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Washington Debrief: CMS, ONC to Hold Listening Session on EHR Upcoding

April 30, 2013
by Jeff Smith, Director of Public Policy at CHIME
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Jeff Smith, Director of Public Policy at CHIME

CMS, ONC to Hold Listening Session on Billing and Coding The Centers for Medicare & Medicaid Services (CMS) and the Office for the National Coordinator of Health IT (ONC) will host a listening session on May 3 to discuss the increase in code levels billed for some Medicare services, and appropriate coding in an increasingly electronic environment.  Stemming from a pair of high-profile New York Times and Washington Post articles and a letter from Attorney General Eric Holder to five hospital associations, HHS is addressing accusations of fraud via EHRs aggressively.  This session will be important for health IT leaders to understand how government regulators are viewing the issues of upcoding and cloning.  Regulations and / or guidance in the near future are likely.

According to CMS and ONC, topics will include key issues such as the impact of EHRs on high quality clinical care, provider efficiency, and coding, as well as coding challenges and opportunities facing various groups, including hospitals, clinicians, and other stakeholders.  More information and to register for the event, from 9 a.m. to 2 p.m. Eastern Time at the CMS campus in Baltimore can be found here. Webinar and conference call options are presented during registration.

Pioneer ACOs, CMS move closer to agreement on quality measure benchmarks For the better part of two months, Pioneer ACOs [Accountable Care Organizations] and CMS have been at odds over proposed quality benchmarks.  At issue is how the vanguard ACOs will be assessed using quality measures – either based on flat percent benchmarks or benchmarks based on previous ACO performance data.  The methodological approach that Pioneers and CMS develop will be important as larger swaths of providers move into a shared savings or risk-based reimbursement model.  In a letter signed by nearly all of the 32 Pioneer ACOs participating in the CMMI pilot, the group “strongly recommend” that CMS give the ACOs another year to be paid just for reporting on the program’s 33 quality measures, not against benchmarks.  The group argued more data was needed to inform proposed quality measure benchmarks for performance year 2013.  This week, CMMI Director Richard Gilfillan responded by holding to the commitment that Pioneer ACOs would be paid for performance on schedule this year.  He contends the agency has enough data to move away from report-only status, based on quality data submitted by more than 200 ACOs, including those in the Medicare Shared Savings Program.  He continued that, but that CMS will put out proposals “in the near future” about how it intends to use the reported data to calculate the benchmarks.  “We are not going to delay holding ACOs accountable for these quality measures,” CMS spokesman Alper Ozinal said in a statement, “but we will speed up the collection and application of data to these important quality metrics to ensure that they are as accurate as possible.”

Decertified:  ONC Rescinds EHR Certification Ambulatory and inpatient EHR developer EHRMagic Inc. of Santa Fe Springs, Calif., has lost its certified status, according to an HHS news release.  ONC received a tip that EHRMagic-Ambulatory and EHRMagic-Inpatient products were not meeting the required functionality and after an investigation ONC ACB InfoGard Laboratories determined the EHR was not meeting select requirements.  According to ONC spokesperson Peter Ashkenaz no provider has attested to using the system for EHR Incentive Payments, though he did not comment on what a provider should do in the event that their system ends up being retroactively decertified.  “We and our certification bodies take complaints and our follow-up seriously. By revoking the certification of these EHR products, we are making sure that certified electronic health record products meet the requirements to protect patients and providers,” ONC head, Farzad Mostashari, M.D., said.  Here’s more from ONC on their Health IT Buzz Blog.

Harkin Halts Tavenner Confirmation In a move that caught nearly everyone off guard, Senator Tom Harkin (D-Iowa) put a hold on Marilyn Tavenner’s confirmation as the next Administrator of CMS.  According to statements made by Sen. Harkin, he’s upset about the Obama administration’s decision to take money from a preventive health fund created in the ACA and use it for exchange education and enrollment efforts.  “They shouldn’t be taking the money out of the prevention fund for setting up the exchanges.  There are other places they can go for the money.  That’s what we’re going to talk about, I want to see what they’re willing to do,” Sen. Harkin said in a conference call with Iowa reporters.  The Prevention and Public Health Fund has an appropriation of $15 billion through the ACA, but has been cut by $6 billion to help keep doctor payments stable and CMS is looking to take another $454 million to help build the federal health insurance exchange. Tavenner had been on a fast track to confirmation, receiving votes of confidence from both sides of the isle.  Communications will be ongoing, sources from HHS and the Senator’s office indicated.

Edited by Gabriel Perna

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