On August 5, 2010, four major insurers announced meaningful use incentives.  Aetna, Highmark, UnitedHealth Group and WellPoint, at minimum, will align their pay-for-performance programs with federal meaningful use criteria.  In a joint statement, National Coordinator for Health Information Technology David Blumenthal, M.D., and Centers for Medicare and Medicaid Services' Principal Deputy Administrator Marilyn Tavenner, stated:

Summary of Changes to Questions Sets - Second Quarter 2010

We would like to notify you of changes that have been made to the ComplyTrack Risk Assessment questions in the Comprehensive Library for the Provider Baseline. As part of the Quarterly Review Process, the following Risk Assessments were reviewed this quarter:

On June 11, 2010, CMS issued a transmittal containing the first two chapters of a new Manual.  The Manual is Pub. 100-22 and is titled "Medicare Quality Reporting Incentive Programs".  The Manual addresses the Physician Quality Reporting Initiative (PQRI) and E-Prescribing (eRx) Medicare Quality Reporting Incentive Programs.  The Manual does not establish new requirements for the PQRI and eRx programs.  It simply manualizes existing requirements to the programs. 

CMS published the 2011 Inpatient Prospective Payment System Proposed Rule on May 4, 2010.  This year's proposals include changes to the MS-DRG payment rates for 2011, clarification on provider aggreements and supplier approvals, new COPs (Hospital Conditions of Participation) for Rehabilitation and Respiratory care services, and accreditation requirements for Inpatient Psychiatric services for individuals under the Age of 21.

This year's rule is 472 pages, with additional data and files not included in the rule (published instead on the CMS website).

On May 5, 2010, CMS issued an interim final rule implementing provisions of the Patient Protection and Affordable Care Act (PPACA).  The rule implements the provision which requires all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the programs.

Questions, questions, some answers, but more questions as I reflect on the 2010 ICD-10 AHIMA Summit that I attended earlier this week. One of the big questions is are YOU ready for this big change in healthcare and have you started to PREPARE? ICD-10 will affect all aspects in healthcare (payers, providers, vendors, clearinghouses, third party administrators, independent laboratories, employers, and researchers) to name a few. 

The March issue of the Harvard Business Review contains an article by Mary Gentile called Keeping Your Colleagues Honest.  HBR adapted from that article to provide one of its recent Management Tips of the Day.  For those of us in compliance, we are often forced to raise and confront others on ethical issues.  This can be challenging!  Read through these tips and think about how you presently handle these situations.  Can you do it better?  These tips may help make any future discussions you have just a little less painful.

CMS is once again deeming claims as “insufficient documentation” if the provider’s signature is missing or illegible as part of a post-payment review.  According to the Medicare Program Integrity Manual (Pub 100-8) Ch. 3, Sec.