Dr. George Taler, Board Member and Chair of Public Policy Committee, Constance Row, Executive Director and Gary Swartz, Associate Executive Director met Friday, June 8 with Dr. Janet Lawrence, Medicare Medical Director for NY/CT and Dr. Laurence Clark, Medicare Medical Director.

 

Drs. Clark and Laurence stated that the pre-payment CPT 99350 medical record review process that had been conducted in Connecticut and New York was officially ended and that this approach would not resume.

 

This major Academy accomplishment took place with the involvement of the public policy and practice management committees and affected members who worked with Academy staff to educate and persuade NGS officials to end this harmful overbroad medical record review process that has had such negative financial effects on member practices.  The financial harm also impacted beneficiary access to care as practices had to retrench while the pre-payment review was in place.

 

Additional information regarding housecall practice, minimum organizational standards for practice, medical necessity for encounters and levels of coding was exchanged during the two hour meeting. This additional important information will be distributed and posted for your review. Related information will be included in the up-coming diagnostic coding webinar.

The CMS project officer for the IAH demonstration project, Linda Colantino replied today to our inquiry regarding the status of the IAH Consortium Applications. She explains that "it takes time for CMS to pull all of the information and claims data related to the applicants before they can start the review process", and that "they hope to complete the process in the next few weeks, but that is not a definite." Thus, there is no definite date at this time for the announcement of those selected.

 

In the meantime, as previously announced, the IAH Learning Collaborative for those selected so far will proceed as scheduled with the first call June 19.  

The June edition of the important policy journal Health Affairs contains two articles featuring the work of current AAHCP President, Dr. Bruce Leff, Johns Hopkins University. The first displays his leadership in the field of geriatrics generally and the second in home care medicine. The first article called "Rapid Reengineering of Acute Medical Care for the Medicare Beneficiaries: the Medicare Innovations Collaborative" describes the work of this grant-funded group led by Dr. Leff and others in disseminating"best geriatric practices" in six applicant healthcare systems. Member Dr. Peter deGolia leads the effort at University Hospitals Case Medical Center.  Dr. Leff begins the article by explaining other new approaches to improving care for Medicare beneficiaries in the ACA including IAH, then goes on to describe the success with this dissemination approach. Second, in another article, the success of Dr. Leff's Hospital at Home model as demonstrated in a New Mexico health system is outlined. Dr. Leff spoke at the recent Health Affairs Washington session which discussed this important edition. This is the first mention of models from the field of home care medicine in this most-influential publication. Thanks to Dr. Leff, and may other publications follow!

 

A webinar on the guidelines to ICD -9 coding will be held on Wednesday June 27, 3 PM EST. This webinar will help you understand the guidelines to specific ICD - 9 coding. This will support your documentation of medical necessity, of services rendered and claim submission.

 

This webinar is timely given the diagnostic coding related issues discussed during last week's meeting with the NGS medical directors.  Additionally, accurate and specific ICD-9 coding also supports mapping to Hierarchical Condition Categories (HCC) codes and scoring that is used for payment/shared savings systems such as Independence at Home, Medicare Advantage Plans and others that are emerging in the market. Dial in information will be provided prior to the webinar. The webinar will be repeated and PowerPoint slides posted to the Academy site. 

 

Click here to register. 

CMS has announced agreements with 45 commercial, federal and State insurers in seven markets across the country to participate in the Comprehensive Primary Care Initiative, a new multi-payer demonstration project designed to improve quality while lowering costs. 

 

CMS will pay primary care practices, through this Innovation Center initiative, a care management fee to support enhanced, coordinated services. The selected payors are also offering enhanced payment to participating primary care practices. The markets in which payors were selected include Arkansas, Colorado, New Jersey, Oregon, New York's Capital District-Hudson Valley Region, Ohio and Kentucky's Cincinnati-Dayton Region, and greater Tulsa, Oklahoma.

 

Now 75 primary care practices will be selected to participate with the payors in each market. Selected practices will receive a new care management fee to support enhanced primary care services for their Medicare patients. The enhanced services will include: improved care coordination; increasing patients' access to care; delivering preventive care; engaging patients and caregivers in managing their own care, and providing individualized, enhanced care for patients living with multiple chronic diseases and higher needs. Additional information about the CPCI and whether your practice is eligible to participate can be found here. 

The HIPAA 5010 electronic transaction standard was to go in effect January 1, 2012. However, CMS provided an enforcement discretion period through the end of June to give providers and clearinghouses additional time to complete testing and for vendors to complete software installation.

 

The enforcement discretion period will end June 30. Claims submitted using the replaced Version 4010 format are subject to be rejected. While it is likely your organization, clearinghouse and you have successfully tested and migrated to Version 5010 we want to make sure you are aware of the June 30 end date to Version 5010 enforcement discretion.

 

Additional information regarding Version 5010 can be found here.

June 30, 2012 is also the last day to submit a hardship exemption request, or report at least 10 instances of e-prescribing on claims to CMS to avoid the 1.5 percent reduction on all Medicare claims in 2013.  The available hardship categories are;

• Inability to electronically prescribe due to state, or federal law, or local law or regulation
• The eligible professional prescribes fewer than 100 prescriptions during a 6- month payment adjustment reporting period
• The eligible professional practices in a rural area without sufficient high-speed Internet access (G8642)
• The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing (G8643)

Hardship exemption requests must be submitted annually and by June 30 to claim an exemption request to avoid next year's penalty. Additional information about thee-Prescribing incentive program and the hardship exemption process can be found on the CMS site here.

  

Advertise with us 

Many of you have been approached by or wish to approach hospitals to offer the support of your housecalls program to their effort to reduce readmissions. You have asked us for a basic briefing document you could take with you, something that would explain how house calls can help, and give some concrete examples of benefits.

 

An interested group met at the Annual Meeting to give the background needed and to describe their programs.Click here for a Policy Brief giving the argument and their examples. Consider this an Annual Meeting gift that we hope will keep on giving! And many thanks to those who participated!

The Academy is pleased to announce an updated and expanded Medical Management of the Home Care Patient (MMHCP) is Now Available. This important publication for care of your patients and operating a home care medicine practice is updated with the most current and relevant material.  This book is applicable to the practice and patients of all Academy members including physicians, nurse practitioners and physician assistants. Leaders of your Academy in conjunction with the AMA authored the MMHCP. Order you copy here.

 

This 4th edition, like the field of home care medicine, has grown across many aspects of care, organization and regulation and covers the changing landscape from care of special populations, relationships with community based long term care supportive services through skilled nursing and therapy services to the latest in acute hospital in the home programs.

 

Specific topics include:

• The basis for care of the home care medicine patient.
• Care transitions and the importance of care transitions in reducing hospital readmissions.
• Legal, compliance and ethical issues that arise or are present in practice of home care medicine.
• The Veterans Administration's Home Based Primary Care Program.
• Special home care medicine populations from neonatal through hospice and end of life care.
• A caregiver self-assessment tool.
• A comprehensive glossary.
• Listing of national, state and local resources.
• Case studies, tables, figures and easy-to-read text.
• A continuing medical education component for physicians interested in obtaining AMA PRA Category 1 Credits™

The MMHCP is a care delivery complement to the expanded Field Guide to Home Care Medicine  and both beginning and growing practices will want to have both references.