HFMA Express News - July 23, 2004

IN THIS WEEK’S ISSUE:

1. CMS Antes Up $1 Billion To Help Cover Unpaid Emergency Room Costs
2. HHS Launches Decade of Health Information Technology Initiatives
3. 75 Percent Rule for Inpatient Rehab Facilities in Question
4. JCAHO Backs Down on Bar Coding
5. GAO: JCAHO’S Accreditation Surveys Are Inadequate
6. Providers Can Correct Minor Claim Errors Without Formal Appeal
7. CMS Will Allow Coverage Determination for Obesity Treatment
8. Project Bioshield Act Approves Medical Preparedness Funding
9. Quick Links

1. CMS ANTES UP $1 BILLION TO HELP COVER  EMERGENCY 
    ROOM COSTS

CMS announced that over the next four years it will pay a total of $1 billion to hospitals and other providers to help recover the costs of emergency medical care to uninsured patients who cannot pay their medical bills regardless of their undocumented alien status. Under the new policy, mandated by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA), payment will be made directly to providers based on the cost incurred for the initial emergency services and associated services, including physician and ambulance services. 

Under the new law, two-thirds of the funds will be distributed to all states and the remaining third will go to states with the largest number of "apprehensions" of undocumented aliens. In addition, to receive payments, providers must not receive additional funds from any other source, such as an insurance company or the uninsured patient. 

CMS is seeking public comment through August 16 and anticipates having an implementation plan in place by the September 1 deadline set in the MMA. In addition, there will be an open door forum on the implementation strategy paper on August 2, 2004, at 2 p.m. (eastern time). To participate by phone, dial 1-800-837-1935 and reference conference ID 8408913. 

2. HHS LAUNCHES DECADE OF HEALTH INFORMATION
   TECHNOLOGY INITIATIVES

HHS secretary Tommy Thompson on July 21 outlined a 10-year plan to implement a new health information infrastructure, including electronic health records (EHRs) and a network to link health records nationwide. 

At the same event, the Secretarial Summit on Health Information Technology in Washington, DC, David Brailer, national coordinator for health information technology, presented a plan to achieve a nationwide system of “always current, always available” online EHRs. 

Thompson announced several actions to begin implementing the initiative: ·

Appointment of a leadership panel to assess total costs and benefits of health information technology and report to him by October ·

Efforts to develop private-sector certification for health information technology products and assess the feasibility of a private-sector consortium to develop a nationwide health information network ·

Plans to create an Internet portal allowing beneficiaries to access their personal Medicare information ·

3. 75 PERCENT RULE FOR INPATIENT REHAB FACILITIES IN
    QUESTION

The House Appropriations Committee has approved an amendment to the FY05 Labor, HHS, and Education appropriations bill that would halt enforcement of the “75 percent” rule on inpatient rehabilitation facilities (IRFs) pending receipt by Congress of an Institute of Medicine (IOM) study on the issue. Under the rule, in order to qualify as an IRF, hospitals must show that 50 percent (moving to 75 percent in 2007) of inpatients require intensive rehabilitation services for several medical conditions. The American Hospital Association challenged the rule, contending it would force many rehabilitation facilities out of business. 

If it becomes law, the amendment will require CMS to contract with IOM to make recommendations for modernizing the rule. In addition, CMS would be required to report the study and recommendations to Congress by October 1, 2005, and cease enforcing the rule until nine months after the report is submitted to Congress. 

Congress is not expected to vote on the full appropriations bill until September. 

4.  JCAHO BACKS DOWN ON BAR CODING

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) withdrew its proposed bedside bar-coding system in hospitals to ensure correct medications are given to patients. The proposal was among several recommendations by an expert panel advising JCAHO on issues related to patient safety. The bar-coding proposal called for hospitals to develop a bedside bar-code medication management capability by January 1, 2007. However, the American Hospital Association rejected the proposal, saying that it locks accredited hospitals into a single technology solution that may not be the best for improving patient safety. 

5. GAO: JCAHO’S ACCREDITATION SURVEYS ARE
    INADEQUATE

JCAHO failed to identify some hospitals not in compliance with Medicare requirements and should be subject to greater federal oversight, the General Accounting Office (GAO) stated in a new report. State regulators found that JCAHO missed deficiencies in 123 out of 500 hospitals. These deficiencies include: · 

Inadequate procedures to prevent the spread of infections ·

Inability to ensure competent performance of physicians and nurses ·

Failure to adequately protect patients and staff from fire-related disasters
The GAO recommended that JCAHO improve its evaluation process, and suggested giving CMS greater oversight authority over JCAHO. 

In a statement responding to the report, JCAHO said it “does not object” to the proposal for increased CMS oversight of JCAHO, but “strongly urges policymakers not to make decisions based on an incomplete portrayal of the Joint Commission’s effectiveness.” 

6. PROVIDERS CAN CORRECT MINOR CLAIM ERRORS
    WITHOUT FORMAL APPEAL

Providers can correct minor errors and omissions on Medicare claims without having to go through a formal appeals process, such as a review or reconsideration, CMS explained in a Medlearn Matters article posted on its web site. The article provides information needed to make minor corrections to Medicare claims within existing procedures. Providers should refer to the Medicare Claims Processing Manual, Pub 100-4, for CMS’s instructions on correcting incomplete or invalid claim submissions, correcting mistakes in previously processed claims, reopening and revising claim determinations or decisions, and correcting claims that are not HIPAA-compliant. 

7. CMS WILL ALLOW COVERAGE DETERMINATION FOR
    OBESITY  TREATMENT

In a July 15 announcement, HHS Secretary Tommy Thompson introduced a new Medicare policy to “remove barriers to covering anti-obesity interventions if scientific and medical evidence demonstrates their effectiveness in improving Medicare beneficiaries’ health outcomes.” The new policy removes language in the CMS Coverage Issues Manual that states obesity is not an illness. Currently, CMS does not pay for treatment solely because of obesity, but does cover treatment when obesity adversely affects another disease. The Medicare Coverage Advisory Committee will meet in the fall and evaluate evidence on obesity-related surgical procedures that may reduce the risk of heart disease and other illnesses. 

8. PROJECT BIOSHIELD ACT APPROVES MEDICAL
    PREPAREDNESS FUNDING

On July 21, President Bush signed the Project BioShield Act of 2004 (S. 15), which authorizes medical countermeasure expenditures of $6 billion over the next 10 years. The funds will go toward the development and availability of modern drugs and vaccines to protect against attack by biological, chemical, nuclear, and radiological agents. Congress approved the legislation last week. 

9. QUICK LINKS

NON-HIPAA-COMPLIANT REIMBURSEMENT DELAYS. CMS issued a reminder that the Medicare reimbursement delays for claims in nonstandard HIPAA format (13 days after the 14-day payment window for compliant claims) began July 6, 2004. 

MOST WIRED” HOSPITALS ANNOUNCED. The nation's hospitals are making headway in building the electronic medical records that many health experts say will improve quality, patient safety, and efficiency, according to results released from the Hospital and Health Networks’ 2004 Most Wired Survey and Benchmarking Study. 

JCAHO LAUNCHES WEB SITE ON QUALITY. JCAHO launched a website that allows consumers to compare treatment quality in about 16,000 facilities nationwide for heart attack, heart failure, pneumonia, and pregnancy. 

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