Follow ACMA
Twitter Facebook Linkedin Instagram
v
GO
Updates & Calls to ActionMake a Donation
PUBLIC POLICY UPDATES

Public Policy Committee: CMS Update


Posted on: 7/11/2016

By Patricia Velky, RN, BSN, MS, MBA, CPHQ, FAACM, FABC, ACM

The Centers for Medicare and Medicaid Services (CMS) continues to pursue a proactive stance to protect both the Medicare trust fund and improve outcomes for beneficiaries. CMS recently held a second Open Door Forum (ODF) call to provide additional details regarding a three-year Medicare pre-claim review demonstration for home health services set to begin in the states of Illinois, Florida, and Texas in 2016, and in the states of Michigan and Massachusetts beginning in 2017.

As noted on the website “CMS is testing whether pre-claim review improves methods for the identification, investigation, and prosecution of Medicare fraud occurring among Home Health Agencies (HHAs) providing services to people with Medicare benefits. Additionally, CMS is also testing whether the demonstration helps reduce expenditures while maintaining or improving quality of care.”

CMS representatives assured callers that the pre-claim review process does not create new documentation requirements, would not delay access to care or alter the Home Health benefit. A key component of the demonstration project is that the documentation to support payment will be submitted earlier in the process. Direct feedback will be provided to the agency on deficiencies in the submitted documentation thus avoiding improper payments to and potential appeals from the Home Health agencies. Specific turnaround times are spelled out in the Operational guide and CMS stressed that this pre-claim review process should not be a barrier to the start of care for any Medicare beneficiary.

For more information, visit CMS.gov or click the link to the fact sheet below: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Pre-Claim-Review-Initiatives/Downloads/Pre_Claim_Review_Fact_Sheet.pdf

Additionally, on July 6, 2016, CMS released the Calendar Year (CY) 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule (CMS-1656-P). Among other things it has key language to implement Section 603 of the Bipartisan Budget Act of 2015, which impacts the way Medicare pays for certain items and services furnished by certain off-campus outpatient departments of a provider. This is often referred to as “site neutral payment.”

Another key component receiving media attention is the proposed removal of the Pain Management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for purposes of the Hospital Value Based Purchasing Program. Changes to the incentive program for EHRs and changes to definitions/documentation requirements for organ procurement agencies are outlined. As always the annual update to the Medicare Inpatient Only (IPO) List (addendum E) is included. For CY 2017, CMS is proposing to remove six procedures from the IPO list. The procedures include four spine procedures as well as two laryngoplasty procedures. The proposed rule also includes for the second year in a row a comment solicitation regarding whether total knee arthroplasty (TKA) should be removed from the IPO list in a subsequent year.

For more information, visit CMS.gov or click the link to the fact sheet below: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-07-06.html

Return to Legislative Postings

Announcements

Save the Date | 2025 Leadership and Physician Advisor Conference

The 2025 Leadership and Physician Advisor Conference is November 12-14 in Boston, MA! Health plans and providers, this conference has everything you need.
Save the date!

SAVE THE DATE | ACMA 2026 National Conference

Join us for ACMA 2026 National Conference, April 20-23, 2026 in Orlando, FL. Don't miss out on the premier case management and transitions of care conference of the year!
Experience ACMA at National!

Share Your Research | Collaborative Case Management

Do you have a project or measurable initiative you've instituted at your organization? Have you conducted research on a current issue in the field? Share your experiences and results with your professional community! Email your proposal or questions: vmatthews@acmaweb.org.
Learn more!

Now Accepting Presentations for Chapter Conferences

We are now accepting presentations for upcoming ACMA chapter conferences. If you have a unique solution, intervention or strategy to improve case management, this is a great opportunity to share your knowledge and be a part of ACMA's national-caliber education at the local level. There is no deadline to submit; presentations will be accepted throughout the year so you can prepare a submission as your schedule allows.
Submit a presentation!

Care Transitions Today Podcast

Our upcoming series, Case by Case, is co-presented by the American Case Management Association (ACMA) and the Association of Physician Leadership in Care Management (APLCM). In the Case by Case series, we delve deep into real-world medical cases, sharing experiences, best practices, and innovative approaches to patient care. Led by returning experts Dr. Rebecca Severe and Dr. Sweta Singh, along with rotating guest panelists, our hosts bring you a new case study, offering a unique learning opportunity for health care professionals at all levels of experience. Learn more!

Get ACMA News in the Palm of Your Hand

Join the conversation with ACMA! Text the keyword ACMA to 844-554-2497 to stay up to date on all the latest news and announcements, delivered straight to your phone!

Karen Vanaskie Scholarship Fund

Karen Vanaskie was one of case management's brightest and most dedicated professionals. She was serving as Secretary / Treasurer on the ACMA National Board of Directors at the time of her unexpected passing on June 21, 2024.

At the request of Karen's family, ACMA has set up the Karen Vanaskie Scholarship Fund. Karen was passionate about the need for case management certification. She actively supported her staff in pursuing the Accredited Case Manager (ACM) Certification. To continue her legacy, this scholarship fund will cover the cost of their ACM certification application fee for those to whom it is awarded. We believe this continues Karen's legacy.

To apply for the scholarship, click here. For eligibility details, please see below.

To donate to the scholarship fund in Karen's memory, click here.

2024 National Survey Results are Live!

ACMA and APLCM are proud to announce the latest iterations of the National Case Management and Transitions of Care Survey and the Physician Leaders in Care Management Survey, which have been the only source of comprehensive data for the case management industry since 2001. This ongoing research incorporates over 20 years of data, offering invaluable insights into the evolving landscape of case management, transitions of care, and physician advising. Access the full reports through your ACMA and APLCM member portals!

SAVE THESE DATES | National Case Management Week

2025 - October 12-18
2026 - October 11-17
2027 - October 10-16
2028 - October 8-14

American Case Management Association
17200 Chenal Parkway Ste 300 #345
Little Rock, AR 72223
Phone: 501-907-ACMA (2262)
Fax: 501-227-4247