Payment rates for hospice care, the hospice aggregate cap amount, and the hospice wage index are updated annually. The 2013 payment rates equal the 2012 payment rates plus 1.6 percentage points. The new rates are effective for care and services from Oct. 1, 2012 through Sept. 30, 2013. (more…)
August 9th, 2012
Aarches Community Health Care, a consumer operated and oriented plan (CO-OP) in Utah, received an $85,400,303 loan from the Centers for Medicare & Medicaid Services (CMS). The Beehive state CO-OP is the 16th non-profit, consumer-oriented CO-OP to receive loans so far.
Update: CMS awarded on July 27 a $69,396,000 loan to Colorado Health Insurance Cooperative, Inc. (CHI) in Colorado to launch a 17th CO-OP.
CO-OPs, created by the Affordable Care Act (ACA), are private, non-profit entities promoted by CMS to “create new, innovative, and consumer-responsive” health insurance companies to increase competition in individual and small markets. CO-OPs will be closely monitored to assure they are meeting incremental goals, and will only receive parts of their loans as they meet the goals, CMS says. More than half of the CO-OP’s board of directors must be customers or members of the CO-OP, and all directors must be elected by a majority vote of the members, which will improve accountability and transparency, the agency says. Each patient will have a “medical home,” a doctor or group who will be the primary care provider. The incentive will be to keep patients out of the hospital.
According to the Salt Lake Tribune, Utah already has two not-for-profit insurers: Regence BlueCross BlueShield and SelectHealth. They are two of the reasons that health care costs are relatively affordable in Utah, the paper says. Intermountain HealthCare, which started SelectHealth before spinning it off, and the University of Utah Medical Center also have pioneered data-driven standards of care.
To ensure CO-OPs are truly new entities, the health care reform law prohibits any state-licensed health insurance company that existed on July 16, 2009 from qualifying for the CO-OP program.
CMS will closely monitor CO-OPs to ensure they are meeting program goals. To ensure strong financial management, CO-OPs are required to submit quarterly financial statements, including cash flow and enrollment data, receive site visits, and undergo annual external audits. This monitoring is concurrent with the financial and operational oversight by state insurance regulators. The CO-OPs are required to meet state and federal standards for qualified health plans to sell coverage through the exchanges and the State’s Small Business Health Option Program (SHOP) exchanges.
July 26th, 2012
Home oxygen for cluster headaches (CH) will be reimbursed for up to 36 months beginning Oct. 1, the Centers for Medicare & Medicaid Services (CMS) recently announced. The move follows a Jan. 14 transmittal announcing clinical studies.
Codes and modifiers to be used for the service are now outlined and include:
E0424 Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing
E0441 Stationary oxygen contents, gaseous, 1 month’s supply = 1 unit
E0443 Portable oxygen contents, gaseous, 1 month’s supply = 1 unit
QF Prescribed amount of oxygen exceeds 4 liters per minute (LPM) and portable oxygen is prescribed
QG Prescribed amount of oxygen is greater than 4 liters per minute (LPM).
Please note that for the treatment of CH, this policy refers to the use of gaseous oxygen equipment and contents only. The usual dosage of oxygen for the treatment of CH is between 6-12 liters per minute. Modifiers QG or QF will be used with E0424 to adjust the monthly stationary oxygen payment amount to recognize that oxygen is prescribed for CH at a rate that exceeds 4 liters per minute. During the 36 month rental period:
- If the beneficiary is prescribed stationary gaseous oxygen at a rate that exceeds 4 LPM, suppliers may use modifier QG with E0424 to increase the monthly stationary oxygen payment amount by 50 percent.
- If the beneficiary is prescribed both stationary and portable gaseous oxygen at a rate that exceeds 4 LPM, suppliers may use modifier QF with E0424 to increase the monthly stationary oxygen payment amount by 50 percent, in accordance with the payment rules found in the Medicare Claims Processing Manual, chapter 20 (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)), section 130.6 (Billing for Oxygen and Oxygen Equipment).
A separate monthly payment is not allowed for the portable gaseous oxygen equipment described under E0431 Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing.
For more information about coding home oxygen for cluster headaches, go to “Code Home Oxygen Use for Cluster Headaches” on AAPC News.
June 1st, 2012
The Centers for Medicare & Medicaid Services (CMS) is postponing until 2013 the collection of data mandated by the Physician Payments Sunshine Act. CMS missed the implementation deadline of October 2011, and instead released draft regulations that solicited strong reactions from stakeholders.
May 11th, 2012
To help Medicare set appropriate payment rates for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), the Centers for Medicare & Medicaid Services (CMS) has announced plans to recompete the DMEPOS Competitive Bidding Program contracts in nine areas. (more…)
April 27th, 2012