Quality Reporting

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On August 19, 2013, the Centers for Medicare & Medicaid Services (CMS) published a final rule updating FY 2014 Medicare payment policies and rates under the acute inpatient prospective payment system (IPPS) and the long-term care hospital (LTCH) prospective payment system (PPS). The following are highlights of the lengthy rule:
Continue Reading CMS Finalizes FY 2014 Medicare IPPS, LTCH Rates

CMS’s proposed Medicare home health PPS (HH PPS) rule for CY 2014 would cut payment by 1.5% ($290 million) compared to 2013 levels. This proposed reduction reflects a 2.4% home health payment update, which is more than offset by an ICD–9 grouper refinement and an ACA-mandated rebasing adjustment to the national, standardized 60-day episode payment…

CMS has opened an “informal” comment period on potential quality of care measures for cancer hospitals exempt from the Medicare prospective payment system (PPS). A CMS contractor has developed the following candidate measures intended to address gap areas not covered by the current PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program: (1) Initiation of Osteoclast Inhibitors …

On May 10, 2013, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule updating Medicare inpatient prospective payment system (IPPS) and long-term acute care hospital prospective payment system (LTCH PPS) rates and policies for fiscal year (FY) 2014, which begins October 1, 2013. Comments on the proposed rule will be accepted until June 25, 2013. Highlights of the sweeping rule include the following: Continue Reading CMS Proposes Medicare IPPS and LTCH PPS Rates/Policies for FY 2014

CMS published a proposed rule on May 8, 2013 that would update Medicare inpatient rehabilitation facility (IRF) prospective payment system (PPS) rates for FY 2014. CMS proposes a 1.8% payment update for FY 2014, reflecting a 2.5% market basket increase factor, reduced by a 0.4% multi-factor productivity adjustment and an additional 0.3 percentage point…

On April 26, 2013, the Centers for Medicare & Medicaid Services (“CMS”) released the proposed update to the Medicare long-term acute care hospital prospective payment system (“LTCH PPS”) policies and payment rates for fiscal year (“FY”) 2014. The proposed changes would apply to discharges occurring on or after October 1, 2013 through September 30, 2014. CMS will accept comments on the proposed rule until June 25, 2013, and will respond to comments in a final rule to be issued by August 1, 2013. Reed Smith has prepared a Client Alert that provides a summary of the most significant proposed changes to the LTCH PPS in the proposed rule.
Continue Reading CMS Proposed Changes to Medicare LTCH Payment Rates and Policies for FY 2014

The chairmen of the House Energy and Commerce Committee and Ways and Means Committee have provided additional details regarding their proposal to repeal the current Medicare physician fee schedule sustainable growth rate (SGR) methodology and replace it with an alternative physician payment system. The update builds on comments received from the public on the panels’…

The GAO has examined how private-sector efforts to adjust physician payments to reflect quality and efficiency could be applied successfully to the Medicare program.  As previously reported, CMS developing a physician value-based payment modifier (Value Modifier), which was mandated by the ACA as a way to reward physicians for providing higher quality and more…

On January 3, 2013, CMS published a request for information from hospitals, electronic health record (EHR) vendors, and other interested parties regarding hospital readiness beginning calendar year 2014 discharges to electronically report certain patient-level data under the Hospital Inpatient Quality Reporting (IQR) Program using the Quality Reporting Document Architecture (QRDA) Category I. While feedback originally…

On December 7, 2012, CMS published an interim final rule with comment period that updates the Data Element Catalog (DEC) standard and the Quality Reporting Document Architecture (QRDA) Category III standard adopted in a September 4, 2012 final rule. The interim final rule with comment period also revises the Medicare and Medicaid Electronic Health Record…

On November 27, 2012, CMS published a notice inviting public comments regarding health plan quality management requirements for qualified health plans (QHPs) participating in Affordable Insurance Exchanges. Specifically, CMS is seeking feedback on current and potential quality measures and rating systems, quality improvement strategies and requirements, purchasing strategies to promote care redesign and patient…

On November 21, 2012, CMS announced that it is entering into contracts with three organizations to implement the ACA’s Medicare Data Sharing for Performance Measurement provision. The provision requires CMS to make available to “qualified entities” standardized extracts of Medicare claims data under Parts A, B, and D for purposes of evaluating provider and supplier…

On November 15, 2012, the Centers for Medicare & Medicaid Services (CMS) published its publishing its final rule with comment period updating Medicare payment and other policies for the hospital outpatient prospective payment system (OPPS) and ambulatory surgical centers (ASCs) for CY 2013. The rule also updates Medicare quality reporting program policies and various other Medicare policies. Key provisions of the final rule include the following:Continue Reading CMS Finalizes OPPS, ASC Rates and Policies for 2013

Medicare home health rates will be largely unchanged in 2013 under a CMS final rule published November 8, 2012. Specifically, under the final rule, Medicare home health PPS (HH PPS) rates will be cut by approximately 0.01%, or a total of $10 million compared to 2012 levels. This reduction results from a 2.3% market basket…