HFMA NEWS

The National Committee for Quality Assurance (NCQA), in collaboration with Mathematica Policy Research and the American Medical Association (AMA)-convened Physician Consortium for Performance ImprovementTM, on June 10 released a set of measures assessing clinician performance in four areas of care for public comment. The set comprises 22 measures in rheumatoid arthritis care, palliative/end-of-life care, endoscopy and polyp surveillance, and chronic wound care. These measures may be used for quality improvement efforts, maintenance of certification programs, or pay-for-performance initiatives.

Clinician-level measures allow physicians, nurse practitioners, and other health professionals to improve performance in specialty areas.

All topic areas for public comment will be available for review on NCQA’s web site (www.ncqa.org) through July 1. All interested parties are invited to comment. Read the press release.

The Centers for Medicare and Medicaid Services (CMS) on June 10 announced that Pinnacle Business Solutions, Inc. (PBSI) has been awarded a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in Arkansas, Louisiana, and Mississippi.

PBSI will serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians, and other healthcare practitioners in the three states.

The new Part A/Part B Medicare administrative contractor (A/B MAC) will take claims payment work now performed by three fiscal intermediaries and two carriers in the three states. The A/B MAC contract has an approximate value of $178 million over five years. PBSI will immediately begin implementation activities and will assume full responsibility for the claims processing work in its three-state jurisdiction no later than February 2009. Read the press release.