An inventory of quality measures used for reporting, payment, or quality improvement by its agencies and operating divisions was recently announced by Health and Human Services (HHS).

The HHS measures inventory is available on the National Quality Measures Clearinghouse, an Agency for Healthcare Research and Quality (AHRQ), Web site. Read more »

The Centers for Medicare & Medicaid Services (CMS) has added two new quality measures to the Dialysis Facility Compare consumer Web site to show the percentage of patients at any given dialysis facility whose hemoglobin levels are reportedly unsafe.

Previously, the Web site only showed the percentage of patients in a facility whose hematocrit levels were at 33 percent or more (or hemoglobin levels of 11 g/dL or more). Read more »

Although the Medicare fee-for-service (FFS) error rate has dropped from 14 percent in 1996 to 3.6 percent in 2008, that’s still billions of dollars—$10.4 billion to be exact—in improper payments.

The news is always the same. “For Medicare FFS, most improper payments are due to claims for services that were medically unnecessary or incorrectly coded,” reports a Centers for Medicare & Medicaid Services Nov. 17 press release. Read more »

National Heritage Insurance Corp. (NHIC) is the newest Part A/Part B Medicare Administrative Contractor (A/B MAC) to be named by the Centers for Medicare & Medicaid Services (CMS).

CMS has awarded NHIC a five-year, cost-plus-award-fee contract to administer Part A and Part B Medicare claims payment in Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont — also known as jurisdiction 14. The contract is reportedly worth about $176 million, according to a press release issued by CMS on Nov. 19. Read more »

In a proposed decision memo, the Centers for Medicare & Medicaid Services (CMS) states that there is little evidence to support open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, or open and laparoscopic biliopancreatic diversion with duodenal switch as reasonable and necessary in patients with type 2 diabetes mellitus (T2DM) and a body-mass index (BMI) less than 35. Read more »

As of Jan. 1, 2009, eligible originating sites for payment of telehealth services will include hospital-based or critical access hospital-based renal dialysis facilities (including satellites), skilled nursing facilities and community mental health centers. This amendment to the Social Security Act is mandated by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. Read more »

A federal district court last month found Medicare and some of its contractors had unlawfully limited payments for DuoNeb, an inhalation drug used to treat chronic obstructive pulmonary disease, according to The New York Times. Read more »

In 2002, less than a year after 9/11, the U.S. Department of Health and Human Services (HHS) made available more than $7 billion in funding to increase state and local public health preparedness and emergency response capabilities. In 2006, the Centers for Disease Control (CDC) allocated $766 million of that to 62 awardees to meet nine out of 11 preparedness requirements for Preparedness Goal 3: Detect and Report through its Public Health Emergency Preparedness Cooperative Agreement (Cooperative Agreement).  Six years later, with the completion goal of 2010 less than two years away, less than 10 percent of states have met two of the nine requirements, concludes the Office of Inspector General (OIG) in an October 2008 report. Read more »

The Centers for Medicare & Medicaid Services (CMS) updated the therapy services chapter of the Medicare Claims Processing manual to reflect the extension of the therapy caps exceptions process to Dec. 31, 2009, mandated by the Medicare Improvements for Patients and Providers Act (MIPAA) of 2008. CMS also added HCPCS Level II coding requirements. Read more »

Hospitals can add to their list of covered services new HCPCS Level II code C9899, Implanted prosthetic device, payable only for inpatients who do not have inpatient coverage, that will be effective for services furnished on or after Jan. 1, 2009. Use form TOB-12X for claims of this nature.

This code was missing from an earlier Centers for Medicare & Medicaid Services (CMS) transmittal. Transmittal 1628, issued Nov. 3, rescinds transmittal 1597, issued Sept. 12. Read more »