Dec 20, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
Pathologists and medical laboratory managers have only nine months to prepare their labs for ICD-10 implementation
Most clinical laboratory managers and pathologists know that October 1, 2014, is the date for implementation of ICD-10. After that date, each Medicare claim submitted by a medical laboratory must include the ICD-10 code provided by the referring physician.
This is a unique reason why clinical laboratories and pathology groups have keen interest in a smooth transition from ICD-9 to ICD-10. Medicare will reject clinical laboratory test claims that either don’t have an ICD-10 code or have an incorrect ICD-10 code. Thus, labs hope that their client physicians make a smooth transition from ICD-9 to ICD-10. (more…)
Sep 3, 2013 | Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
Commission issues 12 recommendations to enhance physician and patient satisfaction, while creating a financially sustainable healthcare system
How quickly will fee-for-service disappear as a primary source of reimbursement for clinical laboratories, pathologists, hospitals, and physicians? If the recommendation of one credible group of physicians has its way, fee-for-service reimbursement could disappear in as little as five years.
This recommendation was made by National Commission on Physician Payment Reform as part of a report it issued in May. In its press release, the commission issued a call “for eliminating stand-alone fee-for-service payment by the end of the decade.” The group urges a transition over five years to a blended payment system that will yield better results for both public and private payers, as well as patients.” (more…)
Feb 25, 2009 | Laboratory News, Laboratory Pathology
February 25, 2009
Providers might blame soaring healthcare costs in part on caring for uninsured patients, but a new study published by the journal Health Affairs suggests this argument may not hold much water. (more…)
Dec 24, 2008 | Laboratory News, Laboratory Pathology
Hospitals, physicians, laboratories and others have until January 1, 2009, to provide comments on the proposal by the Centers for Medicare and Medicaid (CMS) on three National Coverage Determinations about preventable surgical errors, or “never events.”
Dark Daily readers know that, beginning October 1, CMS stopped paying hospitals for care or services associated with a list of eight “never events.” Other insurers, including Blue Cross and Blue Shield Association, Aetna, Cigna Corp and Wellpoint, have followed the CMS lead, implementing similar nonpayment policies for medical errors.
A never event is the industry term for a serious preventable medical incident occurring while the patient is under the care of a medical provider. The National Quality Forum (NQF) has developed a list of 28 never events, ranging from surgical and other procedural errors to sending an infant home with the wrong parents.
CMS is proposing to add these three categories of errors to its “no pay” list:
- Wrong surgical or other invasive procedures performed on a patient
- Surgical or other invasive procedures performed on the wrong body part; and,
- Surgical or other invasive procedures performed on the wrong patient.
The CMS proposal to expand the number of “never events” on the no pay list is not without controversy. So far, the American Medical Association (AMA) and AHA have voiced disagreement with the proposal. The AMA opposes CMS using its National Coverage Determination process, which dictates procedures Medicare will or will not pay for, to fight surgical errors. Instead, the AMA suggests that the agency “develop a clear payment policy outlining the circumstances under which surgery would not be payable by Medicare.” The AHA also wants CMS to provide a clear definition of what costs or services would not be covered, but also wants the agency to describe how it would assign accountability for an error.
Meanwhile, there is support for the CMS “never event” policy from other sectors of healthcare. Researchers determined that, since CMS announced implementation of the first “never event” policy for eight conditions in August 2007, 23 state hospital associations had adopted policies forbidding or discouraging billing for serious preventable medical errors.
Large insurance companies quickly responded to the CMS announcement on “never events” by instituting their own no-pay policies for “never events. Aetna was first to publicize its policy. WellPoint and CIGNA soon announced similar policies.
Hospital laboratories are already experiencing the impact of the first round of the CMS “never event” policy that took effect on October 1, 2008. Among the eight conditions were nosocomial infections and administering incompatible blood products to a patient. In both cases, laboratory test services play a key role in providing clinicians with information to properly diagnose the patient and chose the appropriate course of treatment.
Related Information:
CMS Proposes Three National Coverage Determinations to Protect Patients from Preventable Surgical Errors
What Are Never Events and Why Do They Matter?
Aug 15, 2008 | Laboratory News, Laboratory Pathology
Reluctance of small and mid-sized physician practices to invest in electronic medical record (EMR) systems has been oft noted by Dark Daily. Now, Medicare is hoping to motivate these physician groups to adopt electronic health records (EHRs) with a new incentive program.
In an effort to jump-start physician adoption of EHR systems, the Centers for Medicare and Medicaid launched a five-year demonstration that offers small and mid-size physicians offices the opportunity to earn bonuses and receive a free EHR system.
Over the five years of the project, each doctor chosen for the demonstration could receive up to $58,000, with a limit of $290,000 per practice. The initiative will operate in Alabama; Delaware; Georgia; Louisiana; Maine; the Maryland/Washington, D.C., area; Oklahoma; and Virginia. Demonstration sites with communities in multi-county areas will also be in South Dakota; Jacksonville, Florida; Madison, Wisconsin; and Pittsburgh, Pennsylvania.
Participation alone will not guarantee the extra Medicare payments. CMS will randomly choose only half of the 200 practices recruited in each community to get EHR incentive payments The other half will serve as a control group and will get no bonuses, even if they use certified systems. Some physicians are frustrated about the prospect of being in the control group and not getting bonuses, but most accept the control group system as necessary.
According to coverage from American Medical News physician practices put into the control group will know from the outset. These groups will be required only to complete an annual survey of their EHR status. They will receive a small fee for participating in the survey. CMS wants to see how physician practices in the group progress in IT adoption, despite not receiving financial incentives from the Medicare program. No physicians in the control group will be required to use an EHR. Incentive payments will not be available to non-primary care doctors or to practices with more than 20 physicians.
“This demonstration is designed to show that streamlining health care management with electronic health records will reduce medical errors and improve quality of care for 3.6 million Americans,” stated Health and Human Services (HHS) Secretary Mike Leavitt. “By linking higher payment to use of EHRs to meet quality measures, we will encourage adoption of health information technology at the community level, where 60% of patients receive care. “We also anticipate that EHRs will produce significant savings for Medicare over time by improving quality of care. This is another step in our ongoing effort to become a smart purchaser of health care-paying for better care, rather than simply paying for more care.”
According to the HHS press release, the demonstration will be open to participation by up to 1,200 physician practices. Over a five-year period, the program will provide financial incentives to physician groups using certified EHRs to meet certain clinical quality measures. A bonus will be provided each year based on a physician group’s score on a standardized survey that assesses the specific EHR functions a group employs to support the delivery of care.
This EHR incentive program demonstrates the federal government’s resolve to push providers to eliminate paper charts and adopt electronic health records. Because this demonstration project will last five years, that fact alone indicates that health policy makers don’t expect to see rapid acceptance of EHRs by small and mid-sized physician groups in the near future.
Related Articles:
HHS Announces Project to Help 3.6 Million Consumers Reap Benefits of Electronic Health Records
CMS selects communities for Medicare EHR bonus pilot project
Doc groups back EHR study (Modern Healthcare subscription required)
