Editor's Note The Centers for Medicare & Medicaid Services (CMS), on December 30, 2015, published a final rule that establishes a prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies to help reduce unnecessary and fraudulent claims. Under the final rule, the same information necessary to submit…

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Editor's Note The Centers for Medicare & Medicaid Services (CMS) on December 16 announced that ambulatory surgery centers (ASCs) subject to a reduction in Medicare outpatient payments in CY 2016 because of noncompliance with the ASC quality reporting program may submit a request for reconsideration by March 17, 2016. Eligible…

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Editor's Note A Bill in Congress would enable ambulatory surgery center (ASC) physicians to receive the same payment incentives for meaningful use (MU) of electronic health records (EHRs) as physicians in other settings, according to the December 15 Healthcare IT News. Currently, physicians practicing in ASCs are excluded. The Electronic…

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Editor's Note The Centers for Medicare & Medicaid Services on December 9 announced that 758 hospitals will have a 1% reduction in Medicare payments for missing targets for hospital-acquired conditions. More than half (54%) of the hospitals were also penalized last year. Penalties are expected to total $364 million. Among…

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Editor's Note A survey of 298 attendees at a November 9 KPMG webinar on the transition to ICD-10 gleaned the following responses: 28% said the transition had been smooth 51% found “a few technical issues but overall successful” 11% described the transition as a “failure to operate in an ICD-10…

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Editor's Note The Centers for Medicare & Medicaid Services (CMS) on December 1 published a notice with comment period on the basis for cutting inpatient hospital payments by 0.2% in accordance with its “two-midnight” rule. The notice comes in response to an October 6 court ruling that challenged the payment…

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Editor's Note The Centers for Medicare and Medicaid Services (CMS) reports that it will reprocess ICD-10 claims with National Coverage Determination and Local Coverage Determination errors automatically and at no cost to providers. CMS is also waiting to reprocess some claims with errors resulting from Local Coverage Determinations until Medicare…

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Editor's Note The US Department of Health & Human Services Office of the Inspector General (OIG) released its 2016 Work Plan announcing new initiatives for ambulatory surgery centers (ASCs), the ASCA News Digest reports. The initiatives include: Review the appropriateness of Medicare’s methodology for setting ASC payment rates. Revitalize outdated…

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Editor's Note In a survey by Himagine Solutions, large hospitals reported a 30% to 45% reduction in productivity for inpatients and a 20% to 40% reduction for outpatients since implementation of the ICD-10 codes, Healthcare Informatics reports. Though loss in productivity can mean a disruption to the revenue cycle, one…

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Three new studies on reducing surgical site infections (SSIs) were reported at the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) conference in July. Researchers at three different institutions identified several process changes that, once implemented, brought down SSI rates. Each study used different methodology, but all…

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