CMS Issues Memo on Telemedicine Rule for Hospitals and CAHs

The Centers for Medicare and Medicaid Services (CMS) has issued a memorandum with information on the final rule streamlining telemedicine credentialing in hospitals and critical access hospitals (CAHs).

To read the memorandum, click here:
http://www.namss.org/Portals/0/Advocacy/CMS%20Final%20Rule%20-%20CAH.pdf


Source: CMS

CMS Proposes Rule Retracting Physician Signature Requirement

The Centers for Medicare and Medicaid Services (CMS) published a proposed rule eliminating the requirement that a physician or qualified non-physician sign test requisitions in order for the tests to be paid for under the Clinical Laboratory Fee Schedule.

The rule was supposed to go into effect on January 1, 2011, but was indefinitely delayed after many argued that the rule would create inefficiency.

The proposed rule is open for a 60-day comment period and will likely be finalized later this year.

To see the Federal Register announcement, click here:
http://www.gpo.gov/fdsys/pkg/FR-2011-06-30/pdf/2011-16366.pdf

Register for a NAMSS Webinar on the New Telemedicine Rule!

What You Need to Know About the Telemedicine Credentialing Rule
A Live Webinar Brought to You by NAMSS
Wednesday, June 15, 2011 at 1:00 PM EDT
Presented by Commander Scott J. Cooper, MMSc, PA-C

On May 5, 2011, the Centers for Medicare and Medicaid Services (CMS) published a final rule for hospitals and critical access hospitals (CAHs) that will allow for a new credentialing and privileging process for physicians and practitioners providing telemedicine services. The new rule has a 60-day implementation window. This final rule gives hospitals and CAHs more flexibility in credentialing and privileging telemedicine providers. Starting July 5, 2011, the governing body of a hospital or CAH will be allowed to rely on the credentialing and privileging decisions of a distant-site hospital or telemedicine entity when making its own credentialing and privileging decisions. The rule also allows hospitals and CAHs to rely on information from non-hospital telemedicine providers such as teleradiology and other telehealth centers.

The revision is intended to make it easier for hospitals to adopt and implement telemedicine, providing patients with access to a greater range of services. But what does this mean for medical staff departments and your current credentialing and privileging practices?

Join Commander Scott J. Cooper, MMSc, PA-C of the Centers for Medicare and Medicaid Services on Wednesday, June 15 from 1:00 to 2:30 PM Eastern as he walks through the final rule and answers questions.

Webinar participants will have the opportunity to ask the speaker additional questions following the presentation.

What You Will Learn:

• What is new about the revised Conditions of Participation?



• What is the difference between telemedicine, telehealth, and teleradiology?



• What should the written agreement between the hospital and telemedicine provider look like?



• What specific information must be received in order for a hospital to rely on the credentialing and privileging decisions of another entity?

Speaker:

Commander Scott J. Cooper, MMsc, PA-C is a member of the United States Public Health Service. He currently serves as a Senior Health Insurance and Policy Analyst with the Clinical Standards Group in the Office of Clinical Standards and Quality at the Centers for Medicare and Medicaid Services (CMS). Commander Cooper and his team at CMS are responsible for the development of CMS standards and policies, including the latest telemedicine final rule.

Who Should Attend:

All MSPs are invited to attend.

CEs:

Webinar participants will receive 1.5 CE credits.

Cost:
NAMSS members: $49 Non-members: $69
You will have the opportunity to purchase additional CE certificates for $10 each. A multi-registrant form will be included with your registration information.

To Register:
Visit the NAMSS Online Store to purchase this course.

Regulatory Alert: CMS Releases Final Rule on Telemedicine Credentialing and Privileging

WASHINGTON (May 2, 2011) -

On May 2, the Centers for Medicare and Medicaid Services (CMS) released a final rule that will make it easier for hospitals and critical access hospitals (CAHs) to credential and privilege telemedicine providers.

The rule allows hospitals and CAHs delivering telemedicine services to rely on the credentialing and privileging information of the distant-site facility. The distant-site facility is defined as the location where the provider is located. Members of the governing body of the hospital or CAH where the patient is located will still need to make their own privileging decision; however, the new rule allows them to rely on the credentialing information and privileging decision of the distant-site facility.

One major change from the May 26, 2010 proposed rule is that CMS will allow hospitals and CAHs to accept credentialing and privileging information from facilities other than Medicare-participating entities as long as there is a written agreement between facilities stating that the distant-site entity will “furnish services that permit the hospital to comply with all applicable conditions of participation and standards for contracted services.” This includes the credentialing and privileging requirements of the conditions of participation.

The proposed rule had originally been written to exclude non-Medicare participating telemedicine entities since CMS would have no oversight over them. These entities include teleradiology providers, telepathology providers, and others, including ambulatory surgery centers accredited by The Joint Commission. CMS realized that preventing hospitals and CAHs from applying the new rule to these providers would do little to increase patient access to services or to reduce the burden on small hospitals and CAHs that want to provide telemedicine services.

The final rule will be published in the Federal Register on May 5. Hospitals and CAHs will be given 60 days from its publication date to implement the rule.

NAMSS is hosting an upcoming webinar with Lieutenant Commander Scott Cooper of the CMS Office of Clinical Standards and Quality. Lt. Cmdr. Cooper will give an overview of the final telemedicine rule and answer any questions you may have. Be sure to watch your e-mail and the NAMSS Homepage at www.namss.org for the date and registration information.

Read the final rule and see CMS’ responses to comments submitted

Read NAMSS’ comments submitted on the proposed rule in July 2010

Need Guidance on the New ACA Provider Screening Rule?

On March 25, a new CMS rule went into effect to strengthen provider and supplier screening requirements under Medicare, Medicaid and SCHIP. The rule, which was ordered under the Affordable Care Act, is intended to crack down on waste and fraud.

The rule outlines various risk categories of providers and the screening methods that should be used for each category, such as checking for licensure and querying the NPDB.

In February, Reed Smith LLP published a comprehensive review of the rule. To read their summary and outline of the rule's requirements, click here:

http://www.reedsmith.com/_db/_documents/RS_HIWW_Alert11039[1].pdf

CMS Expands Hospital Compare to Include HAC Data

CMS announced the expansion of their publically reported data to include “Hospital Acquired Conditions (HAC). MSPs play an important role in patient safety and compliance with these measures as we assist our hospitals by providing education to our medical staffs during orientation and ongoing education opportunities.

For the first time, Medicare patients can see how often hospitals report serious conditions that develop during an inpatient hospital stay and possibly harm patients with important new data about the safety of care available in America’s hospitals added today to the Centers for Medicare & Medicaid Services’ (CMS) Hospital Compare website.

The Hospital Compare website can be accessed at www.HealthCare.gov/compare.

Independent data from the Institute of Medicine estimates that as many as 98,000 people die in hospitals each year from medical errors that could have been prevented through proper care. Although not every HAC represents a medical error, the HAC rates provide important clues about the state of patient safety in America’s hospitals. In particular, HACs show how often the following potentially life-threatening events take place:

· Blood infections from a catheter placed in the hospital;
· Urinary tract infections from a catheter placed in the hospital;
· Falls, burns, electric shock, broken bones, and other injuries during a hospital stay;
· Blood transfusions with incompatible blood;
· Pressure ulcers (also known as bed sores) that develop after a patient enters the hospital;
· Injuries and complications from air or gas bubbles entering a blood vessel;
· Objects left in patients after surgery (such as sponges or surgical instruments);
· Poor control of blood sugar for patients with diabetes.

Today, there is so much information to communicate to our medical staffs. To accommodate our busy doctors have you come up with any innovative ways to provide education using new methods of technology that you would like to share with fellow MSPs?


Source: Centers for Medicare and Medicaid Services

TJC Granted Deeming Authority for Psychiatric Hospitals

The Joint Commission (TJC) has been granted deeming authority for psychiatric hospitals by the Centers for Medicare and Medicaid Services (CMS). For the next four years, hospitals accredited by TJC will be considered as meeting CMS requirements.

In addition to psychiatric hospitals, TJC has deeming authority for ambulatory surgical centers, clinical laboratories, critical access hospitals, durable medical equipment suppliers (DMEPOS), advanced diagnostic imaging centers, hospitals, home care agencies; and hospices.

To read TJC's announcement, click here:
http://www.jointcommission.org/cms_recognizes_the_joint_commission’s_accreditation_of_psychiatric_hospitals/

AAPA Provides Clarification on the Medicare Enrollment of PAs

The American Academy of Physician Assistants (AAPA) recently contacted NAMSS, providing the information below, which may be helpful to MSPs who are responsible for the credentialing and Medicare enrollment of Physician Assistants (PAs):

With the new PECOS requirement, hospitals have been scurrying to get employed PAs enrolled to meet the “ordering/referring” rule.

Some MSPs who are responsible for physician credentialing and enrollment in Medicare have been asked to present Medicare contractors with current certification information. In some states, maintenance of certification is not a requirement for licensure; nor is it a requirement for Medicare enrollment. The PA must have passed the certifying exam. There is no mention of maintenance of certification. Transcripts from the PA program are not required if proof can be presented that the PA is NCCPA certified. In this case, certification and license are all that is required.

The relevant Medicare regulations are below:

Medicare Benefit Policy Manual
Chapter 15 – Covered Medical and Other Health Services
Table of Contents
(Rev. 117, 12-18-09) http://www.cms.gov/manuals/Downloads/bp102c15.pdf

190 - Physician Assistant (PA) Services
(Rev. 1, 10-01-03)
B3-2156

Effective for services rendered on or after January 1, 1998, any individual who is participating under the Medicare program as a physician assistant for the first time may have his or her professional services covered if he or she meets the qualifications listed below and he or she is legally authorized to furnish PA services in the State where the services are performed. PAs who were issued billing provider numbers prior to January 1, 1998 may continue to furnish services under the PA benefit.

See the Medicare Claims Processing Manual, Chapter 12, “Physician and Nonphysician Practitioners,” §110, for payment methodology for PA services. Payment is made under assignment only.

A. Qualifications for PAs

To furnish covered PA services, the PA must meet the conditions as follows:

1. Have graduated from a physician assistant educational program that is accredited by the Accreditation Review Commission on Education for the Physician Assistant (its predecessor agencies, the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and the Committee on Allied Health Education and Accreditation (CAHEA); or
2. Have passed the national certification examination that is administered by the National Commission on Certification of Physician Assistants (NCCPA); and
3. Be licensed by the State to practice as a physician assistant

The AAPA contacted CMS to seek clarification on this issue. The following response was received on January 19, 2011:

“The regulations at 42 CFR 410.74 that contain the PA qualifications should be
interpreted as follows:

1. Have graduated from a PA educational program that is accredited by the Commission on Accreditation of Allied Health Education Programs and be licensed by the State to practice as a PA; or

2. Have passed the national certification examination that is administered by the National Commission on Certification of PAs and, be licensed by the State to practice as a PA.”

For more information, or questions regarding the credentialing and enrollment of PAs, please contact:

Tricia Marriott, PA-C, MPAS
Director, Reimbursement Policy
American Academy of Physician Assistants
tmarriott@aapa.org

CMS to Withdraw Physician Signature Rule

The American Association of Bioanalysts has announced that the Centers for Medicaid & Medicare Services intends to withdraw the current physician signature rule regarding diagnostic laboratory tests. The rule, which was supposed to be in effect starting January 1, 2011, but was delayed, required physicians or qualified nonphysician practitioners to sign requisitions and paperwork for clinical lab tests in order to have the test paid for under Medicare Part B.

Opponents of the rule stated that it was disruptive and complicated matters since many physicians relied on nonphysician staff to process laboratory test paperwork. CMS stated that they will re-evaluate the policy.

To see the American Association of Bioanalysts' announcement, click here:
http://www.aab.org/aab/NewsBot.asp?MODE=VIEW&ID=86&SnID=1949563646


Sources: BNA, American Association of Bioanalysts

Challenge to Nurse Anesthetists' Scope of Practice Continues in California

California physicians are appealing the latest court decision that upheld the right for nurse anesthetists to administer anesthesia without physician supervision, an issue that has pitted nurses and doctors against each other in a nationwide turf battle.

Medicare allows state governors to opt out of a federal policy that requires physician supervision of nurse anesthetists when delivering anesthesia to Medicare patients. This provision is intended to address staffing shortages where anesthesiologists may not be readily available. California and 16 other states currently operate under the opt-out provision.

Opponents of the provision claim that the state's current scope of practice for nurse anesthetists does not allow for unsupervised practice.

To read more, click on the following link:
http://www.healthleadersmedia.com/page-1/TEC-262136/Nurse-Anesthetists-Scope-of-Practice-Challenged-Again-in-CA


Source: HealthLeaders Media

CMS Launches Physician Compare Website

The Affordable Care Act (ACA) required the Centers for Medicare & Medicaid Services (CMS) to develop a Physician Compare website by Jan. 1, 2011. In order to comply with the law, CMS launched the Medicare Physician Compare website in late December. By January 2013, physician performance data collected in 2012 will be made public as part of the CMS requirements of the ACA (Accountable Care Act). Performance Indicators have not been finalized at this time.

The American Medical Association (AMA) has stayed involved and has an excellent summary here to share with your medical staffs:

http://www.ama-assn.org/ama/pub/health-system-reform/resources/insight/january-2011/27jan2011.shtml

CMS Signature Requirement Delayed

The Centers for Medicare & Medicaid Services (CMS) has postponed enforcement of a policy requiring a physician's or qualified nonphysician practitioner's signature on requisitions for clinical diagnostic laboratory tests paid under the clinical laboratory fee schedule. CMS defines a requisition asthe actual paperwork, such as a form, which is provided to a clinical diagnostic laboratory that identifies the test or tests to be performed for a patient.

The policy went into effect on January 1, 2011. However, CMS is delaying enforcement of the policy until after the first calendar quarter of 2011 to educate everyone affected by it.

For more information, click here:
http://www.cms.gov/ClinicalLabFeeSched/


Source: CMS

House Passes Physician Pay Cut Delay

Today, the House passed H.R. 4994, a bill that delays a scheduled 25% Medicare physician pay cut for another year. President Obama is expected to sign the bill. The cut would have been effective January 1, 2011. The bill keeps reimbursement rates for 2011 at the 2010 levels.

The Senate passed the bill on December 8.


Source: BNA

CMS Will Postpone Denying Claims from Doctors Not in PECOS

The Centers for Medicare and Medicaid Services (CMS) announced that it will no longer enforce the January 3, 2011 deadline for denying claims for services performed by providers not listed in the Provider Enrollment, Chain and Ownership System (PECOS). PECOS was developed to move the Medicare enrollment process to an electronic format.

This is the second time PECOS enforcement has been postponed. CMS has not announced a new enforcement date; however, they encourage providers who have not enrolled in PECOS to do so sooner rather than later.


Source: BNA

CMS Final Rule Cuts Physician Payments 24.9% in 2011

The Centers for Medicare and Medicaid Services (CMS) has released a final rule that will cut Medicare payments to physicians by 24.9 percent in 2011. CMS states that the reason for the cut is to provide a permanent fix for the sustainable growth rate and Medicare payment formula.

The rule also attempts to curb physician self-referral for services that may be obtained elsewhere in the area and implements rules on the expansion of preventative services, which went into effect as part of the Affordable Care Act.

The physician pay cut is effective January 1, 2011.


Source: Healthcare Finance News
http://www.healthcarefinancenews.com/news/cms-final-rule-cut-2011-medicare-pay-physicians

OIG Report Shows CMS' Failure to Report Adverse Actions to HIPDB

A report from the Department of Health and Human Services Office of the Inspector General (OIG) shows that although the Centers for Medicare & Medicaid Services (CMS) took adverse actions against providers, it failed to report all of these actions to the Healthcare Integrity and Protection Data Bank (HIPDB).

The HIPDB is a repository of "all final adverse actions against health care practitioners, providers, and suppliers." The purpose of the HIPDB is to provide states, federal agencies, and health plans with a resource to help them prevent dealings with practitioners, providers, and suppliers with a history of fraud and abuse.

The report, titled "CMS Reporting to the Healthcare Integrity and Protection Data Bank," revealed that CMS failed to properly report actions taken against laboratories, DME suppliers, and nursing homes. These adverse actions either went unreported even when final action was taken, or were reported outside of the required reporting timeframe, which is about 30 days from the date action was taken, or the date that the reporting entity discovered the action.

The OIG recommended that CMS resolve the problem by providing staff and contractors with better education on reporting requirements. CMS agreed with the findings and pledged to work with the Health Resources and Services Administration (HRSA) to determine what actions are reportable.

This report reminds us that MSPs must be diligent when performing credentialing functions. The data we rely upon is only as good as the reporting source. You cannot evaluate data pulled from one source with a "vacuum mindset." When pulling reports, compare the information you collect along with other reports as well as the provider's history. This investigative step may help you to disclose adverse actions that may not be found in database reports.

To read the full OIG report, click here:
http://www.oig.hhs.gov/oei/reports/oei-07-09-00290.pdf


Source: Department of Health and Human Services, Office of the Inspector General

MSPs Should Be on the Lookout for ACOs

A new acronym (ACO) to keep on our radar screen. The goal of such organizations is to keep patients healthy AND be cost-efficient. According to BNA, accountable care organizations "are designed to keep patients healthy and out of intensive care settings, while simultaneously shifting reimbursements to pay based on the achievement of top performance goals that drive improved patient outcomes and cost-effectiveness."

The Centers for Medicare & Medicaid Services (CMS) is working on draft regulations that will define what constitutes an ACO. The CMS-regulated ACO program is set to begin in 2012. Currently, there are some ACO models are emerging from Physician Group Practice organizations.

The purpose of the ACO program is to reward providers with higher reimbursement if they attain positive patient outcomes and are successful at promoting patient wellness. The idea is that it is more costly to reimburse providers for the treatment of illnesses; therefore, quality healthcare can be made more cost-efficient if they strive for the maintenance of patients' good health.

It will be interesting to see whether or not MSPs are asked to assist with monitoring "top performance goals" as part of the final ACO rules.


Source: BNA

Study Supports Use of CRNAs without Physician Supervision

A study in Health Affairs shows that patient death rates have not increased among states that allow nurse anesthetists to administer services without the supervision of an anesthesiologist or surgeon.

The Centers for Medicare & Medicaid Services currently require that nurse anesthetists perform under the supervision of an anesthesiologist or surgeon in order to bill under Medicare; however, states have the ability to opt out of this requirement by petitioning CMS. Currently, 14 states have opted out.

The study showed that in the states that have opted out, anesthesiologists have taken on more complicated cases, or cases where the private insurance reimbursement was higher, while unsupervised nurse anesthetists have taken on more routine and Medicare-funded cases. The study compared the performance of nurse anesthetists working unsupervised, supervised nurse anesthetists, and anesthesiologists and surgeons, and found no difference among the number of patient complications and deaths allocated to each group.

The authors of the study encourage CMS to eliminate the supervision requirement, stating that allowing nurse anesthetists to work unsupervised is cost-effective, with no negative impact on patient safety. This would be especially helpful to smaller hospitals, which may not have an anesthesiologist on staff. This study serves as a reminder to MSPs that patient safety does not always have to mean "physician supervision."


Sources: BNA, Health Affairs

AHA Responds to Recent CMS Telemedicine Expansion: "We Believe the Proposed Changes Do Not Go Far Enough"

In response to CMS' proposed changes regarding credentialing and privileging requirements for telemedicine, the American Hospital Association (AHA) submitted a letter to the new CMS Administrator, Donald Berwick, stating that it is in support of the rule but that the changes do not apply to physician groups or other entities that provide telemedicine service.

Click here to read the letter in it's entirety.

CMS Delaying Rejection of Providers Not Enrolled in PECOS

The Centers for Medicare & Medicaid Services (CMS) has announced that they will not enforce the automatic rejection of claims from providers not enrolled in the Provider Enrollment, Chain, and Ownership System (PECOS) until January 3, 2011.

By July 6, 2010, physicians who order or refer for covered Part B services must revalidate their enrollment in PECOS online. Several providers have reported issues in completing the application and revalidation process and called on CMS to delay the rule until problems with the system were worked out. This rule will still be effective by July 6; only the automatic rejection of claims will be delayed until January 2011.

Many hospitals are putting the responsibility on MSPs responsible for credentialing to verify enrollment in Medicare as part of the initial credentialing process. NAMSS will monitor this carefully during the next year. Best practice credentialing procedures include MSPs reviewing the OIG and/or the Medicare/Medicaid Exclusion List. Enforcement guidelines for the PECOS database will likely be developed over the remainder of the year.


Source: BNA