SMED-7972

Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis.  Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis.  Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis.  Lorem ipsum dolor sit amet, consectetur adipiscing elit. Duis ac felis vitae lacus scelerisque maximus nec vel risus. Mauris porttitor tempus metus, vitae scelerisque est efficitur sit amet. Duis ullamcorper dui sed augue feugiat maximus. Etiam et dolor ultricies, fringilla velit id, iaculis elit. Etiam mattis ante nec sem efficitur malesuada. Vestibulum et hendrerit tortor. Quisque molestie pellentesque tortor vitae efficitur. Pellentesque sit amet nunc ac risus efficitur sagittis vel feugiat orci. Duis lorem ligula, fringilla in velit vitae, ullamcorper mollis ante. Integer egestas lacus nec enim gravida, quis bibendum nibh tempor. Maecenas placerat interdum orci ut auctor. Donec congue ante vitae est viverra, malesuada ullamcorper magna varius. Aliquam sit amet tincidunt nunc. Nunc non ligula et sem gravida faucibus. This is a test heading Item 1 Item 2 Item 3 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Marcus Aurelius Row 1 Column 1Row 1 Column 2Row 2 Column 1Row 2 Column 2 Testing Buttons Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum. 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Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Heading 2 Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Heading 3 Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Heading 4 Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos. Related Posts How to test the Yoast Blocks Just add them to any page/post and it should work as expected How to test the Yoast Blocks Just add them to any page/post and it should work as expected What is a Yoast block? Just a SEO-based block that was configured by the Yoast team What is a Yoast block? Just a SEO-based block that was configured by the Yoast team This is a classic block test, we are testing different features and there baseline functionalities. Does this work? What about this? Can I make a list? List Item 1 List Item 2 List Item 3 What about ordered? Item Item Item This is pretty cool This is even better What about this?

Making it as easy for patients to book and attend appointments will be critical during flu season. See how healthcare providers can prepare.

Discover how Experian Health’s solutions can help providers can find unidentified insurance coverage and reduce bad debt.

Discover 6 effective, data-driven revenue cycle management strategies that can help healthcare providers increase cashflow.

Discover three areas where automation can help ease the burden of the healthcare staffing crisis while creating better patient experiences.

Learn more about health insurance eligibility verification software and how it accelerates eligibility verifications, reduces denials and and much more.

Learn how to proactively verify insurance eligibility to maintain cash flow and help patients navigate as the COVID-19 public health emergency ends.

With the Appropriate Use Criteria program slated to go into effect in 2023, healthcare providers shoud implement new alerts for prior authorizations.

COVID-19 provided an unexpected use case for patient portals. In a matter of weeks, the benefits of remote patient access were undeniable. Patient portals allowed patients to schedule, register and pay for care from the comfort and safety of home. Now, as the latest omicron sub-variant triggers another surge in case numbers, providers are again reminded of the value in making digital channels available to minimize face-to-face interaction. With staffing shortages continuing and patient numbers rising, it’s worth recapping the benefits of patient portals. Why should healthcare providers prioritize patient portals? Here are 7 reasons: 1. Patient portals can be used to communicate safely with patients as Covid-19 cases rise Health officials may be cautious about reinstating extreme measures in response to the latest wave of infections. However, they can’t afford to be complacent about an uptick in hospital admissions. Patient portals can mitigate the risks associated with increasing foot traffic by allowing patients to schedule and register for care without attending in person. Completing paperwork from home eliminates the need for patients to share clipboards or sit in stuffy waiting rooms, while online scheduling platforms enable staff to manage the flow of patients safely and efficiently. Remote patient monitoring, secure messaging and online prescription refill requests can also be managed via portals, further reducing the need for in-person visits. 2. They can ease pressure on understaffed teams Providers need to find efficient ways to handle the administrative workload that comes with higher patient volumes. It’s even tougher given increasing retirement and resignation figures. More nurses are embracing the occupational benefits of remote and virtual care and are opting to switch from high-stress facilities to telehealth positions. While this speaks to the growth and impact of remote healthcare, it leaves a gap to be filled in hospitals. Patient portals can alleviate some of the burdens by reducing the need for staff input at various points in the patient journey. For example, online scheduling reduces the number of calls to call centers. Pre-filled data and automated registration can reduce the risk of errors during patient intake, which are time-consuming to fix. Portals can also be used to help patients navigate the payments process, speeding up collections and reducing the time staff spend chasing payments. 3. Patient portals can address inefficient patient access workflows Because patient portals are tethered to the patient’s electronic health record (EHR), they provide a hub for every piece of data relating to the patient. Patients can access that golden record at any time. They get an engaging and transparent experience, and are less likely to call up to ask questions – they already have the answers. They can also check data to make sure that it’s accurate, which helps avoid the delays and misunderstandings that cause friction for patient access teams. It’s important to ensure that the portal itself doesn’t introduce friction. Patients need to be able to enroll in the portal without too much trouble. Automating the patient enrollment process and implementing a multi-layered identity-proofing solution can create a secure and efficient way for patients to get the most out of their portal, without compromising safety or efficiency. 4. To improve patient engagement and meet consumer expectations One of the biggest reasons to invest in patient portals is because patients say they want them. Research from Experian Health and PYMNTS found that 44.1% of patients have obtained test results through patient portals, while 18% used patient portals to fill out forms for their most recent healthcare visit. Overall, two-thirds said they use patient portals. Beyond offering a convenient patient experience, this is also a matter of patient loyalty and retention: 61% of patients say they’d consider switching providers to one that offered a patient portal, which could have a significant impact on revenue. 5. They can boost revenue by offering easy ways to pay Experian and PYMNTS research shows that around a fifth of patients uses their portal to make payments. Unfortunately, 16% of those patients said they’d faced difficulty viewing invoices, setting up payment plans and making payments through their portal, which suggests some room for improvement. Experian Health’s Patient Payment Solutions solves these challenges. A range of self-service, mobile-optimized tools simplify the patient financial journey by giving patients upfront pricing estimates, personalized payment plans and easy ways to pay. 6. Using patient portals can improve health outcomes (especially for “frequent flyers”) Patient portals also play an important role in promoting better health outcomes for patients. Research shows that when patients have access to their medical information, they feel empowered and prepared to speak to their doctor and adhere to care strategies. Multiple providers can engage with the patient through the same platform, and see what other treatments are being prescribed. This helps improve communication between the patient and provider and helps improve care management. It’s especially useful for older patients and those with chronic conditions. In this way, portals support effective care coordination, helping value-based care providers achieve their goals of reducing healthcare costs, promoting population health and closing the gaps in care that have widened over the last few years. 7. Patient portals can support compliance with price transparency regulations Finally, portals offer a route to ensuring compliance with new regulatory requirements around price transparency. The No Surprises Act and hospital price transparency rule call on providers to give patients accurate, upfront cost estimates so they can plan for their financial responsibility more easily. Patient Payment Estimates can be delivered in several ways, including through patient portals. And as noted, once the patient has their estimate, they can also be directed to easy and convenient payment methods, including through their portal. Whether it’s a surge in COVID-19 cases, rising inflation, or labor shortages, providers must find ways to build resilience, stay competitive, and continue to offer patients the flexible and transparent healthcare experience they desire. Patient portals should be part of the plan to open the digital front door. Contact us to find out how Experian Health helps healthcare organizations deliver a reliable and secure patient portal experience.

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Healthcare revenue cycle challenges exist at every stage of the patient journey. Discover the top 7 and strategies to overcome them.

After five years of ICD-10 classification system code freezes, October 1, 2016 will see the system back on the routine cycle for annual updates. On March 9th and 10th, the ICD-10 Coordination and Maintenance committee met to review proposals for both ICD-10-CM and ICD-10-PCS. All PCS codes to date that have been approved as new, revised, and deleted have been compiled into a file for review under the Coordination and Maintenance Committee meeting materials. For the October 1, 2016 update, there are currently 75,625 PCS codes for the FY 2017 update, which includes 3,651 new codes and 487 revised code titles. Of the 3,651 new codes, 3,549 are cardiovascular system codes. These relate to unique device values, the addition of bifurcation as a qualifier, and additional specific body parts, as well as congenital cardiac procedures and placement of an intravascular neurostimulator. All of the revised code titles at this time have come from changing the number of coronary artery sites to the number of vessels, and the specification of the descending thoracic aorta. Additional new codes include the expansion of the body part detail in Removal and Revision of lower joints, and the addition of unicondylar knee replacement. The codes presented at this meeting were for implementation in October 2016 and will be added to the already-approved list There were 24 diagnosis proposals on the agenda for discussion such as: Clostridium Difficile: A proposal was presented to expand the code to differentiate recurrent C. difficile  enterocolitis from enterocolitis not specified as recurrent. Congenital sacral dimple: The American Academy of Pediatrics proposed a new congenital code so this condition can be accurately tracked. Myocardial infarction: Specify the types as defined by several professional cardiology organizations. A specific code was proposed for type 2 myocardial infarction due to demand ischemia or ischemic imbalance so that data can be captured. The additional myocardial infarction types (3, 4a, 4b, 4c, 5) would all be assigned to one ICD-10-CM code. There was much discussion on this proposal related to the code proposals as well as the indexing and impact on subsequent myocardial infarctions. This proposal was requested for inclusion in the 10/1/16 addenda. Zika virus was discussed, regarding a new code being created. NCHS/CDC is proposing it for inclusion in the 10/1/16 addenda which would be consistent with the World Health Organization’s ICD-10 update According to CMS, the coding update will be implemented on Oct. 1, 2016, and will include the “backlog of all proposals for changes to the code set proposed via the ICD-10 Coordination and Maintenance Committee process during the partial code freeze, and receiving public support.” The codes are posted on the Centers for Disease Control and Prevention National Center for Health Statistics website here: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2017/NewICD10CMCodes_FY2017.txt Review the Meeting Agenda here: http://www.cdc.gov/nchs/data/icd/topic_packet_03_09_16.pdf

On February 26th, CMS published a One-Time Notification, Transmittal 1630, Change Request 9540. This change request (CR) is the 6th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs) with   implementation date of July 5, 2016 for all Medicare Contractors The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, CR9087, and CR9252. Some are the result of revisions required to other NCD-related CRs released separately. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates as any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process The NCD’s updated per this CR are listed below: NCD20.29 – Hyperbaric Oxygen Therapy NCD90.1 – Pharmacogenomic Testing for Warfarin Response NCD110.18 – Aprepitant for Chemotherapy-Induced Emesis NCD150.3 – Bone Mineral Density Studies (See also Medlearn Matters SE 1525 04/12/16) NCD160.18 – Vagus Nerve Stimulation for Treatment of Seizures NCD160.24 – Deep Brain Stimulation for Essential Tremor NCD210.3 – Colorectal Cancer Screening Tests NCD210.14 – Screening for Lung Cancer with Low-Dose CT NCD230.18 – Sacral Nerve Stimulation for Urinary Incontinence NCD260.1 – Adult Liver Transplantation NCD110.4 – Extracorporeal Photopheresis NCD20.33 – Transcatheter Mitral Valve Repair NCD220.13 – Percutaneous Image-Guided Breast Biopsy NCD220.4 – Mammograms Read the details of this direction here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2016-Transmittals-Items/R1630OTN.html?DLPage=1&DLEntries=10&DLFilter=R1630Otn&DLSort=1&DLSortDir=ascending  

At HHS, we’re working today with an eye on the horizon. We’re committed to building a health care system that provides better care, spends our health care dollars in smarter ways, and puts patients at the center of their care. Our aim is to strengthen health care so that it works for the health of every American. Our vision for this health care system is one where a patient can easily check their own medical record, where a patient’s different clinicians, from pharmacists to nurses to physicians, can more seamlessly work together to keep that patient healthy, and where treatment can easily be tailored to a specific patient’s needs. The key to unlocking that vision of a modern health care system is joining the data revolution that has already transformed so much of our society. Just recently, Secretary Burwell spoke at the 2016 conference of the Healthcare Information and Management Systems Society. She spoke about our need to unlock data to bring health care into the 21st century and how the security of patient data is essential to our progress. As she told the audience, “People should be able to easily and securely access their electronic health information and send it to any desired location. They need to be able to understand how their information can be shared and used. And they must be assured that this information will be effectively and safely used to benefit their health and that of their community.” Today, we’re taking a significant step to improve the safety of the data and security of life-saving medical devices across our health care system by announcing the membership of the Health Care Industry Cybersecurity Task Force. The members of this Task Force are leaders in government and private industry. They’re innovators in technology and pioneers in health care. They represent organizations of various sizes, and they hail from different parts of the country. Over the next year, these individuals will collectively look across industries and sectors to find the best ways organizations of all types are keeping data and connected medical devices safe and secure. They’ll discuss these ideas among themselves and, in the next year, they’ll report their findings to Congress and the public. They’ll also develop materials to share widely, ensuring every organization that plays a part in our health care system can protect the data that that is part of this system. As President Obama has made clear, cybersecurity is one of the most serious security challenges that our nation faces. So as we look to transform our health care system into one that works better for all Americans, we need to ensure it works safely for all Americans. We need to protect the data at the foundation of our health care system. That’s our commitment here at HHS, and it’s why we’re so excited to launch the Health Care Industry Cybersecurity Task Force.

On March 16, CMS released three special edition MLN Matters articles on submitting claims to MACs for chiropractic services provided to Medicare beneficiaries. Special edition MLN Matters article SE 1601 helps clarify the CMS policy regarding Medicare coverage of chiropractic services and documentation requirements for the beneficiary’s initial visit and subsequent visits to the chiropractor. Special edition MLN Matters article SE 1602 explains the Active Treatment modifier (AT), which was developed to clearly define the difference between active treatment and maintenance treatment. Special edition MLN Matters article SE1603 provides a detailed list of informational/educational resources that can help chiropractors avoid billing errors due to insufficient or inaccurate documentation. Read More: MLN Matters article SE 1601: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1601.pdf MLN Matters article SE 1602: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1602.pdf MLN Matters article SE1603: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1603.pdf

On March 11, CMS released a change request to display the list of telehealth services that were once available through the manual updates to now be displayed via a weblink going forward. CMS is also adding CRNAs to the list of Medicare practitioners who may bill for covered telehealth services. Lastly, the telehealth language has been removed from Pub 100.02, Medicare Benefit Policy Manual, Chapter 15, Section 270 and a reference added in text to see Pub 100.04, Chapter 12, Medicare Claims Processing Manual, section 190 for further information regarding telehealth services. Implementation date: April 11, 2016 Transmittal R3476CP here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3476CP.pdf Transmittal R221BP here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R221BP.pdf MLN Matters article MM9428 here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9428.pdf

On March 11, CMS posted a transmittal stating it awarded Noridian Healthcare Solutions, LLC, a new contract for the administration of Medicare Fee-for-Service claims for DME, prosthetics, orthotics, and supplies in Jurisdiction A. The incumbent is NHIC, Corp. The Jurisdiction A DME MAC serves Medicare beneficiaries who reside in the states of Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont, and the District of Columbia. Under this contract, Noridian will process and pay Medicare DMEPOS claims; process redetermination requests; respond to supplier inquiries; perform supplier outreach and education; and, review claims for medical necessity. Noridian will begin processing Jurisdiction A claims in May 2016 from its offices in Fargo, ND. Jurisdiction A includes over 8.2 million Medicare Fee-for-Service beneficiaries. The Jurisdiction A DME MAC will serve approximately 20,000 Medicare DMEPOS suppliers. This jurisdiction comprises nearly 18% of the overall national Medicare Fee-for-Service DMEPOS claims volume. The Jurisdiction A DME MAC contract includes a base year and four option years, for an anticipated duration of five years. The contract is a “cost plus award fee” contract; the award fee will be earned only if the contractor exceeds the base requirements of the contract. Effective date: December 16, 2015 Implementation date: July 1, 2016, for all cutover requirements outside of those related to system changes; July 5, 2016, for system changes View Transmittal R1634OTN here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1634-OTN.pdf View MLN Matters article MM9546 here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9546.pdf

CMS recently released an extensive revision of QIO Manual Chapter 9 related to QIO reviews in cases potentially involving sanction recommendations from the OIG for quality and EMTALA issues. The chapter has been renamed to include the reference to EMTALA. This update supersedes all the information in the October 3, 2003 version of Chapter 9, any previously issued Question & Answer guidance, and any previously issued TOPS, Standard Data Processing System, and Healthcare Quality Information System memos related to Chapter 9. Effective date: March 14, 2016 Implementation date: March 14, 2016 View Transmittal R139DEMO.

On March 17th, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) released a new interactive map to increase understanding of geographic disparities in chronic disease among Medicare beneficiaries. The Mapping Medicare Disparities (MMD) Tool identifies disparities in health outcomes, utilization, and spending by race and ethnicity and geographic location. Understanding geographic differences in disparities is important to informing policy decisions and efficiently targeting populations and geographies for interventions. “Our commitment to health equity begins with properly measuring the care people get and having an honest dialogue on how and where we need to improve,” said CMS Acting Administrator Andy Slavitt. “Today’s tool aims to make it harder for disparities to go unaddressed.” Racial and ethnic minorities experience disproportionately high rates of chronic diseases, and are more likely to experience difficulty accessing high quality of care than other individuals. The identification of areas with large differences in the proportions of Medicare beneficiaries with chronic diseases is an important step for informing and planning health equity activities and initiatives. The Mapping Medicare Disparities Tool features: A dynamic interface with data on the prevalence of 18 chronic conditions, end stage renal disease, or a disability; Medicare spending, hospital and emergency department (ED) utilization, preventable hospitalizations, readmissions, and mortality rates. The ability to sort by state or county of residence, sex, age, dual-eligibility for Medicare and Medicaid, and race and ethnicity. Built-in benchmarking features to investigate disparities within counties and across racial and ethnic groups, and within racial and ethnic groups across counties. “It’s not enough to improve average health care quality in the U.S.,” said CMS OMH Director Cara James.  “As the CMS Equity Plan lays out, we must identify gaps in quality of care at all levels of the health care system to address disparities. We are excited to share this new tool, which allows us to pinpoint disparities in health care outcomes by population and condition.” See the Medicare Mapping Disparities Tool here: https://www.cms.gov/About-CMS/Agency-Information/OMH/OMH-Mapping-Medicare-Disparities.html The Medicare Mapping Disparities Tool FAQ’s are here:https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/MMDT-FAQs.pdf  

Beginning in 2016, claims for CT (Computed Tomography) scans identified by the CPT codes listed  below  (and by successor codes) that are furnished on non-NEMA (National Electric Manufacturers Association) Standard XR-29-2013-compliant CT scans must include modifier “CT” that will result in an applicable payment reduction. 70450-70498 71250-71275 72125-72133 72191-72194 73200-73206 73700-73706 74150-74178 74261-74263 75571-75574 CMS Change Request (CR) 9250 informs providers that effective January 1, 2016, a payment reduction of 5 percent applies to CT services furnished on equipment that is inconsistent with the CT equipment standard and for which payment is made under the physician fee schedule. When such payment reductions are made, MACs will supply: Claim Adjustment Reason Code 237 – Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Remittance Advice Remark Code N759 – Payment adjusted based on the National Electrical Manufacturers Association (NEMA) Standard XR-29-2013; and Group Code: CO (contractual obligation) The payment reduction increases 15 percent in 2017 and subsequent years. System attestation by providers will be verified through the periodic supplier accreditation process. Read the official instruction here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3402CP.pdf

The Centers for Medicare & Medicaid Services (CMS) published a final rule February 11, 2016 that requires Medicare Parts A and B health care providers and suppliers to report and return overpayments by the later of the date that is 60 days after the date an overpayment was identified, or the due date of any corresponding cost report, if applicable. A separate final rule was published in the May 23, 2014 Federal Register (79 FR 29844) that addresses Medicare Parts C and D overpayments. Summary The requirements in this rule are meant to support compliance with applicable statutes, promote the furnishing of high quality care, and to protect the Medicare Trust Funds against improper payments, including fraudulent payment. This rule clarifies requirements for the reporting and returning of self-identified overpayments. Health care providers and suppliers have been and will remain subject to the statutory requirements found in section 1128J(d) of the Social Security Act (the Act) and could face potential False Claims Act (FCA) liability, Civil Monetary Penalties Law (CMPL) liability, and exclusion from federal health care programs for failure to report and return an overpayment. Health care providers and suppliers will also continue to be required to comply with current CMS procedures when we, or our contractors, determine an overpayment exists and issue a demand letter. Background Section 6402(a) of the Affordable Care Act established a new section 1128J(d) of the Act. Section 1128J(d)(1) of the Act requires a person who has received an overpayment to report and return the overpayment to the Secretary, the state, an intermediary, a carrier, or a contractor, as appropriate, at the correct address, and to notify the Secretary, state, intermediary, carrier, or contractor to whom the overpayment was returned in writing of the reason for the overpayment. Section 1128J(d)(2) of the Act requires that an overpayment be reported and returned by the later of: (A) the date which is 60 days after the date on which the overpayment was identified; or (B) the date any corresponding cost report is due, if applicable. Section 1128J(d)(3) of the Act specifies that any overpayment retained by a person after the deadline for reporting and returning an overpayment is an obligation (as defined in 31 U.S.C. 3729(b)(3)) for purposes of 31 U.S.C. 3729. In the February 16, 2012 Federal Register (77 FR 9179), CMS published a proposed rule to implement the provisions of section 1128J(d) of the Act for Medicare Parts A and B providers and suppliers. Major Provisions The major provisions of this final rule include clarifications around: the meaning of overpayment identification; the required lookback period for overpayment identification; and the methods available for reporting and returning identified overpayments to CMS. Meaning of “Identification” Section 1128J(d) of the Act provides that an overpayment must be reported and returned by the later of: (i) the date which is 60 days after the date on which the overpayment was identified; or (ii) the date any corresponding cost report is due, if applicable. This final rule states that a person has identified an overpayment when the person has or should have, through the exercise of reasonable diligence, determined that the person has received an overpayment and quantified the amount of the overpayment. Creating this standard for identification provides needed clarity and consistency for health care providers and suppliers regarding the actions they need to take to comply with requirements for reporting and returning of self-identified overpayments. Lookback Period Under this final rule, overpayments must be reported and returned only if a person identifies the overpayment within six years of the date the overpayment was received. Specifying the length and other parameters of the look back period provides additional clarity for providers and suppliers who have identified an overpayment that is covered by the provisions of 1128J(d). How to Report and Return Overpayments This final rule provides that providers and suppliers must use an applicable claims adjustment, credit balance, self-reported refund, or another appropriate process to satisfy the obligation to report and return overpayments. This approach for returning overpayments provides an array of familiar options from which providers and suppliers can select. This rule also provides that if a health care provider or supplier has reported a self-identified overpayment to either the Self-Referral Disclosure Protocol managed by CMS or the Self-Disclosure Protocol managed by the Office of the Inspector General (OIG), the provider or supplier is considered to be in compliance with the provisions of this rule as long as they are actively engaged in the respective protocol. View the final rule in the Federal Register here: https://www.gpo.gov/fdsys/pkg/FR-2016-02-12/pdf/2016-02789.pdf

Experian Health is pleased to announce that its Patient Estimates solution has joined the athenahealth® Marketplace, also known as  the More Disruption Please (MDP) program. Experian Health has participated in this program since the launch of the marketplace in 2013 (starting with our Contract Management offerings) and has worked with athenahealth to integrate its industry-leading capabilities into the organization’s growing network of more than 73,000 healthcare providers. Learn more about Experian Health’s Patient Estimates solution. Read the press release To learn more about athenahealth’s MDP program and partnership opportunities, please visit https://www.athenahealth.com/disruption.

Experian Health is pleased to announce that we went live with Patient Estimates at St. Clair Hospital located in Pittsburgh, PA on February 22, 2016. A true representation of vendor and hospital collaboration and commitment, the Patient Estimates cost transparency tool gives St. Clair a competitive edge as the first hospital in its region to offer patients cost estimates in advance. Patient Estimates is not a list of charges, but an interactive and user-friendly tool that provides information that is highly specific to the individual. Estimates are designed to determine, in advance, each patient’s out-of-pocket costs (deductibles, co-pays and co-insurance) for services at St. Clair based upon his/her insurance coverage. The estimates also incorporate St. Clair’s discounts for payment on the date of service and for those without insurance. The estimates remain in the system and can be recalled for future reference. Patient Estimates is simple to use and is conveniently available 24/7 at www.stclair.org. On the home page, patients will select the “Financial Tools” option, then click on Patient Estimates. They will then enter their health insurance information before choosing one of the 100 listed clinical services (e.g., a procedure, treatment or diagnostic test) from the drop-down menu. The tool then provides a customized estimate of their out-of-pocket expenses. Patient Estimates is designed to help insured and uninsured patients get clear, real-time, easy-to-understand cost estimates for St. Clair’s services so patients can make informed decisions about their care. Below are some of the press mentions of St. Clair Hospital’s implementation of Patient Estimates: Pittsburgh TRIBLIVE https://bit.ly/1oxlKna Pittsburgh Post-Gazette: https://bit.ly/219dqfd Pittsburgh Business Times: https://bit.ly/1QWfqNa