Yesterday, the Centers for Medicare and Medicaid Services (CMS) proposed to change the way it pays Medicare reimbursements to hospitals. (Kaiser Network) CMS seeks to reduce payments by a flat rate (2 percent to 5 percent) to create an "incentive payment pool" for hospitals that meet quality of care thresholds. According to CQ HealthBeat, the plan would create a "Value-Based Purchasing Program." Under this program, a hospital's diagnosis-related group reimbursements would be based on quality … [Read more...] about CMS Set to Base Medicare Hospital Reimbursements on Quality of Care
Tropical Storms and Texas
There are two tropical storms presently aimed at the Texas Coast. Here is the latest on Tropical Storm Erin: Here is its projected path: In the Gulf of Mexico, Tropical depression Five took shape last night, and has been upgraded to Tropical Storm Erin at 10 am CT moving northwest toward the southeastern Texas Coast. Conditions appear favorable for Tropical Storm Erin to be a flooding rain threat into Friday night. The current forecast track brings this system into the … [Read more...] about Tropical Storms and Texas
HIPAA–Stonewalling Families is NOT the Law
HIPAA continues as the gift that just keeps giving--to lawyers at any rate. Apparently, it is being misconstrued around the country to be an obstacle to families seeking to ascertain the condition of their loved ones. From an interesting editorial in the Idaho Mountain Express: American medicine and its practitioners are among the finest anywhere in the world. However, getting to that treatment through the maze of government and insurance paperwork and waiting for an appointment is … [Read more...] about HIPAA–Stonewalling Families is NOT the Law
LTC Facilites: Prepare to Update FIVES Daily June 4-7!
In a provider letter dated June 1, 2007, DADS is notifying Texas long-term care facilities that it will be conducting a hurricane preparedness exercise "involving local, state, federal, and private sector partners." DADS is requesting that you update your number of vacancies in the Facility Inventory, Vacancy and Evacuation Status application (FIVES) on a daily basis. FIVES can be accessed here.. The provider letter can be accessed here. … [Read more...] about LTC Facilites: Prepare to Update FIVES Daily June 4-7!
Provider Letters: ‘Clarifying the Myths in Assisted Living Facilities,’ Cost of Living Adjustments
In a letter dated May 14, the Texas Department of Aging and Disability Services (DADS) notified assisted living providers, provider organizations, and surveyors about a conference called, “Clarifying the Myths in Assisted Living Facilities.†The conference will be held on July 19, 24, and 31. Topics to be presented include aging in place, emergency preparedness, and medication management. For locations and times, you may download the letter here. DADS reminded nursing facilities (in a … [Read more...] about Provider Letters: ‘Clarifying the Myths in Assisted Living Facilities,’ Cost of Living Adjustments
Cooperation Key to Nursing Home Quality Improvements
Mary Ousley, past chair of the American Health Care Association, which represents long term care providers, testified before a congressional committee last week about the long term care profession’s experience with the Omnibus Budget Reconciliation Act of 1987 (OBRA ‘87). OBRA '87 is considered landmark legislation because it established many nursing home oversight rules in place today. Ousley said that in order to improve nursing facilities, providers, regulators, and consumers must … [Read more...] about Cooperation Key to Nursing Home Quality Improvements
Payment Reforms for Inpatient Hospital Services
In an effort to improve the accuracy of payment under the acute care hospital inpatient prospective payment system and give hospitals incentives to improve quality, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule. From the press release: Medicare’s inpatient rates for operating expenses will increase by 3.3 percent in FY 2008 for those hospitals that report quality data to CMS. Overall, the proposed rule is estimated to increase payments to more than 3,500 acute … [Read more...] about Payment Reforms for Inpatient Hospital Services
National Provider Identifier
A National Provider Identifier (NPI) is a 10-digit number used to identify providers under the 1996 Health Insurance Portability and Accountability Act (HIPAA). According to the Centers for Medicare and Medicaid Services, there are only 151 days left to comply with the NPI requirement. From the site: If you are a health care provider who bills for services, you probably need an NPI. If you bill Medicare for services, you definitely need an NPI! Getting an NPI is easy. Getting an NPI is … [Read more...] about National Provider Identifier
Private Lawsuits Under the False Claims Act
The recent decision in United States v. Regence Blue Cross (10th Cir 12/05/2006) illustrates the power of qui tam, or private, civil lawsuits under the False Claims Act (FCA). Under the FCA, an action can be commenced either by the United States itself, or as a “qui tam†action, by a private person acting “for the United States Government†against providers “in the name of the Government.†The false claim may take many forms: overcharging for a product, failing to perform a service, … [Read more...] about Private Lawsuits Under the False Claims Act
Fifth Circuit: No Private Cause of Action for HIPAA Violations
While HIPAA protects the health information of individuals, it does not create a private cause of action for those aggrieved (65 Fed. Reg. 82566).  This is made abundantly clear from the commentary to the regulations and HIPAA’s legislative history. And while many federal district courts have dismissed individual plaintiffs’ lawsuits under this rule, the Fifth Circuit, in the case of Acara v. Banks (5th Cir. Nov.13, 2006), has become the first federal appellate court to affirm the ruling. … [Read more...] about Fifth Circuit: No Private Cause of Action for HIPAA Violations
