CMS proposes major initiative for total joints
Editor's Note The Centers for Medicare & Medicaid Services is planning to require more than 800 hospitals in 75 geographic areas to participate in a bundled payments initiative for hip and knee replacements. These procedures are among the most common that Medicare beneficiaries receive, and prices vary significantly across geographic…
CMS releases CY 2016 proposed physician payment rule
Editor's Note The Centers for Medicare & Medicaid Services on July 8 released its proposed rule for the physician fee schedule for CY 2016. Physicians will have a 0.5% overall increase in Medicare reimbursement under the rule, which will be finalized this fall. The rule also calls for reimbursement for…
CMS, AMA announce efforts to help with transition to ICD-10
Editor's Note In less than 3 months, healthcare providers will switch from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures. To help providers get ready for the October 1 deadline, the Centers for Medicare & Medicaid Services is releasing additional guidance that will allow for flexibility in…
Aetna to buy Humana for $37 Billion
Editor's Note Aetna Inc has agreed to buy rival health insurer Humana Inc for $37 billion in cash and stock, creating the second-largest provider of health insurance in the US. The Affordable Care Act has spurred mergers by introducing rules that push insurers to look for savings. Humana’s 3.2 million Medicare…
New ACS Interactive Web Tool Helps Surgeons Avoid Medicare Penalties
Editor's Note The American College of Surgeons has launched a new web tool to help surgeons navigate and succeed in Medicare’s mandatory quality programs: Physician Quality Reporting System, Electronic Health Record-Meaningful Use, and Value-Based Modifier. Surgeons who do not successfully participate in these programs in 2015 could face up to…
CMS Proposes Changes to the 'Two-Midnight' Rule
Editor's Note On July 1, the Centers for Medicare & Medicaid Services released proposed updates to the “Two-Midnight” rule regarding when inpatient admissions are appropriate for payment under Medicare Part A. The proposed update allows physicians to use their judgment to admit patients for short hospital stays on a case-by-case…
Potential rewards justify efforts to create bundled payment programs
Physician alignment is a key element of current hospital strategy. Last month, we looked at how hospital ORs can use co-management agreements to build strong collaboration with surgeons. Payment reform has created an even more sophisticated option—participation in a bundled payment program. Bundled payment initiatives are more complex than most…
Prepare now for more stringent joint replacement documentation requirements
Medicare administrative contractors (MACs) in several states recently ratcheted up their documentation requirements for joint replacement surgery and other orthopedic procedures. For hospital ORs, these changes represent the tip of an iceberg that calls for careful navigation. Enhanced medical necessity documentation requirements were launched in Florida in 2011. The state’s…
Anticipate & educate to navigate murky healthcare reform waters
Anxiety over changes in healthcare delivery and payment systems has permeated hospitals and ambulatory surgery centers (ASCs). Administrators are concerned about how the Affordable Care Act (ACA) and other initiatives will hit the organization’s bottom line. Increasingly, perioperative services leaders are being drawn into discussions in these areas. “The OR…
New quality measures, tight deadline mark CMS payment rule for ASCs
It sounds like déjà vu all over again, as Yogi Berra used to say. That is likely to be the first reaction of many ambulatory surgery center (ASC) administrators to the Calendar Year 2014 Ambulatory Surgical Center Payment Proposed Rule. Pay formula unchanged Medicare payment updates would continue at…
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