• Hospital Compare Star Ratings: Overview of HCAHPS Star Ratings — Registration Opening Soon
• Hospital Appeals Settlement Update — Registration Now Open
• Transitioning to ICD-10 — Register Now
• New MLN Connects™ National Provider Call Video Slideshow

Announcements

• Volunteers Sought for ICD-10 End-to-End Testing in January: Forms due October 3
• National Partnership to Improve Dementia Care Exceeds Goal to Reduce Use of Antipsychotic Medications in Nursing Homes: CMS Announces New Goal
• Hospital Appeals Settlement: New FAQs Posted
• Groups: Remember to Register for 2014 PQRS GPRO Participation by September 30
• 2014 PQRS 2nd Quarter Interim Feedback Dashboard Reports Available
• 2013 PQRS and eRx Incentive Program Incentive Payments Available
• 2013 PQRS and eRx Incentive Program Feedback Reports Available
• 2012 eRx Incentive Program and 2012 PQRS Supplemental Incentive Payments Available
• Completion and Submission Timeframes for Hospice Item Set Records
• Important Skill Sets for Doctors and Nurses: CME Articles Available on Medscape
• New Resources and Webinars from National Health IT Week
• PQRS: New Quality Reporting Training Modules to Help Ensure Satisfactory 2014 Reporting
• 2014 CAHPS for PQRS Survey
• New PQRS FAQs Available
• New and Updated FAQs for the EHR Incentive Programs

Claims, Pricers, and Codes

• FDG PET for Solid Tumor Claims

Medicare Learning Network® Educational Products

• “Medicare Billing Information for Rural Providers and Suppliers” Booklet — Revised
• “Rural Health Clinic” Fact Sheet — Revised
• “Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians” Fact Sheet — Revised
• “Critical Access Hospital” Fact Sheet — Revised

Subscribe to the Medicare Learning Network® Educational Products and MLN Matters® Electronic Mailing Lists

The post MLN Connects™ National Provider Calls appeared first on Welcome to our Blog!.

Thirteen new studies will address pain with non-drug approaches.

The National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM) and National Institute on Drug Abuse (NIDA) and the U.S. Department of Veterans Affairs (VA) Health Services Research and Development Division provided funding for this initiative. The research projects are located at academic institutions and VA medical centers across the United States.

“Pain is the most common reason Americans turn to complementary and integrative health practices,” said Josephine P. Briggs, M.D., Director of NCCAM. “The need for nondrug treatment options is a significant and urgent public health imperative. We believe this research will provide much-needed information that will help our military and their family members, and ultimately anyone suffering from chronic pain and related conditions.”

A 2011 Institute of Medicine (IOM) report states that nearly 100 million American adults suffer from chronic pain at a cost of $635 billion per year and notes a need for a cultural transformation to change this problem. Chronic pain disproportionately affects those who have served or are serving in the military. A June 2014 report in JAMA Internal Medicine showed an alarmingly high rate of chronic pain—44 percent—among members of the U.S. military after combat deployment, compared to 26 percent in the general public.

“Unless the ‘cultural transformation’ called for by the IOM begins in earnest, our nation faces additional crises in the future. Many service members and veterans with pain also have comorbid conditions such as posttraumatic stress syndrome or traumatic brain injury,” a commentary in the journal said. “Many of them are at risk for a lifetime progression of increasing disability unless the quality, variety, and accessibility of evidenced-based ‘self-management’ skills are improved. Without more effective and less costly approaches to pain management, the estimated costs of care and disability to the country will approach $5 trillion.”

One co-author of the commentary is Eric B. Schoomaker, M.D., Ph.D., a retired U.S. Army lieutenant general who is a scholar-in-residence and Distinguished Professor of Military and Emergency Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Maryland, and is a member of NCCAM’s Advisory Council. The other is Wayne B. Jonas, M.D., a retired U.S. Army lieutenant colonel who is president of the Samueli Institute, a nonprofit organization in Alexandria, Virginia, with a mission that includes applying academic rigor to research on healing, well-being, and resilience; and translating evidence into action for the U.S. military and large-scale health systems.

Pain is not the only issue. According to the JAMA Internal Medicine report, 15 percent of U.S. military post-deployment use opioids, compared to 4 percent of the general public. Drugs such as opioids that are available to manage chronic pain are not consistently effective, have disabling side effects, may exacerbate pain conditions in some patients, and are often misused. According to NIDA, an estimated 52 million people (20 percent of those aged 12 and older) have used prescription drugs for nonmedical reasons at least once in their lifetimes.

“Prescription opioids are important tools for managing pain, but their greater availability and increased prescribing may contribute to their growing misuse,” said Nora D. Volkow, M.D., Director of NIDA. “This body of research will add to the growing arsenal of pain management options to give relief while minimizing the potential for abuse, especially for those bravely serving our nation in the armed forces.”

Read about the researchers and descriptions of the thirteen projects.

This work is supported by the following grants: DA038971, AT008347, AT008399, AT008427, AT008336, AT008448, AT008404, AT008422, AT008423, AT008387, AT008349, HX001704, AT008398.

For b-roll, other visuals, and to arrange interviews, contact the NCCAM Press Office at 301-496-7790 ornccampress@mail.nih.gov.

VA Research has been contributing to improvements in the lives of veterans and all Americans since 1925. The program, part of the nationwide VA health care system, is unique because of its focus on health issues that affect U.S. veterans. To learn more about VA Research, visit http://www.research.va.gov .

NCCAM’s mission is to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care. For additional information, call NCCAM’s Clearinghouse toll free at 1-888-644-6226, or visit the NCCAM website at http://nccam.nih.gov/.

NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at http://www.drugabuse.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

The post NIH and VA address pain and related conditions in U.S. military personnel, veterans, and their families appeared first on Welcome to our Blog!.

Medical billing has direct connection with your RCM. Minor mistakes can delay the process of getting the desired reimbursements from insurance companies. So, to have a smooth revenue cycle and track-able flow of money, avoid the following ten billing mistakes.

1. No Document No Billing

When you have nothing to prove your claims, refrain from billing the same and I am not indicating malpractice here! Consider this, you have a genuine suffering patient but he doesn’t have his symptoms documented by the physician and thus, in the records too. Now, you have incurred losses alright but how do you convince the payer?

2. Club the Particulars of the Bill

A visit to the doctor involves all these things together: diagnosis, tests for ruling out conditions or pinpoint diseases, the treatment, prescription of medicines, other services to assist the treatment. So, it is important to club all of these together when billing.

3. Do Code When There’s a Code

There is a reason why a certain code exists in the CPT to describe the patient’s condition. Having proper knowledge of which code to assign plays an important role in not getting a denial. Hence, the billing staff should assign the precise code instead of a non-specified one.

4. Be Lenient with Modifiers

A modifier is an alpha numeric code which should be assigned when multiple services are performed on the patient under special or unusual circumstances. Do not forget to add E&M (Evaluation and Management) coding when clubbed with any kind of surgery.

5. Submit Non-Standardized Forms

Bills should be submitted in the proper format and that very much includes the prescribed forms, e.g. the CMS-1500. This is as far as the hardcopy submissions are concerned. As for the electronic records are concerned HIPAA rules should be diligently followed to avoid audits.

The post Top 5 Don’ts of Medical Billing appeared first on Welcome to our Blog!.

·         To identify families with compelling personal stories, connect with organizations and trained assisters who help eligible individuals enroll in Medicaid and CHIP. People who help families enroll are likely to have established trust and have a good rapport with them. Ask enrollment assisters for basic information about the family to help you determine if the story is a good fit for your organization’s outreach efforts.
·         Once you identify a family with a story to share, set up a one-on-one conversation to get more information. Ask how the family learned about Medicaid and CHIP and whether they got help enrolling in the program or enrolled on their own. Ask for details that can help others identify with the story – for example, does the enrolled child have any particular health problems? Seek specific examples of how enrollment in Medicaid or CHIP has improved the family’s quality of life. You may have to ask some sensitive questions about their worries before health insurance and how they managed to get through illnesses, along with questions about household income to confirm that they are eligible for Medicaid and CHIP in your state.

Working with Media Outlets
Having at least one or two families that are willing to talk to the media can increase the likelihood that your organization and your issue will be featured by local news outlets. Personal stories, such as this one shared by a parent with a child receiving CHIP coverage during a recent radio interview featuring Positively Kids in Las Vegas, NV, may be a “news hook” and can demonstrate the relevance of the story to the local community. Always obtain the family’s permission before sharing their information with the media, each and every time. Don’t assume that family members will be comfortable meeting the news team at their home, workplace or school. Always confirm with the family before suggesting a location to a reporter. Listen carefully during these conversations, if someone seems uncomfortable, don’t push the person to give the interview.

Before introducing a family spokesperson to a media contact, make sure he or she feels comfortable sharing his or her story and responding to questions. For all media interactions, encourage your spokespeople to speak clearly and with confidence, stay on the topics you practiced and smile when appropriate. When possible, join the family for the interview to help respond to difficult questions about the program and jump in if the spokesperson is struggling for an answer or has veered off topic. Campaign Resources: Check out this Connecting Kids to Coverage Back-to-School Booster, or watch the recorded webinar “Using Media to Amplify Outreach and Enrollment Efforts” for tips on media outreach.

Campaign in Action – Health Care for All (MA)
Health Care for All in Massachusetts uses personal stories to generate media coverage and reach the diverse families in their community. After identifying and confirming the stories of Spanish- and Portuguese-speaking families, Health Care for All features them in language-specific newspapers or on radio shows. Health Care for All helps the families prepare to speak to the media and have their stories featured in written materials and on the news. Families may also attend public events to share their experiences with other eligible families. Campaign Resources: Check out our Outreach Video Library to learn more about how Health Care for All effectively reached out to ethnic media outlets and faith-based communities to execute a successful phone-a-thon.

Other Helpful Resources
Several organizations that have additional tools and helpful ideas on effective storybanking:

·         Community Catalyst has an online guide on storybanking, with resources, such as a sample discussion guide.
·         Families USA has a PDF guide that provides a step-by-step process for gathering stories. If your organization does in-person enrollments, you may also want to listen to Families USA’s May 14, 2014webinar specifically geared to help enrollment assisters start story banks.

Stay Connected With the National Campaign – In 3 Easy Steps
· Follow the Campaign on Facebook and Twitter. Don’t forget to re-tweet or share our messages with your network or use our #Enroll365 hashtag in your posts.
· Share our materials widely. We have more than 50 National Campaign resources available, including translated print materials, to use in outreach and enrollment efforts.
· Contact us to get more involved with the National Campaign at InsureKidsNow@fleishman.com or 1-855-313-KIDS (5437).

The post sing Personal Stories to Heighten Interest in Medicaid and CHIP Enrollment appeared first on Welcome to our Blog!.

Source: http://www.hhs.gov/news/press/2014pres/09/20140916a.html

The post New Affordable Care Act tools and payment models deliver $372 million in savings, improve care appeared first on Welcome to our Blog!.

Coalition provides tools and support to achieve continued decreases
The National Partnership to Improve Dementia Care, a public-private coalition, today established a new national goal of reducing the use of antipsychotic medications in long-stay nursing home residents by 25 percent by the end of 2015, and 30 percent by the end of 2016. The coalition includes the Centers for Medicare & Medicaid Services (CMS), consumers, advocacy organizations, providers and professional associations.
Between the end of 2011 and the end of 2013, the national prevalence of antipsychotic use in long-stay nursing home residents was reduced by 15.1 percent, decreasing from 23.8 percent to 20.2 percent nationwide. The National Partnership is now working with nursing homes to reduce that rate even further.
“We know that many of the diagnoses in nursing home residents do not merit antipsychotics but they were being used anyway,” said Patrick Conway, M.D., deputy administrator for innovation and quality and the CMS chief medical officer. “In partnership with key stakeholders, we have set ambitious goals to reduce use of antipsychotics because there are – for many people with dementia – behavioral and other approaches to provide this care more effectively and safely.”
Coalition members, including AMDA – The Society for Post-Acute and Long-Term Care Medicine, American Health Care Association (AHCA), LeadingAge and Advancing Excellence in America’s Nursing Homes, are committed to achieving these new goals. The groups set these goals because they are challenging, yet achievable with the continued hard work of many stakeholders. These goals build on the progress made to date and express the coalition’s commitment to continue this important effort. The National Partnership seeks to optimize the quality of life for residents in America’s nursing homes by improving care for all residents, especially those with dementia.
“We have created many tools for nursing homes to use to help achieve these goals,” said Dr. Conway. “Ultimately, nursing homes should re-think their approach to dementia care, re-connect with the person and their families, and use a comprehensive team-based approach to provide care.”
While the initial focus is on reducing the use of antipsychotic medications, the Partnership’s larger mission is to enhance the use of non-pharmacologic approaches and person-centered dementia care practices. CMS will monitor the reduction of antipsychotics as well as the possible consequences. For example, CMS will review prescriptions of anxiolytics and sedative/hypnotics to make sure nursing homes do not just replace antipsychotics with other drugs. In addition, CMS will review the cases of residents whose antipsychotics are withdrawn to make sure they don’t suffer an unnecessary decline in functional or cognitive status as a nursing home tries to reduce its usage.
Some states have achieved significant reduction in their rate of antipsychotic usage. For example, Georgia reduced its rate by 26.4 percent and North Carolina saw a 27.1 percent reduction. CMS released a fact sheet today with full state-by-state data as well as other data from the program.
CMS and its partners are committed to finding new ways to implement practices that enhance the quality of life for people with dementia, protect them from substandard care and promote goal-directed, person-centered care for every nursing home resident. The Partnership has engaged the nursing home industry across the country around reducing use of antipsychotic medications with momentum and success in this area that is expected to continue. In 2011, Medicare Part D spending on antipsychotic drugs totaled $7.6 billion, which was the second highest class of drugs, accounting for 8.4 percent of Part D spending.
In addition to posting a measure of each nursing home’s use of antipsychotic medications on the CMS Nursing Home Compare website, in the coming months CMS plans to add the antipsychotic measure to the calculations that CMS makes for each nursing home’s rating on the agency’s Five Star Quality Rating System.

Source: http://cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-09-19.html

The post National Partnership to Improve Dementia Care exceeds goal to reduce use of antipsychotic medications in nursing homes: CMS announces new goal appeared first on Welcome to our Blog!.

Seniors and people with disabilities will have continued access to a wide range of Medicare health and drug plans in 2015; CMS reports $12 billion in prescription drug savings
Today, the Centers for Medicare & Medicaid Services (CMS) announced that more people with Medicare will have access to higher quality Medicare Advantage (MA) plans, and for the fifth straight year, enrollment is projected to increase to a new all-time high, while premiums remain affordable.
The average MA premium submitted by health plans for 2015 would increase by $2.94 next year, to $33.90 per month. However, CMS estimates the actual 2015 MA average premium will increase by only $1.30, as more beneficiaries elect to enroll in lower cost plans. The vast majority of MA enrollees will face little or no premium increase for next year with 61 percent of beneficiaries not seeing any premium increase at all.
“Since the Affordable Care Act was enacted, enrollment in Medicare Advantage plans is now at an all-time high, and premiums have fallen,” said CMS Administrator Marilyn Tavenner. “Seniors and people with disabilities are benefiting from a transparent and competitive marketplace for Medicare health and drug plans.”
More MA plans will offer supplemental benefits that traditional Medicare beneficiaries value, such as dental and vision benefits. Access to the MA program remains strong, with 99 percent of beneficiaries having access to a plan. Between 2010 when the Affordable Care Act was enacted and 2015, enrollment in MA plans is expected to increase 42 percent and premiums will have decreased by 6 percent.

MA quality continues to improve as approximately 40 percent of MA contracts will receive four or more stars for 2015, an increase of around 6 percent from 2014. About 60 percent of MA enrollees are currently enrolled in plans with four or more stars for 2015, an increase of approximately 31 percent compared to the percentage in four or five star plans based on 2012 ratings. CMS calculates star ratings from 1 to 5 (with 5 being the best) based on quality and performance for Medicare health and drug plans to help beneficiaries, their families, and caregivers compare plans.
Earlier this year, CMS announced that the average estimated basic Medicare prescription drug plan premium in 2014 is projected to be $32 per month. Because of the Affordable Care Act, people with Medicare are seeing reduced costs through both savings on covered brand-name and generic drugs and having access to certain preventive services at no cost sharing. Since the passage of the Affordable Care Act, more than 8.3 million people with Medicare have saved over $12 billion on prescription drugs through July 2014, an average of $1,443 per beneficiary. The Affordable Care Act closes the “donut hole” over time. In addition, in 2014 through July, an estimated 18.6 million people with traditional Medicare took advantage of at least one preventive service with no cost sharing, and more than 2.6 million took advantage of the Annual Wellness Visit.
The Annual Open Enrollment period for Medicare health and drug plans begin on October 15, and ends December 7. Each year, plan costs and covered benefits can change. Medicare beneficiaries should look at their Medicare coverage choices and decide what options best meet their needs. Beneficiaries who need assistance can visitwww.medicare.gov, call 1-800-MEDICARE, or contact their State health Insurance Assistance Program (SHIP).
For more information on Medicare Open Enrollment and to compare benefits and prices of 2015 Medicare health and drug plans, please visit: http://www.cms.gov/Center/Special-Topic/Open-Enrollment-Center.html.
For state-by-state information on discounts in the donut hole, please visit: http://downloads.cms.gov/files/Summary-Chart_2010-July-2014.pdf.
For state-by-state information on utilization of preventive services at no cost sharing to beneficiaries in Medicare, please visit: http://downloads.cms.gov/files/State-Level-Preventive-Services_YTD-2014_July-2014.pdf.

source: http://cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-09-18.html?DLPage=1&DLSort=0&DLSortDir=descending

The post Medicare Advantage enrollment at all-time high; premiums remain affordable appeared first on Welcome to our Blog!.

The post Health care law saves consumers money, provides more resources to states appeared first on Welcome to our Blog!.

Of 966,000 individuals with citizenship or immigration data matching issues as of May 30th, 851,000 are now closed or in progress, a reduction of 88 percent
Of 1.2 million households with income data matching issues as of May 30th, 897,000 households are now closed or in progress; consumers will be getting letters this week asking for information
The Centers for Medicare & Medicaid Services (CMS) is committed to assisting consumers and protecting taxpayers by helping to ensure those who are enrolled in Marketplace coverage meet the eligibility requirements. As CMS prepares for the next Marketplace open enrollment period beginning on November 15, it is resolving data matching issues that occurred during the first year so that its records are accurate before the renewal process begins, and so that consumers have the information they need about their coverage. Throughout this process CMS has worked to maintain coverage for those who have sought it in the Marketplace, while meeting its obligation to the taxpayer to spend its dollars wisely.
Today, the Federal Health Insurance Marketplace (Federal Marketplace) began sending notices to consumers who have an income-related data matching issue. Individuals who do not respond to numerous previous attempts to contact them by September 30, 2014 may see the costs of their coverage change. For instance, this may impact the cost of their monthly premium, deductibles, copays, and co-insurance, and even their tax bill or refund during filing season.
“The Affordable Care Act is working for millions of Americans who are able to access quality health coverage at a price they can afford. In fact, most individuals who selected a plan with tax credit in the Federal Marketplace are paying less than $100 a month in premiums,” said CMS Administrator Marilyn Tavenner. “We are committed to keeping coverage affordable for the millions of Americans who depend on it, and to doing so in an efficient, transparent way that protects taxpayers. It’s critically important that consumers who still owe income-related documents to the Marketplace send them in by September 30 so we can continue to hold down their costs. We are pleased that the number of individuals who were at risk of losing their Marketplace coverage, or seeing changes in their costs because of data matching issues has been dramatically reduced in the last three months.”
Consumers often have more up-to-date information than what’s in CMS data sources. For example, the Marketplace verified income by checking 2012 tax return information, but a consumer could have switched jobs since those returns were filed. Just because CMS is double-checking data and requesting more documentation, doesn’t mean that a consumer has provided false information or that he or she is ineligible for help paying for coverage or health services – it simply means that the information on their application doesn’t match what’s in trusted data sources and therefore has to be verified.
On May 30, there were roughly 1.2 million households with income-related data-matching issues. This represents about 1.6 million people. We’ve made significant progress since then based on an extensive outreach campaign and enhanced operational effectiveness. As of September 14, approximately 467,000 household income data-matching issues have been closed and an additional 430,000 are currently in the process of being resolved. There are still about 279,000 households with unresolved income-related data-matching issues that haven’t sent in supporting information, representing 363,000 individuals. CMS will send letters starting today to individuals who, if they do not send in supporting documents by September 30, may see their costs change.
Income-related data matching notices are being sent in English and Spanish and will provide straightforward instructions on how consumers should submit the necessary information to the Marketplace to help keep their costs down. Those individuals receiving a letter referencing September 30 should log into their HealthCare.gov account and select their current application to upload their documents. They can also mail their information to our consumer center. To facilitate timely processing, consumers mailing in a copy of their documents should include the bar code page from the notice with their documents. Consumers may also contact our call center at 1-800-318-2596 to see what documents they need to submit and check whether the Federal Marketplace has received their information.
A network of partners, local assistors and other stakeholders including community health centers are actively communicating and engaging consumers to help them keep their health insurance and eligibility for financial assistance. Consumers may contact one of our partners in their community to get one-on-one help. To find one of these local partners, visit Find Local Help on HealthCare.gov.
Today, CMS is also providing an update on individuals with citizenship and immigration data matching issues. In August, we sent letters to about 310,000 Federal Marketplace consumers who had not submitted any outstanding citizenship or immigration documents after numerous requests. We’ve made progress in resolving these cases. We received hundreds of thousands of documents in response to the September 5th deadline resulting in a decrease from 966,000 as of the end of May to 115,000 as of September 14. To date, 115,000 individuals with citizenship and immigration data matching issues have not responded to our numerous contacts and will be receiving notices saying their last day of Federal Marketplace coverage is September 30, 2014. Those who submit information that confirms their eligibility after the deadline may be eligible for a special enrollment period to enroll in coverage.
For more helpful tips and the steps these consumers need to take,

Source: https://www.healthcare.gov/blog

http://cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-09-15.html

The post CMS update on consumers who have data matching issues appeared first on Welcome to our Blog!.

By: Marisa Torrieri

– Source: http://www.physicianspractice.com/medical-billing-collections/top-healthcare-technology-tools-and-trends-2013#sthash.sJ2I6IyL.dpuf

The post Top Healthcare Technology Tools and Trends of 2013 appeared first on Welcome to our Blog!.