Medical Business Journal - Volume 2, Issue 2, January 2011

Medical Business Journal Letter from the Editor I S S U E 2 , V O L U M E 2 , F E B R U R A R Y 2 0 11

3 4 5 6 8 9 10 11 2

HEALTH CARE EMPLOYMENT RATE EHR INCENTIVE REGISTRATION OPEN

WAIVED COPAY AND DEDUCTIBLE FOR CERTAIN PREVENTATIVE SERVICES CHART SURVEYS SHOWS INCREASED EHR ADOPTION

PERMANENT EHR CERTIFICATION PROGRAM IMPLEMENTED

OUT WITH THE OLD IN WITH THE NEW 2010 - 2011

Dear Readers,

It is my pleasure to welcome you to the new format of the Medical Business Journal (MBJ). The MBJ is distributed to over 50,000 professionals in the community of educators and students dedicated to the business of medicine. This is going to be an exciting year for the MBJ! Many innovative approaches to meeting our commitment to the development, improvement, and advancement of medical business through education and communication are on the horizon. The healthcare delivery system has changed dramatically over the last few years, and the future inevitably holds many more changes. In order to survive, providers must depend upon dedicated professionals to run their practices and facilities. In other words, they depend upon you! It is our mission to provide information from highly qualified medical business professionals so you can depend on us and the community. Likewise, it is our goal to become a vehicle for you to advertise your practice and/or services to other medical business professionals. For advertising options, please contact MMI at MBJ@ mmiclasses.com In addition to providing you with the tools and references for success, I would also like to encourage you to contact the MBJ with any suggestions you may have that will continue to fulfill the needs of our professional community. Please feel free to contact me directly at any time. Trust, I will be receptive to any ideas you may have about strengthening our community! For information about being published in the Medical Business Journal, please contact me freely as well. Thank you for reading. Sincerely, Jennifer Donovan, RMC, CPC, RMM Managing Editor, Medical Business Journal

SLEEP TO DREAM MONITOR SLEEP TO GET PAID Medical Business Journal Issue 2, Volume 2, Februrary 2011

2011 CPT SLEEP CODES

CMS PROPOSES NEW QUALITY CARE INCENTIVES CLINICAL PROCESS OF CARE MEASURES

2011 CONVERSION FACTOR PULMONARY REHABILITATION EHR LEGACY CERTIFICATION PROGRAM UNDERWAY

Medical Business Journal - February 2011

Managing Editor Assistant Editor Contributors Layout and Design Production

Jennifer Donovan, RMC, CPC, RMM Christopher Myers Christopher Myers Jennifer Donovan, RMC, CPC, RMM Chris Rottmann Clockwork Graphics

The Medical Business Journal is a monthly source of up to date information on all issues affecting the healthcare industry. Its content ranges from medical coding and billing to healthcare reform legislature and beyond. The MBJ is not affiliated in any way with the Department of Health and Human Services, Medicare, or the Centers for Medicare and Medicaid Services. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting or other professional services, and is not a substitute for individualized expert assistance. The CPT codes, descriptors, and modifiers are copyrighted by the American Medical Association. The MBJ is sponsored by the Medical Management Institute. For more information, please call MMI at: (866) 892-2765

Health Care Employment Rate RELATIVELY STABLE IN A SHAKY ECONOMY

J Code Assigned to XIAFLEX® Effective January 1, 2011

Healthcare was one of the few industries to expand its workforce in December, according the Bureau of Labor Statistics. Ambulatory services saw 21,000 new jobs, hospitals 8,000 and nursing, and residential care facilities 7,000. An AAPC survey showed that unemployment rates of credentialed coders were also lower than the national average of 9.6 percent. Only 6.8 of coders with CPC and 5.6 of coders with CPC-I certification reported being unemployed within the past 12 months. Additionally, the survey showed that the average salary of certified coders rose this past year to $45,404, from $44,740. CPC-I credentialed coders had the highest average salary, at $50,543.

EHR Incentive Registration Open

Beginning January 1, 2011, use

FIRST PAYMENTS EXPECTED IN MAY

J code J0775

As of Jan. 3, registration for the Medicare Electronic Health Record (EHR) Incentive Program is open. Additionally, Alaska, Iowa, Kentucky, Louisiana,

for XIAFLEX

Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee, and Texas have opened up their Medicaid EHR incentive programs. Eligible physicians and hospitals are encouraged to register as soon as they are ready so they can start seeing returns on their EHR investment. Eligible professionals may apply to either the Medicare or the Medicaid programs, but not both. However, after payment for the first year is received they are able to switch one time. Eligible Hospitals may apply to both. Attestation for the program begins in April, so if you register today you

• XIAFLEX Xperience™ Program provides support throughout the billing process

• Speak to a live reimbursement specialist at 1-877-XIAFLEX (1-877-942-3539) or visit XIAFLEX.com for more information

won’t have to immediately start recording EHR data. A step-by-step walkthrough of the registration process is available at: www.cms.gov/ehrincentiveprograms The Medical Management Institute held a class on receiving EHR incentives Wednesday, Jan. 12. Our next one is scheduled for March 30, so be sure to

1210-009.a

register in order to learn how to earn maximum incentive payments. www.mbjonline.com - Medical Business Journal

3

Table of Preventative Services Codes, Co-Pays and Deductibles

WAIVED COPAY AND DEDUCTIBLE FOR CERTAIN PREVENTATIVE SERVICES CHART Service Initial Preventative Physical Examination (IPPE) Abdominal Aortic Aneurysm (AAA) Cardiovascular disease screen Diabetes screening tests Diabetes selfmanagement training services (DSMT

Medical nutrition therapy (MNT) services

Screening pap test

Screening pelvic exam Screening mammography

Code Description G0402 IPPE, first 12 mos Electrocardiogram, performed G0403 with IPPE ECG, tracing only w/o interpretation and report; with G0404 IPPE ECG, interpretation and report G0405 only; with IPPE Ultrasound, B-scan and/or real G0389 time with image 80061 Lipid panel 82465 Cholesterol 83718 Lipoprotein 84478 Triglycerides 82947 Glucose, quantitiave blood 82950 Glucose, post glucose dose 82951 Glucose, tolerance test

CoPay Waived

Deductible Waived

Not waived

Waived Waived Waived Waived Waived Waived Waived Waived

G0108 DSMT, individual per 30 mins

Not waived

G0109 DSMT, group session, 30 mins MNT, iniital assessment, ea. 15 97802 mins 97803 MNT, re-assessment, 15 mins 97804 MNT, group, 30 mins MNT, subsequent intervention, G0270 individual MNT, subsequent intervention, G0271 group Screen cervical or vaginal, thin G0123 layer G0124 Screen c/v layer by MD Sreen c/v, automated system and G0141 MD G0143 Screen c/v, thing layer, rescreen G0144 Screen c/v thin layer, resreen G0145 Screen c/v thin layer, rescreen G0147 Screen c/v, automated system Screen c/v, automated system, G0148 rescreen Screen pap by tech with MD P3000 supervision

Not waived

Waived Waived Waived

Waived

Waived Waived

Waived Waived Waived Waived Waived

Waived

P3001 Screening pap smear by physician Q0091 Obtaining screen pap smear Cervical or vaginal screen, G0101 pelvic/breast exam Comp screen mammogram add77052 on 77057 Mammogram screening G0202 Screening mammography, digital G0130 Single energy X-ray study 77078 CT bone density measure

Waived Waived

Waived

Waived Waived Waived Waived Waived

Bone mass measurement

Surveys Shows Increased EHR Adoption

Service

Code Description G0402 IPPE, first 12 mos Electrocardiogram, performed G0403 with IPPE ECG, tracing only w/o interpretation and report; with G0404 IPPE ECG, interpretation and report G0405 only; with IPPE Ultrasound, B-scan and/or real G0389 time with image 80061 Lipid panel 82465 Cholesterol 83718 Lipoprotein 84478 Triglycerides 82947 Glucose, quantitiave blood 82950 Glucose, post glucose dose 82951 Glucose, tolerance test

Initial Preventative Physical Examination (IPPE) Abdominal Aortic Aneurysm (AAA) Cardiovascular disease screen Diabetes screening tests Diabetes selfmanagement training services (DSMT

Medical nutrition therapy (MNT) services

Screening pap test

Screening pelvic exam Screening mammography

CoPay Waived

Deductible Waived

Not waived

Waived Waived Waived Waived Waived Waived Waived Waived

G0108 DSMT, individual per 30 mins

Not waived

G0109 DSMT, group session, 30 mins MNT, iniital assessment, ea. 15 97802 mins 97803 MNT, re-assessment, 15 mins 97804 MNT, group, 30 mins MNT, subsequent intervention, G0270 individual MNT, subsequent intervention, G0271 group Screen cervical or vaginal, thin G0123 layer G0124 Screen c/v layer by MD Sreen c/v, automated system and G0141 MD G0143 Screen c/v, thing layer, rescreen G0144 Screen c/v thin layer, resreen G0145 Screen c/v thin layer, rescreen G0147 Screen c/v, automated system Screen c/v, automated system, G0148 rescreen Screen pap by tech with MD P3000 supervision

Not waived

Waived Waived Waived

Waived

Waived Waived

Waived Waived Waived Waived Waived

Waived

P3001 Screening pap smear by physician Q0091 Obtaining screen pap smear Cervical or vaginal screen, G0101 pelvic/breast exam Comp screen mammogram add77052 on 77057 Mammogram screening G0202 Screening mammography, digital G0130 Single energy X-ray study 77078 CT bone density measure

Waived Waived

Waived

Waived Waived Waived Waived Waived

Bone mass measurement

NEED 12 CEUs?

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Medical Business Journal - February 2011

Permanent EHR Certification Program Implemented ONC NOW ACCEPTING APPLICATIONS Replacing the temporary Electronic Health Record (EHR) certification program, the Office of the National Coordinator (ONC) has established a permanent certification program. The program is scheduled to create permanent certification bodies to replace the temporary ones by the beginning of 2012, according to the final rule. These ONC-Authorized Certification Bodies (ONC-ACB) will have the option of certifying Complete EHRs, Modular EHRs, (potentially) other HIT products, or any combination thereof. They will have to renew their certification every three years. ONC is taking a tiered approach to the structure of certification. First ONC will name an ONC- Approved Accreditor (ONC-AA) which will approve ONC-ACBs (ONC estimates six at a time). The ONC-AA will also have to renew its certification every three years. Once approved by the ONC-AA, ONC-ACBs can then submit an application to ONC. EHR testing facilities must be separately certified by the National Voluntary Laboratory Accreditation Program (NVLAP), as administered by the National Institute of Standards and Technology (NIST). Organizations seeking ONC-ACB status may also perform testing if they acquire this separate certification, or they can test EHR products through a certified third party. The ONC-ACBs will be required to submit to ONC a weekly update on any EHR product they have approved. These updates will translate into a “Certified HIT Products List (CHPL) that will be made publicly available on ONC’s website.” The ONC-ACBs will have to attend mandatory ONC training programs. They will also be required to conduct internal surveillance on the EHRs they certify, which will be reviewed by ONC. In the event that an ONC-ACB loses its certification due to violations, the EHRs it has certified will be inspected to see if they were certified in error. If that is the case, then the EHR will have to be completely recertified. EHRs certified under the temporary certification program will be able to be recertified in a “gap-certification” process. In other words, only the updates in certification criteria will be required to be analyzed. Gap certification has been defined in the final rule to mean “…the certification of a previously certified Complete EHR or EHR Module to: (1) all applicable new and/or revised certification criteria adopted by the Secretary at subpart C of this part based on the test results of a NVLAP-accredited testing laboratory; and (2) all other applicable certification criteria adopted by the Secretary at subpart C of this part based on the test results used previously to certify the Complete EHR or EHR Module.” EHR Modules presented in a bundle will be considered as a complete EHR if they can meet criterion as such. Each individual Module, in this case, will not have to meet all criterion (for example, security) if the entire bundle meets the definition of a complete EHR. For example, Modules A, B, C, and D are bundled together, but all their security software is located on C. In this case, the bundle can still be approved, even though A, B, and D would not meet the criterion for certified EHR Modules. A pdf version of the full final rule, as well as other ONC resources, is available at: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov_certification_program/2884 www.mbjonline.com - Medical Business Journal

5

A look at where

pneumococal conjugate, 13 valent, see 90670 or the 7 valent, see 90669.

took us...

DSM-V A DSM-V draft was released in

DELAYED MEDICARE CUTS

PROSTATE CANCER SCREENING

We were threatened all year with

The advent of better tests can in

2-month review and is estimated

these cuts and fought back, with

some cases, save lives with early

for release this year. The DSM is

Congress on our side, to cause

treatment. Tests can pick up benign

a publication used by the majority

several delays in 2010. These pay

diseases in addition to cancer, but

of mental health specialists in the

cuts are triggered by the Sustainable

can’t distinguish between aggressive

US. Published by the American

Growth Rate (SGR) and the results

and mild forms. Some cases of

Psychiatric Association (authored

would force doctors to stop seeing

prostate specific antigen (PSA)

by its members), it provides

Medicare patients or completely

have led to expensive and massive

information from the rarest to most

drop out of the Medicare program

treatments in patients who may

common mental health disorders as

altogether. If this occurs, it could

never experience symptoms. ACS

well as standardizes both diagnostic

debilitate the entire system. The

encourages providers to spend

and treatment of such problems.

latest motion has been set to delay

the extra time to consult patients

The current version, DSM-IV was

the pay cut through 2011. This

regardless of billing difficulties.

released in 1994 and reflects studies

delay will keep the 25% cut in

To report screening of the second

up until 1992. DSM-IV-TR, was

Medicare Physician Reimbursement

leading cause of cancer-related

published in 2000. The work on the

rate and give the physician

deaths in men (approx. 62% being

DSM-V is in the process of being

community time to work with

65 or older), use CPT 88305. For

completely re-written to reflect

Congress on a permanent solution.

Medicare patients, report with

the clinical and scientific advances

G0102 and G0103

made over the last 17 years.

In short, the ACA subsidizes health

MAMMOGRAMS

care cost for those who can’t afford

ACS and the Society of Breast

MEDICARE PART D AND THE DONUT HOLE

it, penalizing those who refuse

Imaging contradicted the 2009

to purchase it and limit cases for

recommendation from U.S.

insurance companies to deny

Preventative Services Task Force

coverage. On the provider side,

(USPSTF) calling an end to the

this act boosts pay for primary

routine mammogram for women

care providers (PCP), encourages

under 50. More on coding for

compensation based on quality

mammograms in next months issue

AFFORDABLE CARE ACT

care and bars co-pays for most preventative services. Lawsuits continue about individual mandate to buy health insurance and will likely end up before Supreme Court.

UPDATED PNEUMOCOCCAL VACCINE Updated Pneumococcal Vaccine guidelines state 23-valent vaccines in adult persons 19-64 with chronic

* Stay tuned for more on this in the

or immunosuppressive medical

March issue of MBJ.

conditions including asthma should get vaccinated. To report this, see CPT code 90732. To report the

6

Medical Business Journal - February 2011

February 2010. It underwent a

The Donut Hole is the gap in coverage that beneficiaries may find themselves in after they reach their deductible and before catastrophic coverage kicks in. The Donut Hole was $3,610 in 2010 and is expected to reach $6,000 by 2020. Beneficiaries who reach the doughnut hole are give $250 plus up to 50% off their prescriptions to help alleviate the burden until their coverage reachs “catastrophic” status.

2010 FDA RECALLS & WARNINGS The following is a list of drugs the

FDA recalled and the reasons for the decision. Propoxyphene, (aka. Darvon, Darvocet) by Xanodyne Pharma and generic manufacturers were instructed by the FDA to remove the product from the market due to potentially serious or fatal hearth rhythm abnormalities established with patient use. This drug was formally reported with G0430. Calcium boosts heart attack risk. Calcium without Vitamin D may increase heart attacks by 30%. Suggested for osteoporosis it showed relatively small benefits. Recommendations to eat calcium rich foods as opposed to supplements are the best alternative. Quinine, prescribed for leg cramps, may result in serious to life threatening hematologic adverse effects. The FDA warned manufacturers and distributors of the associated risk of myopathy including Rhabdomylosis, opioid tramadol which is linked to increased suicide risk, bisphosphonates used to treat osteoporosis possibilities include risk of atypical femur fracture; rosiglitazone remained available under stringent restricted access despite adverse cardiovascular effects and triglycine linked to include death in patients with certain severe infection. Obesity drug Sibutramine was removed from the market in October. The drug was related to an increase in stroke and myocardial infarction risk. Over 100,000 people in the US were prescribed this drug.

... and where we go from here in 2011 THE YEAR OF INCENTIVES & PENALTIES 2011 brings many opportunities to earn bonuses to help offset the cost of transforming your practice’s information technology systems to, reduce care costs and improve outcomes. There is, of course, the EHR bonus of up to $18,000 [depending on your Medicare charges] when you attest to meaningful use of a certified EHR system. Registration for this

your participation in the EHR program begins.

KEY BILLING AND PAYMENT CHANGES FOR 2011: THE ANNUAL WELLNESS VISIT Providers can start the AWV services detailed in the 2011 MPFS by meeting the requirements to report and earn up to $172 per patient. To report the first AWV service, use G0438 for subsequent, G0439.

WAIVED COPAY AND DEDUCTIBLE FOR CERTAIN PREVENTATIVE SERVICES longer collectible for specific

providing the following shots, use

preventative services.

the coinciding codes:

See chart on page 4.

MULTIPLE PROCEDURE PAYMENTS REDUCTION (MPPR) ON THERAPY SERVICES CMS states a reduction of 25%

administration. They have been

outpatient therapy services by 20%.

replaced with 90460 and 90461 to

SELF-REFERRAL LIST

bonus. There is opportunity to

of $155. In 2011, Medicare Part

advanced imaging services when

earn more money in the following 4

B beneficiaries are responsible for

you offer to provide an advanced

years when your practice continues

$162.

imaging service in your office.

PRIMARY CARE BONUS

COUNSELING AND TOBACCO CESSATION

e-prescribe in 2011 could reduce

of your Medicare allowable charges

your Medicare reimbursement in

to come from office visits. Bonuses

future years. Eligible professionals

for this program are paid quarterly.

(EPs) are to report G8553 at least

Eligibility is determined by CMS

10 times by June to avoid Medicare

based on your 2009 claims.

Providers must now give patients

and 1.5% in 2013. Those who do not

GENERAL SURGERY BONUS

implement an EHR by 2015 will be

CMS is also offering 10% quarterly

One or two G-codes can be reported when you provide tobacco cessation counseling to a patient who doesn’t suffer from a tobaccorelated disease. Remember, the codes are G0436 for 3 to 10 minutes of counseling; and G0437 for more than 10 minutes. CMS instructs the use of ICD-9 code 305.1 (tobacco use disorder) and V15.82 (history of tobacco use) when reporting this

penalized in the same manner.

bonus payments to general surgeons

service.

payment reduction by 1% in 2012

practicing in health professional Remember, EPs cannot participate

shortage areas (HPSA).

vaccine.

expense component for multiple

(within a 25-mile radius) for

requires providers have at least 60%

Q2039 not otherwise specified flu

also been deleted for the vaccine

by 4.5% over the 2010 deductible

EPs Medicare charges. Eligibility

Q2038 Fluzone or

payments will reduce the practice

must attest for 90 days to earn the

reimbursements as well. Failure to

Q2037 Fluvirin

CPT codes 90465-90468 have

attestation begins this April. You

play a big factor in your future

Q2036 Flulval

in institutional settings. These

a list of five alternative suppliers

This bonus is worth 10% of an

Q2035 Afluria

for therapy services provided

The Part B deductible increased

Conversely, there are penalties that

up) is no longer billable to Medicare as of January 1, 2011. When

DEDUCTIBLE

to utilize the system.

CPT 90658 (flu vaccine, 3 years and

Copays and deductibles are no

program began on January 3 and rd

NEW Q-CODES FOR FLU SHOTS

allow separate reporting of multiple vaccine/toxoid components for pediatric patients (18 and under).

EXPANSION OF TELEHEALTH G0420 and G0421 are not reportable with a telehealth system, for individual and group diabetes self-management training. Use 96153 and 96154 for health and behavior assessment and intervention and 99231-99233 for subsequent hospital service, which may only be billed every three days by the patient’s admitting provider (AI).

PAYMENT FOR CERTIFIED NURSE MIDWIVES Services provided by these CNM will be paid at 100% of the fee schedule rate (same as physicians).

TIMELY CLAIMS

in these two particular two

As of March 2010, Medicare

programs simultaneously. If you are

requires claims to be submitted

already in the e-prescribe program,

within 12 months of the date-of-

you must wait until it is over before

service, effective January 1, 2010.

Previously, midwives were paid 65% only.

www.mbjonline.com - Medical Business Journal

7

SLEEP TO DREAM

MONITOR SLEEP TO GET PAID From 2011 and beyond, sleep codes may see some restlessness. Four major forces became effective January 1, 2011. Each new code (presumably) includes the recording of heart rate and oxygen saturation and respiratory analysis, by airflow or peripheral arterial tone. CPT codes 95808, 95807, 95810 and 95811 were all cut 20-25%. Cuts were also seen across the board for interpretation only codes (those reported with modifier 26). CMS rebased the practice expense (PE) data, which resulted in the PE component to increase the malpractice component. In many cases, the PE increase will offset the loss of physician work. The PE increase is temporary for the next 4 years as CMS transitions to a new system for collecting and reimbursing the PE codes that will likely impact the CPT system. The PE component for sleep codes saw a reduction of 7-20% where the largest PE values saw the greatest reduction. So in short, you will see TC codes go up, and 26 codes go down (see chart).

WHAT ABOUT THE CHANGES IN PHYSICIAN WORK? Lets start with a brief background. CPT code 95810 was created in 1994 and 95811 in 1998. First, created to reflect the intensity and time required to conduct as polysomnograph, equipment, staff time and supplies for service were evaluated in 2002. CMS is required to review RVUs of procedures based on the Resource Based Relative Value Scale (RBRVS - used by Medicare and other insurance companies). Since, many advances have taken place, polysomnographs can now be conducted with less provider time, less sleep, and less lab technician time, PE costs were lowered. CMS was aware and after, established reimbursement for unattended studies in home and initiated steps to review and adjust reimbursement for facility-based polys. These cuts are said to be painful and accurate as they reflect the time and cost it currently associates with providing these specific procedures. On the bright side, the addition of unattended home sleep studies (95800-95801) were introduced from their former position as Category III codes 0203T and 0203T. Revisions were also introduced for 95806. Specifically, the reduction in facility-based polys services may be offset by the expected growth of unattended sleep studies. Facility-based studies still play a role in the diagnosis of atypical and challenging patients suspected with sleep related disorders. 8

Medical Business Journal - February 2011

2011 CPT SLEEP CODES 2011 CPT Sleep Codes 2011 CPT Sleep Codes

CPT Code CPT Code 95800 95800 95800-TC 95800-TC 95800-26 95800-26 95801 95801 95801-TC 95801-TC 95801-26 95801-26 95803 95803 95803-TC 95803-TC 95803-26 95803-26 95805 95805 95805-TC 95805-TC 95805-26 95805-26 95806 95806 95806-TC 95806-TC 95806-26 95806-26 95807 95807 95807-TC 95807-TC 95807-26 95807-26 95808 95808 95808-TC 95808-TC 95808-26 95808-26 95810 95810 95810-TC 95810-TC 95810-26 95810-26 95811 95811 95811-TC 95811-TC 95811-26 95811-26

Desriptor Sleep studyDesriptor unattended Sleep study unattended Sleep study unattended Sleep study unattended w/ anal Sleep study unattended w/ anal Sleep study unattended w/ anal Sleep studytesting unattended w/ anal Actigraphy Actigraphy testing Actigraphy testing Actigraphy testing Mulitple sleep latency test Mulitple sleep latency test Multiple Multiple sleep latency test Mulitple Mulitple sleepunattened latency test Sleep Study & resp Sleep Study unattened & resp effort effort Study unattened & resp Sleep Sleep Study unattened & resp effort effort Study unattened & resp Sleep Sleep Study unattened & resp effort effort study attended Sleep Sleep study attended Sleep study attended Sleep study attended Polysomn 1-3 channels Polysomn 1-3 channels Polysomn 1-3 channels Polysomn 1-3 channels Polysomnograph 4 or more Polysomnograph 4 or more Polysomnograph 4 or more 4 or more Polysomnograph w/cpap Polysomnograph w/cpap Polysomnograph w/cpap Polysomnograph w/cpap

2010 2010 Payment Payment NA

2011 2011 Payemnt Payemnt pending

Monetary Monetary Differnce Differnce NA

NA NA NA NA NA NA $120.57 $120.57 $70.43 $70.43 $50.15 $50.15 $395.65 $395.65 $302.73 $302.73 $92.92 $92.92 $204.28 $204.28 $122.05 $122.05 $82.23 $82.23 $479.35 $479.35 $397.86 $397.86 $81.49 $81.49 $668.87 $668.87 $537.98 $537.98 $130.90 $130.90 $769.17 $769.17 $596.60 $596.60 $172.57 $172.57 $848.08 $848.08 $662.97 $662.97 $185.10 $185.10

pending pending pending pending pending pending $176.25 $176.25 $125.74 $125.74 $50.52 $50.52 $446.90 $446.90 $379.79 $379.79 $67.11 $67.11 $198.38 $198.38 $130.16 $130.16 $68.21 $68.21 $511.80 $511.80 $443.21 $443.21 $68.58 $68.58 $707.59 $707.59 $609.88 $609.88 $97.71 $97.71 $756.26 $756.26 $619.83 $619.83 $136.43 $136.43 $816.00 $816.00 $673.67 $673.67 $142.33 $142.33

NA NA NA NA NA NA $55.68 $55.68 $55.31 $55.31 $0.37 $0.37 $51.25 $51.25 $77.06 $77.06 ($25.81) ($25.81) ($5.90) ($5.90) $8.11 $8.11 ($14.02) ($14.02) $32.45 $32.45 $45.35 $45.35 ($12.91) ($12.91) $38.72 $38.72 $71.90 $71.90 ($33.19) ($33.19) ($12.91) ($12.91) $23.23 $23.23 ($36.14) ($36.14) ($32.08) ($32.08) $10.70 $10.70 ($42.77) ($42.77)

* Note all payment rates consider 2010 Medicare conversion factor as $36.8729 and are all * Note allpayments payment without rates consider 2010 Medicare conversion factor as $36.8729 and are all national reflection of geographic differences national payments without reflection of geographic differences

www.mbjonline.com - Medical Business Journal

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CMS Proposes New Quality Care Incentives INPATIENT VALUE-BASED PURCHASING PROGRAM FOR FY 2013 A new hospital inpatient quality care incentive program has been proposed by the Centers for Medicare and Medicaid Services (CMS). The program would expand on the Hospital Inpatient Quality Reporting (IQR) Program which provides incentives for hospitals that report quality measures. The new program will take this a step further by rewarding hospitals for achieving quality benchmarks in addition to just reporting them. The new program will affect acute-care hospitals paid under the Medicare Inpatient Prospective Payment System (IPPS) for inpatient services furnished to Medicare beneficiaries. It is set to take effect for fiscal year (FY) 2013 and was authorized by the Affordable Care Act (ACA). Under the new program, CMS would determine a hospitalsâ&#x20AC;&#x2122; base performance levels during an observation period and use that to measure quality improvements. The incentive payments could apply to discharges occurring as soon as Oct. 1, 2012. Below is a table of the proposed measures, provided by CMS:

CLINICAL PROCESS OF CARE MEASURES Measure ID

Measure Description

ACUTE MYOCARDIAL INFARCTION AMI-2 AMI-7a AMI-8a

Aspirin Prescribed at Discharge Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival Primary PCI Received Within 90 Minutes of Hospital Arrival

HEART FAILURE HF-1 HF-2 HF-3

Discharge Instructions Evaluation of LVS Function ACEI or ARB for LVSD

PNEUMONIA PN-2 PN-3b PN-6 PN-7

Pneumococcal Vaccination Blood Cultures Performed in the ED Prior to Initial Antibiotic Received in Hospital Initial Antibiotic Selection for CAP in Immunocompetent Patient Influenza Vaccination

HEALTHCARE-ASSOCIATED INFECTIONS SCIP-Inf-1 SCIP-Inf-2 SCIP-Inf-3 SCIP-Inf-4

Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision Prophylactic Antibiotic Selection for Surgical Patients Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time Cardiac Surgery Patients with Controlled 6AM Postoperative Serum Glucose

SURGICAL CARE IMPROVEMENT

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SCIP-Card-2

Surgery Patients on a Beta Blocker Prior to Arrival That Received a Beta Blocker During the Perioperative Period

SCIP-VTE-1

Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered

SCIP-VTE-2

Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery

Medical Business Journal - February 2011

EHR Legacy Certification Program Underway CCHIT OPENS EACH PROGRAM Beth Israel Deaconess Medical Center (BIDMC), Boston, is the first hospital to have its self-developed electronic health record (EHR) technology Office of the National Coordinator for Health Information Technology (ONC)

2011 Conversion Factor CONGRESS ACTED TO POSTPONE BIG DROP

certified as a complete EHR for meaningful use on Jan. 24. This comes as part of the pilot program launched by Certification Commission for Health Information Technology (CCHIT). The program, titled EHR Alternative Certification for Hospitals (EACHâ&#x201E;˘), aims to give hospitals the option to certify both legacy EHR technology,

Set for $25.5217 for 2011, Congress acted to raise this figure and maintain the which they already have in place, and self-developed or customized EHRs. 2010 conversion factor of $36.8729. This will likely fall to $33.9764. How The ONC-Authorized Temporary Certification Body (ATCB) certification does this happen? CMS made several budget neutral RVU adjustments to

label allows for hospitals to receive incentive funds by assuring that their

the fee schedule. Changes to RVU and other fee schedule fixes can cause the

technology has the capability to achieve meaningful use.

conversion factor to fluctuate. In addition to certification, the EACH program offers self-paced, online learning courses, inventory and self-assessment tools, and hands-on support

Pulmonary Rehabilitation HOSPITAL OUTPATIENT & PHYSICIAN SETTING SEES INCREASE

provided by CCHIT staff. CCHIT also plans to launch a similar program for physicians in the upcoming months. For more information about CCHIT and the EACH program, visit their website at: http://each.cchit.org/web/each/home/

Medical reimbursement for pulmonary rehab increased for both hospital outpatient and physician settings. Hospital outpatient 2011 payment is now roughly $60 per session, which is an increase of approximately 24% over 2010. The physician-based rehabilitation increased also by 38% to just over $33 per session and is reported with G0424. Payments above may fluctuate due to Medicareâ&#x20AC;&#x2122;s conversion factor of $36.8729 for 2010/2011 depending on geographic area. www.mbjonline.com - Medical Business Journal

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