Reimbursement Roundup
HCFA experiments with coordinated care
A new demonstration project sponsored by the Health Care Financing Administration could lead to expanded coverage for coordinated care services for the chronically ill, say agency observers. The idea for this pilot is to test the concept that coordinated care for a variety of chronic ailments can reduce the high costs associated with unnecessary utilization by teaching patients to understand triggers, in turn preventing acute episodes and complications that usually lead to emergency room visits.
Based in Maine, the four-year demonstration project is scheduled to be launched this fall and will involve between 700 and 800 Medicare beneficiaries.
"A shift in HCFA’s reimbursement policy toward coordinated care could create an incentive for health care systems to provide additional services that can increase the quality of patient care while decreasing unnecessary costs," notes Nancy Steele, vice president of New York City-based Pfizer Health Solutions, which markets a disease management software program being used in the pilot by some of the providers in the project.
Under a cardio coordinated care program, for instance, a nurse could telephone beneficiaries several times a week to get a reading on their weight; any unusual sudden weight gain could mean excessive fluid build-up, signaling the onset of a possible medical problem.
General information about the demonstration program is available on HCFA’s Web site at www.hcfa.gov/ord/coorcare.htm.
HCFA releases Form 855 revised draft
The Health Care Financing Administration has released its most recent draft of the revised provider enrollment form, Form 855. Formal comments on the latest version are due by April 2, with a final form expected this summer.
The draft form is available on-line at www. hcfa.gov/regs/prdact95.htm. Scroll down to Information Collection Requirements in HCFA-0855 and click on HCFA0855.EXE. This will enable you to download the draft forms.
HCFA sets procedures for advance benefit notice
As part of a recent crackdown on advance benefit notification procedures by providers, the Health Care Financing Administration has issued a program memorandum (Transmittal A-01-05) setting procedures home health agencies (HHAs) must follow when informing patients, prior to provision of health care services, that the proposed procedures may not be covered fully or partially by Medicare.
Under the memo, as of March 1, HHAs must start giving their patients an advance beneficiary notice to sign before providing a service that the agency believes might not be covered by Medicare or that might be covered at a reduced rate. The notice must inform beneficiaries that they would be responsible for the cost of any non-covered care.
Feds adding more common HIPAA questions
The Department of Health and Human Services (DHHS) has expanded the "frequently asked questions" (FAQs) section of its Health Insurance Portability and Accountability Act of 1996 Web site. The new site focuses on the final rule on Electronic Transactions and Code Sets. An added feature of this site allows users to submit specific questions that DHHS can choose to post and answer on the site if they are pertinent to the general readership.
To submit a question on the Transactions final rule, go to this address: aspe.hhs.gov/admnsimp/bannertx.htm. To read the FAQs, go to aspe.hhs.gov/admnsimp/qdate01.htm.
Physician panel preparing top 10 bad rules
Provider insiders are hoping the Physicians’ Regulatory Issues Team (PRIT) created by the Health Care Financing Administration can help reduce Medicare’s regulatory burden on doctors. Comprising 24 members, half of whom are physicians, the PRIT was organized as way to get give practitioners direct input into the way HCFA does business. PRIT is presently developing a "top 10" list of regulations or agency practices that it hopes to target for action over the next year, say sources close to the process.
Among the items to look for on this Top 10 regulatory hit list: reducing the time it takes new physicians to get Medicare billing numbers; creating a system to compile a list of "frequently asked questions" for public distribution; and refining HCFA’s proposed evaluation and management documentation guidelines.
Medicare may expand medical device coverage
Odds are looking very good that Medicare will expand its coverage of medical devices in the near future, say industry experts. One reason for the upbeat outlook is the strong support from U.S. Rep. Richard M. Burr (R-NC), the new vice chairman of the House Energy and Commerce Committee, which has jurisdiction over many heath care issues.
Burr has let it be known that he plans to be aggressive in his oversight of the Health Care Financing Administration, hoping to make the agency more responsive to both patients’ and providers’ needs.
Medical device hearings to be held
One of Burr’s first official acts will be to hold a series of hearings on Medicare’s treatment of medical devices, including how HCFA deals with coverage of drugs and devices, in response to complaints from device makers’ complaints that Medicare is slow to pay for breakthrough medical technologies.
"We’ve gotten used to paying higher prices for drugs, but we haven’t gotten used to paying incredibly high prices for devices," says Burr. In response, his office is pushing HCFA to alter its cost/benefit analyses to give more consideration to "savings per incident" from such things as the avoidance of invasive surgery and less need for medications when new technology is used.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content