will result in a 3.2 percent increase in Medicare payment for providers paid under the OPPS. The rule includes items such as proposals to strengthen ties between payment and quality, changes to ambulatory payment classifications (APCs), and changes for partial hospitalization services. CMS will accept comments on the proposed rule until September 2 and will respond to comments in a final rule to be issued by November 1. For more information on the CY 2009 proposals for the OPPS, visit the CMS Web site.
CMS Publishes 2009 ASC PPS Proposed Rule
The proposed rule builds on efforts across Medicare to transform the program into a prudent purchaser of healthcare services, paying based on quality of care, not just quantity of services. CMS is proposing to add nine surgical procedures to the list of procedures for which Medicare will pay when performed in an ambulatory surgical center (ASC). CMS is also proposing to add five procedures to the list of office-based procedures, and to update the list of device-intensive procedures and covered ancillary services and their rates, consistent with proposals in the OPPS update. CMS will accept comments on the proposed rule until September 2, and will respond to comments in a final rule to be issued by November 1. For more information on the CY 2009 proposals for the ASC payment system, visit the CMS Web site.
House Subcommittee Passes
Health IT Bill
The Health Subcommittee of the House Energy and Commerce Committee passed by voice vote HR 6357, the Protecting Records, Optimizing Treatment, and Easing Communication through Health Care Technology Act (PROTECT Act). Although the bill passed by voice vote, it did not come without controversy as the bill re-opens the HIPAA privacy rules requiring consent for the use of health information for healthcare operations. Several amendments were introduced to address the privacy provisions but were ultimately withdrawn. The full House Energy and Commerce Committee will also have to mark up the bill which has not yet been scheduled. HR 6357 was also referred to the House Science and Technology Committee and the House Ways and Means Committee who will also have to address portions of the bill. Visit the Action Center of the AHIMA Advocacy Assistant for further information on HR 6357. Negotiations in the Senate on advancing S. 1693, the Wired for Healthcare Quality Act, are continuing but no breakthroughs have occurred.
CMS Proposes Payment, Policy Changes for Physicians’ Services in 2009
The Centers for Medicare and Medicaid Services (CMS) proposed new efforts to promote access to higher quality and more efficient healthcare delivered by the nation’s physicians to people with Medicare under the 2009 Medicare Physician Fee Schedule (MPFS). Through the MPFS, CMS is encouraging greater efficiency in the delivery of care, while reducing treatment errors through the use of electronic health records and exploring new payment models to see if there are ways to promote greater coordination of care among providers, producing better outcomes for the healthcare dollar. For more information, click here.
CMS Issues Final Rule on Conditions of
Participation for Hospices
The Centers for Medicare and Medicaid ( CMS) issued a final rule revising the existing conditions of participation that hospices must meet to participate in the Medicare and Medicaid programs. The final rule focuses on the care delivered to patients and their families by hospices and the outcome of that care. The final requirements continue to reflect the unique interdisciplinary view of patient care and allow hospices flexibility in meeting quality standards. These changes are an integral part of the administration’s efforts to achieve broad-based improvements in the quality of healthcare and CMS’ efforts to improve the quality of care furnished through its programs. For a copy of the final rule, click here.
CMS Allows Access to Part D Data Through Final Rule
On May 28, the Centers for Medicare and Medicaid Services (CMS) published a final rule authorizing the collection of claims data under the Medicare Part D drug benefit program for research and other public health functions. The rule allows for the automated population in personal health records (upon an individual’s consent) of medication histories and the physicians who prescribed drugs.
CMS is seeking Medicare beneficiaries in South Carolina to participate in a pilot program to assess the benefits of using PHRs. But absent this rule, the program was to start with beneficiaries entering their own prescription and over-the-counter medications into the PHR, because CMS believed present law limited its use of Part D data. To view the final rule in the Federal Register, click here.
CCHIT Rolls Out 2008 Programs
The Certification Commission for Healthcare Information Technology (CCHIT) has approved updated 2008 criteria for certifying ambulatory electronic health records (EHRs) systems. The criteria include optional, additional certifications for EHRs for child health and cardiovascular medicine. The criteria also include a new interoperability function—the capability of an EHR to send and receive patient summaries electronically using approved standards for Continuity of Care Documents, according to HDM Daily.
The final criteria, test scripts, and associated documents are available here. CCHIT will accept applications for its first round of certification under ambulatory 2008 criteria from July 1-14, with results announced in October.
President Bush Signs Genetic Information Nondiscrimination Act
With President Bush’s signing of H.R. 493, the Genetic Information Nondiscrimination Act of 2008 (GINA), one of AHIMA’s long-time policy goals is now complete. President Bush said on Wednesday in a press release, “I want to thank the members of Congress who've joined us as I sign the Genetic Information Nondiscrimination Act, a piece of legislation which prohibits health insurers and employers from discriminating on the basis of genetic information. In other words, it protects our citizens from having genetic information misused, and this bill does so without undermining the basic premise of the insurance industry.”
AHIMA is excited about GINA’s progress and thanks you for your strong support through the years for this important legislation. AHIMA released an updated position statement on genetic nondiscrimination in 2007.
CMS Publishes Proposed Rule for Hospice Wage Index Fiscal Year 2009
On May 1, CMS published a rule proposing the hospice wage index for fiscal year 2009, according to the Federal Register (73FR24000). This proposed rule also suggests phasing out the Medicare hospice budget neutrality adjustment factor and clarifies two wage index issues pertaining to the definition of rural and urban areas and to multi-campus hospital facilities. Comments are due by 5 p.m. ET on June 27. To read more, click here.
CMS Announces Rate Year 2009 Payment and Policy Changes for Long-Term Care Hospitals
CMS published the final regulation establishing rate year (RY) 2009 federal payment rates and policies for long-term care hospitals (LTCHs). The final payment rule for RY 2009 increases the standard federal rate for LTCHs by 2.7 percent from the 2008 rate. The final rule is posted here.
CMS Publishes Hospital Inpatient PPS Proposed Rule
CMS published the proposed rule regarding changes to the hospital inpatient prospective payment system (PPS) and fiscal year 2009 rates in the Federal Register (73FR23528). As part of this proposed rule, several additional hospital-acquired conditions (HACs) that would be subject to the HAC payment provision on October 1 are under consideration: surgical site infections following certain elective procedures, Legionnaires’ disease, glycemic control, iatrogenic pneumothorax, delirium, ventilator-associated pneumonia, deep vein thrombosis/pulmonary embolism, Staphylococcus aureus Septicemia, and Clostridium difficile-associated disease. The payment provision for the HACs that were selected through the fiscal year 2008 final rule will take effect on October 1. Due to new ICD-9-CM codes that will become effective October 1, CMS is proposing the removal of the CC/MCC designation for the existing pressure ulcer codes that identify site and the addition of the MCC designation to the new codes for stage III and IV pressure ulcers. This change would impact the HAC payment provision for pressure ulcers. Comments on the proposed rule are due to CMS by June 13. AHIMA will be preparing written comments. Access the proposed rule.
Long-sought Genetic Nondiscrimination Bill Passes Senate
On April 24, the Senate passed HR 493, the “Genetic Information Nondiscrimination Act” (GINA) by the unanimous vote of 95-0. Now, both Houses of Congress have overwhelmingly passed very similar versions of the GINA and AHIMA expects the bill to go to the President shortly.
AHIMA has spent more than a decade working unilaterally and with the Coalition for Genetic Fairness to pass a genetic nondiscrimination bill. In fact, GINA was a main focus of recent 2008 Hill Day activities.
Since the outset of our efforts on genetic nondiscrimination legislation in the 1990s, AHIMA’s membership has been with us through thick and thin to see this legislation enacted. GINA has been a part of AHIMA Hill Day efforts since their outset and have had countless letter-writing campaigns spanning back before the ease of the Advocacy Assistant.
Through the years, AHIMA have worked with many outstanding representatives and senators whose dogged determination on GINA has helped make its passage a reality. Representative Louise Slaughter (D-NY), who started this fight years ago, Rep. Judy Biggert (R-IL), Senators Edward M. Kennedy (D-MA), Olympia Snowe (R-ME), Susan Collins (R-ME), former Senator Tom Daschle, and countless others were integral to keeping GINA alive and moving it forward.
CMS Issues Final Rule for Standards for e-Prescribing
The Centers for Medicare and Medicaid Services (CMS) adopted the final rule on uniform standards for medication history, formulary and benefits, and fill status notification (RxFill) for the Medicare Part D electronic prescribing (e-prescribing) drug program (73FR18918). Additionally, CMS is adopting the National Provider Identifier (NPI) as a standard for identifying healthcare providers in e-prescribing transactions. It also finalizes the June 23, 2006, interim final rule with comment period that identified the National Council for Prescription Drug Programs (NCPDP) Prescriber/Pharmacist Interface SCRIPT standard, Implementation Guide, Version 8.1 as a backward compatible update of the NCPDP SCRIPT 5.0, until April 1, 2009. This final rule also retires NCPDP SCRIPT 5.0 and adopts the newer version, NCPDP SCRIPT 8.1, as the adopted standard.
Finally, CMS is implementing the compliance date of one year after the publication of these final uniform standards. These regulations are effective on June 6. For a copy of the final rule, click here.
CMS Expands PQRI Initiative
The Centers for Medicare and Medicaid Services (CMS) has expanded its 2008 Physician Quality Reporting Initiative (PQRI) to make it easier for healthcare organizations to participate. The program, which began in 2007, establishes a financial incentive for physicians and other healthcare practitioners to participate in a voluntary quality reporting program.
In addition to submitting PQRI measurement data as part of their Medicare claims submissions, the program enables participants to report to a medical registry, which ultimately will report the information to CMS. Additionally, participants can choose to report data on either individual measures or on groups of measures that capture a number of data elements. Further, the 2008 PQRI program will enable eligible professionals to begin reporting in July 2008 and still be eligible to earn incentive payments. View details about how to qualify for an incentive payment under this new option.
Inpatient PPS Proposed Rule on Display
The Centers for Medicare and Medicaid Services (CMS) has issued the hospital inpatient PPS proposed rule for fiscal year 2009 and it is expected to be published in the Federal Register on April 30. Several additional hospital-acquired conditions (HACs) that would be subject to the HAC payment provision on October 1 are being proposed. Under the HAC payment provision, CMS is proposing to pay the CC/MCC MS-DRGs only for those HACs coded as “Y” (yes, present on admission) and “W” (clinically undetermined) present on admission (POA) indicators. The CC/MCC MS-DRGs would not be paid for HACs coded as “N” (no, not present on admission) and “U” (unknown) POA indicators. CMS is considering whether payment should be made for HACs coded as a “U” POA indicator for certain discharge status codes. Comments on the proposed rule are due to CMS by June 13. Written comments from AHIMA will be forthcoming. To access the display copy of the proposed rule, Click Here. (Please note that this is a large file which may take a few moments to open.)
CMS Releases RAC Status Document for FY 2007
The Centers for Medicare and Medicaid (CMS) recently released a report that outlines the status on the use of recovery audit contractors (RACs) in the Medicare program for fiscal year 2007. In the report, CMS highlights improvements that will be made as it implements the permanent RAC program by 2010. Examples of improvements to the RAC program include a set limit on the number of medical records requested by the contractors. The RACs will be required to have certified coders and a medical director on staff for document review and discussion if requested, and they will be required to have a Web-based application to provide status of cases in the permanent program by 2010. Click Here to read report.
CMS Issues Corrections to Final Rule of OPPS,
CY 2008 Payment Rates
CMS issued corrections to the outpatient prospective payment system/ambulatory surgical center final rule with comment in the Federal Register on February 22. The final rule was published on November 27, 2007, and titled, “Changes to the Hospital Outpatient Prospective Payment System and CY 2008 Payment Rates, the Ambulatory Surgical Center Payment System and CY 2008 Payment Rates, the Hospital Inpatient Prospective Payment System and FY 2008 Payment Rates; and Payments for Graduate Medical Education for Affiliated Teaching Hospitals in Certain Emergency Situations Medicare and Medicaid Programs: Hospital Conditions of Participation; Necessary Provider Designations of Critical Access Hospitals.” The document included technical and typographical errors; for a listing and review of the corrections click here.
Updated 2008 Charges for Copying Medical Records
The Ohio Department of Health (ODH) has released the updated amounts hospitals can charge for copying medical records in 2008. Ohio Revised Code 3701.742 requires that ODH increase the amounts using the Consumer Price Index — a 2.8% increase from last year.
The following are amounts hospitals and companies can charge for copying medical records in 2008:
For requests made by patients or their representatives, hospitals may now charge
$2.74 per page for the first 10 pages,
57 cents per page for pages 11-50,
23 cents per page for pages numbering more than 50.
With respect to data recorded on something other than paper (e.g. X-rays, CDs), the new maximum charge is $1.87 per page.
CMS to Begin On-site Reviews for HIPAA Security Compliance
During a workshop sponsored by the National Institute of Standards and Technology (NIST), officials from the Centers for Medicare and Medicaid Services (CMS) indicated they will begin reviewing hospital compliance with HIPAA security in the next nine months. Until recently, CMS has primarily focused its efforts on outreach and education to promote compliance with HIPAA. Now, it will focus reviews of 10 to 20 hospitals, and the results will be published including lessons learned about data security issues. Before the reviews begin, CMS will post on its Web site a checklist of security practices and issues covered in the rules in order to prepare hospitals on what CMS will be looking for. The contractor CMS has hired to conduct the reviews will be interviewing the compliance officer, security director, lead systems security manager, and access controls manager at each hospital. Click Here for an overview of the HIPAA security standard.
CMS Increases Physician Fee Schedule Conversion Factor for First Half of 2008
The Medicare, Medicaid, and SCHIP Extension Act of 2007 made several changes affecting Centers for Medicare and Medicaid Services (CMS) payments to physicians. One such change provides for a 0.5 percent increase to the physician fee schedule conversion factor for dates of service beginning January 1 through June 30, instead of the -10.1 percent that was scheduled to take place. Click Here to view the updated formula.
AHIMA Posts Analysis of CY 2008 Hospital Outpatient PPS Final Rule
An analysis of the final rule addressing calendar year 2008 changes to the Medicare hospital outpatient prospective payment system (OPPS) has been posted on the AHIMA Web site. This analysis covers changes affecting packaged services, Ambulatory Payment Classification (APC) groups, hospital coding and payment for visits, payment for observation services, and quality data reporting. It also describes changes pertaining to non-OPPS topics that are addressed in this final rule, including an update of the revised Ambulatory Surgical Center (ASC) payment system, revisions to the hospital Conditions of Participation, and changes to the fiscal year 2008 hospital inpatient PPS payment rates. The final rule was published in the November 27 issue of the Federal Register. Click Here to read AHIMA's analysis.
POA Reporting for Claims Use Began January 1
Beginning October 1, 2007, the Deficit Reduction Act (DRA) required hospitals to identify secondary diagnoses that are present on admission (POA). The POA indicator is required for the principal and all secondary diagnoses in order to determine whether a selected condition developed during a hospital stay. Specific instructions on how to select and report the correct POA indicator are included in the “ICD-9-CM Official Guidelines for Coding and Reporting” and CMS Transmittal 1240. Click Here for more on POA and to read the Nov/Dec 2007 practice brief “Planning for Present on Admission”) Beginning January 1, hospitals that do not submit a valid POA code will receive a remark code on the remittance advice; however the claim will still be processed. Beginning April 1, claims that do not include a valid POA code for each diagnosis will be returned for completion. For additional resources, go to AHIMA's FORE Library: HIM Body of Knowledge and search for POA.
CMS Updates, Corrects HHA PPS Rule for 2008
The Centers for Medicare and Medicaid Services (CMS) published an update and corrections to the 2008 Home Health Agency (HHA) Prospective Payment System (72FR67656). These changes update the previous HHA-PPS rule published on August 29 (72FR49762). Some coding changes have been included in this correction. Details of this announcement can be found in the November 30 Federal Register by clicking here and looking under CMS.
Please note that AHIMA and the National Association for Home Care and Hospice have partnered to bring you the timely audio seminar, Home Health PPS Update on December 19. This seminar addresses the PPS changes effective January 1, 2008. Earn AHIMA CEUs and American Nurses Credentialing Center nursing contact hours. Click Here for more information.
CMS Issues 2008 Hospital Outpatient PPS Update
This week, the Centers for Medicare and Medicaid Services (CMS) officially released its 2008 interim and final rule for the Hospital Outpatient Prospective Payment System (PPS) (72FR66580). The rule includes updates to the Ambulatory Surgical Center Payment System (including specific HCPCS code updates), the Hospital Inpatient Prospective Payment System and FY 2008 payment rates, and Hospital Conditions of Participation for Necessary Provider Designations of Critical Access Hospitals. It retroactively revises the FY 2008 inpatient PPS rules, which applies the documentation and coding adjustment rates for the FY 2008 rates, including changes impacting Medicare-dependent small rural hospitals and sole community hospitals, previously announced and then changed by Congress in October. The interim portion of the rule applies to graduate medical education payments with comments due by January 28, 2008. The Hospital Outpatient PPS rule goes into effect January 1, 2008.
AHIMA will release an analysis of the final rule for the Hospital Outpatient PPS in the coming weeks, which will be highlighted in an upcoming e-Alert. Click Here for the November 27, 2007, Federal Register notice.
CMS Announces Rules and Requests for Physician and Part B Payment
The Centers for Medicare and Medicaid Services (CMS) has announced the final rule for physician payment and other Part B policies as well as for ambulance services and the amendment of the e-prescribing exemption for computer-generated fax transmissions. Included in the final rule are changes to physician payments, which, subject to potential Congressional reversal, will lower payments by some 10 percent. Other changes include refinements to resource-based practices, expenses, relative value units, requests for additions to the list of telehealth services, several coding issues including additional codes from the five-year review, final PQRI Quality Measures, revisions to the ambulance fee schedule, and amending the e-prescribing exemption for computer-generated fax transmissions to allow for fax use during network outages once the exemption is eliminated in 2009 (72FR66333). Comments will be accepted on the interim relative value units and on the self-referral requirements until December 31, 2007. Details on this announcement can be found in the November 27, 2007, Federal Register by Clicking Here.
CMS Adds Information on Reporting Hospital-Acquired Conditions
The Centers for Medicare and Medicaid Services (CMS) has added information on reporting and coding hospital-acquired conditions to its Web site. As of October 1, all inpatient prospective payment system hospitals have been required to submit present-on-admission indicator information for all primary and secondary diagnoses. On January 1, 2008, CMS will begin processing POA indicator data and will provide feedback to IPPS hospitals on reporting errors. From January 1 to March 31, 2008, hospitals will be educated on reporting errors and will not be subject to returned claims. As of April 1, 2008, claims that are submitted for payment that do not contain proper reporting of the POA indicator will be returned. Click Here to read the reporting requirements.
 Click here for Archived Updates.
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