Healthcare Regulatory 2008 Update

Healthcare Articles

HealthLine Newsletter Articles

October 2007 Program
Presented by
Amper’s Healthcare Services Group

Regulatory Update

Hospital Services

Bush veto of SCHIP expansion sets stage for override battle
Half of U.S. Hospitals reporting to Leapfrog say they won't bill for a "Never Event"
Increase of 3.3 percent, effective October 1, 2007, for Inpatient PPS hospitals providing quality data
MB-2.0 percent, or 1.3 percent for those not submitting data
For FY 2008: DRG’s two thirds on cost; one third on charges
The adopted "Medicare severity" adjusted DRGs (MS-DRGs)
MS-DRGs split some current DRGs based on
- MCCs – major complications or comorbidities
- CCs – complications or comorbidities
- No CCs
To receive the full hospital update for FY 2008, hospitals will be required to report 27 measures
Industry sees need for cost reporting changes to improve accuracy of cost-based DRG weights
Medicare drug benefit has greatly increased seniors' coverage; some still vulnerable to high costs, says study
U.S. not-for-profit 2007 small hospital median ratios modestly improve: S&P
Promises to improve military health care have not been fulfilled, GAO report finds

Physician/Ambulatory Services

HHS Secretary Leavitt announces plan to share Medicare physician performance measures through local value exchanges.
CMS announces next steps toward full implementation of NPI
CMS announces Medicare premiums, deductibles for 2008
Tamper-resistant prescription pad requirement extended until next year
CMS awards contract for ICD-10 impact analysis
NPI: See when your carrier will reject claims with mismatched numbers
Stark III: Third phase of rule adjusts some self-referral exceptions
Assistant-at-Surgery: NPPs can step in when physicians are not available to help a surgeon
NPIs and UPINs: How to find physician and practice ID numbers
UPIN extension: CMS grants 8 more months to use UPIN Registry – May 2008
Revalidation: Top 100 billers per carrier to see revalidation letters
Imaging: House proposal calls for more cuts to imaging services
CCI: Over 14,000 codes in latest CCI update
MAC: Third MAC contract awarded to WPS
CMS-855: Carriers instructed to use contact person for approvals and denials
Weems takes the helm: New CMS administrator named; is awaiting permanent approval
House Calls: Turn profits with a turn-of-the-century office practice
ASC billing: The new payment system
ASC: The final rule adds new procedures
PQRI: Bonuses could grow in 2008
Missed appointments: Practices get go-ahead to bill for no-shows
CMS announces big change in program

Compliance Regulations

ZPICS to do more pay suspension
State-Federal training is under way for OIG quality initiative; never events a big focus
Fraud motives are familiar, but investigative trends have evolved
Clarifying observation rules for physicians
OIG guidance for boards provides quality-of-care queries for execs
Complying with the Deficit Reduction Act
Compliance assessment: Medicare bad debts
Fourteen anti-fraud measures for electronic health records released
Hospitals hammer away at unnecessary admissions for chest pain, high-error DRG’s
CMS finalizes 2008 IPPS and its MS-DRG’s; challenges lie in sequencing for payment
Mandated present-on-admission reporting starts Oct. 1; training needed to avert losses
OIG: compliance auditing is key factor for CCAS; huge settlements diminish chances

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