Medicare Bundled Payments Initiative and Oncology Care

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The following post is provided by our guest author, Ronald Barkley, MS, JD from the Cancer Center Business Development Group. Ron can be reached at: rbarkley@ccbdgroup.com.

According to Modern Healthcare’sInterest Surges in Medicare Bundled Payment Initiative” article on July 31, 2014, enthusiasm for bundled pricing has been associated with the Medicare Bundled Payments for Care Improvement (BPCI) initiative, which has consisted principally of cardiac and orthopedic procedures with a hospital inpatient component. But what about modifying payment methods for oncology/cancer care? Is oncology next in line for alternate/bundled payment? Continue reading this entry

CMS Says: Let's Make a Deal

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In the hours before everyone began enjoying Labor Day Weekend, the Centers for Medicare & Medicaid Services (CMS) issued an important inpatient hospital review update.

To expedite the appeals process and reduce the volume of inpatient status claims currently pending, “CMS is now offering an administrative agreement to any hospital willing to withdraw their pending appeals in exchange for timely partial payment (68% of the net allowable amount).” Continue reading this entry

CMS Issues Final Rule on Hospice Wage Index and Payment Rate Update for FY 2015

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On August 4, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating the hospice wage index and payment rate for Fiscal Year (FY) 2015 and adopting a number of payment reforms addressing concerns about program integrity, beneficiary protection, and quality (Final Rule). CMS also issued an accompanying Fact Sheet which summarizes the significant provisions. The Final Rule will be published in the Federal Register on August 22, 2014 with an effective date of October 1, 2014.

Hospices are paid on a per diem basis in one of four prospectively determined rate categories, i.e., routine home care, continuous home care, inpatient respite care, and general inpatient care. Hospice payments are subject to a patient-specific cap on inpatient days and an annual aggregate payment cap. Continue reading this entry

CMS Issues Final Rule for Inpatient Stays in Acute Care and Long Term Care Hospitals

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On August 1, 2014, the Centers for Medicare and Medicaid Services (CMS) issued its annual final rule for policy and payment changes applicable to inpatient stays in acute care and long term care hospitals (Final Rule). This year’s Final Rule is more than 2,400 pages long and is expected to be published in the Federal Register on August 22, 2014. Revisions set forth in the Final Rule are effective for discharges occurring on or after October 1, 2014 (the start of the federal fiscal year (FY) 2015). CMS also issued a press release and Fact Sheet, explaining the highlights of the Final Rule. Continue reading this entry

340B Drug Pricing Program Interpretative Rule Survives (for Now)

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A federal court entered a new order, on August 27, 2014, in an ongoing dispute between the Health Resources and Services Administration (HRSA) and the Pharmaceutical Manufacturers of America (PhRMA) regarding HRSA’s issuance of regulations for the 340B Drug Pricing Program (the 340B Program). The dispute relates narrowly to the 340B Program’s treatment of orphan drugs purchased by certain hospital covered entities, but is of much broader interest because of its potential impact on the scope of HRSA’s ability to issue regulations that are binding on participating 340B Program covered entities and manufacturers. Continue reading this entry