Hombre Documents

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11/14 Daily Sweep

CMS Requests Comments on Policies and Standards for Medicare ACOs

HHS and DOL Seek Market Information to Aid Development of Process for Federal External Review of Health Plan Denials

NAIC Posts Agenda for Monday Session on Revisions to Model Legislative Language

CMS Corrects Deadline for Comments on Proposed Rule on MA, PDP Changes for 2012

PhRMA Names Executive Vice President of Advocacy

These are examples of what our research platform is tracking today.

Download 11 15 ContentHealth News Release

Download 11 10 MA PDP Proposed Rule

Download 11 12 ACO RFI

Download 11 12 External Review Process

Download 11 12 CMS Correction Notice

Download 11 10 CRS Report

Download 11 09 Medicaid Final Rule

Download 11 05 Medicaid RAC Rule

Download 11 05 Final APC Report

Download 11 04 Part B

Download 11 04 Part A (2)

Download 11 04 Part A for Uninsured

Download 11 03 Medicaid Proposed Rule

Download 11 02 Home Health PPS Final Rule

Download 11 02 Physician Payment Final Rule

Download 11 02 OPPS ASC GME Final Rule

Download 10 29 CMS Notice on Care Transitions Meeting

Download 10 21 LTC Proposed Reg

Download 10 21 HHS Notice on NQF

Download 10 21 Joint Commission Notice

Download 10 21 Info Collection on EHR Incentives

Download 10 21 Info Collection on New Tech APCs

Download 10 21 AHRQ Patient-Safety Events

Download 10 08 HHS Interim Final Rule on EHR Certification

Download 10 08 HHS Notification on Transaction Standards

MySweep Linked Documents

Download 9 17 Outpatient Instructions

Download 9 10 ASC Instructions

Download 9 17 Physician Instructions

Download 9 09 APC Panel

MySweep Demo -- Medicare payment systems

CMS Posts C-Codes for October HCPCS Update (sept 8)

CMS Posts Updated File of C-Codes for Quarter Starting in October (sept 17)

cite the fact that the file was updated on the 17th, then link to the 17th file

CMS Instructions Address Outpatient PPS Update for Quarter Starting in October (sept. 20)

hospitals required to report device category c-codes used for claims billed for procedures in outpatient hospital setting. This file contains c-codes for:

- several c-codes for MRA -- to implement NCD -- effective June 3. Per CMS instructions (below): effective for claims with dates of service on or after june 3, cms permits local contractor to cover or not all indications of MRA not specifically nationally covered or nationally non-covered. cms creted 6 c-codes to allow opps providers to bill for certain MRA services previously non-covered but that may not now be covered at local medicare contractor discretion. must use in place of codes for previously non-covered services. (lists specific replacement codes, and codes being replaced). Some status indicator changes -- from E to B to indicate not recognized by opps for certain bill types.

new hcpcs codes assigned "Q3" status indicator to indicate will be paid with one composite apc payment each time a hospital bills for second and subsequent imaging procedures in he same imaging family on a single date of service.

shows table of mra codes -- perhaps extract this for mysweep

the other c-code noted above -- for endo -- is for an implantable endoscope: gets a pass-through category.

- do reference to the ncd: http://www.cms.gov/mcd/viewnca.asp?where=index&nca_id=236&basket=nca:00142R:236:Magnetic+Resonance+Angiography+%28MRA%29:Closed:1st+Recon:7

- Endo, colon, retro imaging -- new code effective 10/1

CMS Instructions Provide for October Update to ASC Payment System (sept 13)

- on MRA, seems to copy the opps transmittal language, so handle these as a package -- but note separate payment indicators for ASC . . . so may want to show this as a table, along with opps table

CMS Instructions Provide Update to Medicare Physician Fee Schedule Database for Quarter Starting in October (sept 20)

see language re MRA -- same issue as above. so here change procedure status for cpt 72159 and 73225, effective june 3 dates of service.

72159 -- now R (check cch)

73225 -- R

- this is from asc instruction: pass-through category is the endo, colon code C1749

CMS Posts Recommendations, Other Materials from Session of APC Advisory Panel (sept 9)

- stress that cms made available detailed info from aug. meeting (so doesn't look like old news); here are some items noted:

- panel recommends cms report back on reason for decline in median cost for APC 0307, Myocardial Positron Emission Tomography Imaging from cy 2010 opps to proposed cy 2011 opps. a forecast item

[perhaps forecast items are distinct set of

also consideration to cpt 31627 -- bronchoscopy, including fluoroscopic guidance, with computer-assisted image-guided naviagation: recommended continue to be assigned status indicator of "N" (paid under opps, but packaged -- double check in cch) + cms provide claims data for at panel;s winter 2012 meeting re this code. -- flag latter item as a "forecast"

This is from ASC instruction: "This instruction provides information on one newly created pass-through device HCPCS codes, five newly created drug HCPCS codes, and six newly created HCPCS codes describing imaging services that will be added to the ASC list of covered ancillary services effective October 1, 2010."

My-Sweep Demo -- Coverage

Medicare & Private Payer Coverage

new: cigna mra: http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0154_coveragepositioncriteria_magnetic_resonance_angiography_mra.pdf

bcbs fla (don't link): Download 10 1 Fla Virtual Colonoscopy

bcbs fla (don't link): Download 10 1 Fla Ophth imaging

bcbs minn: http://notes.bluecrossmn.com/web/medpolman.nsf/8c1a3acbf6f126e1862574ea0050a7f2/b250001fdb8fc2a5862577a0005db337?OpenDocument

harvard pilgrim: non-covered services: https://www.harvardpilgrim.org/pls/portal/docs/PAGE/PROVIDERS/MANUALS/PAYMENT%20POLICIES/H-3%20NON-COV%20SERVICES_091510.PDF

harvard pilgrim: radiology services: https://www.harvardpilgrim.org/pls/portal/docs/PAGE/PROVIDERS/MANUALS/PAYMENT%20POLICIES/H-5%20RADIOLOGY_091510.PDF

harvard pilgrim: electrocardiography: https://www.harvardpilgrim.org/pls/portal/docs/PAGE/PROVIDERS/MANUALS/PAYMENT%20POLICIES/H-6%20TTE_091510.PDF

Horizon, just outside sweep period:

Horizon BCBSNJ

Uniform Medical Policy Manual

Section:

Surgery

Policy Number:

121

Effective Date:

10/24/2010

Original Policy Date:

08/24/2010

Last Review Date:

Date Published to Web:

09/22/2010

Subject:
Image-Guided Minimally Invasive Lumbar Decompression (IG-MLD) for Spinal Stenosis

Description: Download 10 1 Horizon Image Guided

A/B MAC for Jurisdiction 12 Revises Multiple LCDs (and Related Articles) to Reflect Certain Billing Code Updates (September 8) -- applies to contractor numbers 12102, 12202, 12302, 12501, 12301, 12201, 12401, 12402, 12101, 12502 -- stated as "J12"

J12 =

Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania

these 2 lcds posted for notice . . . become effective November 5 (draft lcds -- comment period concluded; notice period started 8/11)

- cardiovascular nuclear medicine (this is a new original lcd for Parts A and B)

- dynamic electrocardiography (this is a new original lcd for Parts A and B

A/B MAC for Jurisdiction 4 (Texas, CO, OK, NM) Posts Revised LCDs for . . . Diagnostic Colonoscopy -- all items in this entry: changes in diagnosis codes, consistent with CMS instructions -- cite as example of implementation of new ICD-9 coding changes -- take effect 10/1. . . MRI and CT Scans of Thorax and Chest -- . Abdominal and Retroperitoneal Ultrasound -- . Transthoracic Electrocardiography . . . Electrocardiogram (+, on electrocariogram, corrected typos on 8/25) . . . Electrodiagnostic Studies . . . Non-Invasive Venous Studies . . . Non-Invasive Cerebrovascular Studies . . . . (sept 9)

A/B MAC for Jurisdiction 9 (Florida, Puerto Rico, U.S. Virgin Islands) Posts Comments/Responses on Draft LCDs for . . . Various Noncovered Services (sept. 10)

- category III codes for certain injection services [specified in item] made non-covered because ultrasound component not considered standard of care.

[0228T - Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level; 0229T - Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; each additional level (List separately in addition to code for primary procedure); 0230T - Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level; and 0231T - Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; each additional level (List separately in addition to code for primary procedure)]

Mass BCBS (sept. 21)

BCBS of North Carolina Posts 3 Revised Coverage Policies (sept 16)

new policy for Image-Guided Minimally Invasive Lumbar Decompression takes effect Nov. 23

BCBS of Tennessee Posts Draft Coverage Policy on MRI of the Breast (sept. 17) -- disappeared . . . check to see if reappears in a pre-efffective date posting

Oxford Posts Revised Policies for . . . Preventive Care . . . (sept. 20) -- many private plans will be doing this -- tied to sept. 23 effective date for ACA. (plan years after sept. 23)

ACA requirements of no cost sharing for non-grandfathered plans generally tracks USPSTF -- A or B recommendation. Oxford will also cover services not required under ACA, including:

- Mammography (film and digital) screening for all adult women (no age requirements)

- CT Colonography for screening for colon cancer

Image Guided Minimally Invasive Lumbar Decompression (IGMLD) for Spinal Stenosis (new -- not covered) -- write little story, then have link at end and direct viewer to item in the linked document

/B MAC for Jurisdiction 4 Posts Draft LCDs for . . . Renal Angiography (sept 20) -- appears to be draft new original lcd

- comment period starts October 10 -- runs until November 29 -- highlight this in red re possible action

- sets advis comm dates:

TX – 10/13/2010

CO – 10/14/2010

NM – 10/12/2010

OK – 10/06/2010

Text -- Value Proposition 2

Health Care Environment = Complex, Fast-Moving Reforms That Confront Organizations with Disruptive New Threats/Opportunities

ContentHealth Capabilities = Extensive Subject Matter Expertise + Proprietary Platform That Probes Deep Strata of Facts/Data to Generate Instantaneous, Actionable Intelligence

Measures of Value = Products/Services That Make Health Care Change Visible and Understandable so that Organizations Can Anticipate and Manage Them

Text -- Value Proposition

Environment = Disruptive, Fast-Moving Reform That Defines Threats/Opportunities for Health Care Organizations

ContentHealth LLC = Extensive Subject Matter Expertise + Proprietary Platform That Generates Deep, Instantaneous, Actionable Intelligence

Value = Products/Services That Make Health Care Change Visible and Manageable

MySweep Demo -- Public Policy

Public Policy Environment

CMS Posts Updated Qs and As on Medicare Imaging Demonstration Project (Sept. 7)

Section 135(b)of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) mandates an Appropriate Use of Imaging Services demonstration project. The goal of the demonstration is to collect data regarding physician use of advanced diagnostic imaging services to determine the appropriateness of services in relation to established criteria and physician peers.

additional info: http://www.cms.gov/demoprojectsevalrpts/md/itemdetail.asp?itemid=CMS1222075

PricewaterhouseCoopers Publishes Report on New Health Care Business Models Founded on Wireless Technologies (sept 8)

- no apparent connection to imaging

NE Journal of Medicine Piece Says USPSTF's Mammography Recommendations Point Up Innovation's Continuously Diminishing Returns as Threshold for Intervention Falls (sept 8)

- context is USPSTF mammo recs. "Behind the panel’s conclusions regarding mammography lurks an unwelcome reality that our profession has often failed to acknowledge. Every medical intervention — no matter how beneficial for some patients — will provide continuously diminishing returns as the threshold for intervention is lowered."

House Energy and Commerce Health Subcommittee Posts Witness List, Briefing Memo for Wednesday Hearing on Public Health Legislation (sept 13)

- bill to reauthorize telehealth and telemedicine grant programs: among bills on which health subcom held hearing on sept 15.

This bill reauthorizes three telehealth programs currently administered by the Health Resources and Services Administration (HRSA), including (1) the telehealth network program, (2) the telehealth resource center program, and (3) incentive grants to coordinate telemedicine activities among the states. The bill also revises the requirements for funding priorities within both the telehealth network and telehealth resource center programs. It authorizes each of the three programs at $10 million for each of fiscal years 2012- 2016.

- throw in a forecast that takes into account what actually happened to the bill in the post-sweep period

MedPAC Posts Transcript of September Meeting (sept 15)

- context for imaging was re consideration of growth of ancillary services in physicians' offices

- references: staff brief -- http://www.medpac.gov/transcripts/in%20office%20ancillary%20svcs%20meeting%20brief%20Sept%202010.pdf

- presentation -- http://www.medpac.gov/transcripts/In-office%20ancillary%20services_Sept%202010_public.pdf

- full transcript (pages -- note specific pages) ) -- http://www.medpac.gov/transcripts/913-914MedPACfinal.pdf

cite public commenters + try to summarize gist

National Priorities Partnership sept 21 meeting (sept. 17)

- materials cited examples of alleged imaging overuse . . . do quick hits on them via search functions -- perhaps package with nqf item below and note importance of quality standards.

National Quality Forum Posts . . . Agenda . . . Materials . . . for Thursday Board Meeting (sept 21)

- materials similar, perhaps same as, priority partnership. note minutes from previous meeting . . . signals fact that imaging part of ongoing quality measures conversation. do this is fly-by, quick hit fashion

CMS Releases Updated Materials from This Week's ICD-9 Session (AHA Article on Partial Code Freeze is Here) (sept 17)

- materials on icd-10: 2,900 icd-10 code totals for imaging

- in gen. need minutes to know what happened at meeting. so report the code freeze item, below, as a policy item, throwing in the number of icd-10 imaging codes (above, from meeting materials, as punctuation)

The Centers for Medicare & Medicaid Services this week announced that, because of the magnitude and complexity of the transition to ICD-10 coding system, the agency will implement a partial code set freeze, beginning in October. The ICD-10 coding system is scheduled to replace the ICD-9 coding system for medical diagnosis and inpatient hospital procedures on Oct. 1, 2013. The partial code set freeze will be implemented as follows: CMS will suspend issuance of regular annual updates to both ICD-9-CM and ICD-10 code sets starting on Oct. 1, 2011; on Oct. 1, 2012, only a limited number of new technologies and disease codes as required by section 503(a) of Pub. L. 108- 173 will be allowed; on Oct. 1, 2013 only a limited number of code updates to ICD-10 code sets will be permitted to capture new technologies and diagnoses as required by section 503(a) of Pub. L. 108-173. There will be no further updates to ICD-9-CM after Oct. 1 2013 since it will no longer be used for reporting purposes. On Oct. 1, 2014, regular updates will resume to ICD-10 coding. The AHA and others advocated for the partial freeze.

Hombre Documents

Money/Medicine Policy Surveillance Service

AJMC Article Abstract

APC

12/03 Call for TEC

11/15 HealthHombre Joins Suite of New Advisory Products and Services Offered by ContentHealth LLC

11/14 Daily Sweep

MySweep Linked Documents

MySweep Demo -- Medicare payment systems

My-Sweep Demo -- Coverage

Text -- Value Proposition 2

Text -- Value Proposition

MySweep Demo -- Public Policy

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