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WHEN: Wednesday, December 17, 2014
TIME: 1:30pm – 3:00pm Eastern Time


The Centers for Medicare & Medicaid Service (CMS) will host a Special Open Door Forum (SODF) call to allow consumers, home health agencies (HHAs), and other interested parties to give input and feedback on the planned addition of star ratings to Medicare.gov’s Home Health Compare (HHC) web site

CMS is committed to making it easier for consumers to seek and utilize the best care for themselves and their loved ones, and meeting the information needs of health care consumers is the primary aim of CMS’ Compare websites.    

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Shared Savings Program Proposed Rule reflects focus on primary care and improved incentives for participation, quality, and efficiency  

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CMS is pleased to announce that the 2013 Physician Quality Reporting System (PQRS) and 2013 Electronic Prescribing (eRx) Incentive Program feedback reports are now available for eligible professionals who submitted quality data on Medicare Physician Fee Schedule Part B services between January 1, 2013 and December 31, 2013.

Individual eligible professionals who submitted 2013 PQRS data, or individual eligible professionals and group practices who submitted 2013 eRx data, can retrieve their 2013 Feedback Reports through two methods: 

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The OIG determination that E&M coding, especially the determination of new patient vs. established patient criteria will become an increasingly important area for physician practices, especially inside institutions that are switching EMR and billing records. Many of these conversions have led to erroneous classification. 

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The number of uninsured is expected to decline by nearly half from 45 million in 2012 to 23million by 2023 as a result of the coverage expansions associated with the Affordable Care Act, according to a report from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary. The report is being published today in Health Affairs.  

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The Centers for Medicare & Medicaid Services (CMS) today announced changes to the Medicare home health prospective payment system (HH PPS) for calendar year (CY) 2015 that will foster greater efficiency, flexibility, payment accuracy, and improved quality. Approximately 3.5 million beneficiaries received home health services from nearly 12,000 home health agencies, costing Medicare approximately $18 billion in 2013.  

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The goal of the Centers for Medicare & Medicaid Services (CMS) Administrative Simplification initiatives is to standardize certain transactions in order to lower costs, increase efficiency and accuracy, and reduce the clerical burden on providers. A new report, the 2013 U.S. Healthcare Efficiency Index, which tracks data from health care transactions, shows the potential of Administrative Simplification to achieve this goal and realize savings across the health care industry.

2013 Index Results
The study shows that in many cases, switching to electronic processes for health care administrative transactions presents an opportunity to greatly reduce costs: 

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After attending the AICPA’s Banking and Saving Institution’s Annual Conference in Washington, D.C. in September 2014, financial institutions have expressed concern over preparation for the FASB’s proposed Current Expected Credit Loss (“CECL”). Significant differences exist between the current historical loss rate method used to calculate the allowance for loan and lease losses (“ALLL”) and the new CECL model proposed by the FASB. Due to the proposed changes, the CECL model will require financial institutions of all sizes to recognize an immediate allowance for credit losses that represents all expected losses. The proposed model would likely increase a bank’s ALLL by 30-50%, as stated by the OCC’s Thomas Curry and includes gathering and computing a significantly higher volume of data.  Additionally, it was noted that Institution’s should began preparing for the impact of the issuance of the CECL model, in 2018-2019, by beginning the accumulation of this data now.  For additional information or assistance please contact James Dowling (James.Dowling@marcumllp.com) of the Marcum Financial Institutions Services Group.     

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Administration has closed approximately 450,000 citizenship and immigration status data matching cases and another 210,000 are in progress; warns remaining consumers to respond quickly or their Marketplace coverage could end.

The Federal Health Insurance Marketplace began sending notices this week to consumers with a citizenship or immigration data matching issue (also called an inconsistency) who have not responded to previous notices via mail, email, and phone. While the Federal Marketplace has already received documents and cleared a large number of data inconsistencies related to citizenship or immigration status, consumers who have not yet responded must act now and submit supporting documents by September 5 or their Marketplace coverage will end on September 30.

A citizenship or immigration data matching issue can happen when the information reported in a consumer’s application, such as a Social Security or Permanent Resident Card number, is incomplete or different than the information the government has on file. A data inconsistency does not necessarily mean there is a problem with an individual’s eligibility for enrollment; it means that additional information is needed to verify the information provided in an application. However, if these supporting documents are not received, health insurance plans will be terminated in order to ensure program integrity and protect taxpayer dollars. 

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Administration redoubles its efforts to improve quality of post-acute care for Medicare beneficiaries

Today, the Centers for Medicare & Medicaid Services (CMS) announced two initiatives to improve the quality of post-acute care. First, the expansion and strengthening of the agency’s widely-used Five Star Quality Rating System for Nursing Homes will improve consumer information about individual nursing homes’ quality. Second, proposed new conditions of participation for home health agencies will modernize Medicare’s Home Health Agency Conditions of Participation to ensure safe delivery of quality care to home health patients.

“We are focused on using as many tools as are available to promote quality improvement and better outcomes for Medicare beneficiaries,” said Marilyn Tavenner, CMS administrator. “Whether it is the regulations that guide provider practices or the information we provide directly to consumers, our primary goal is improving outcomes.” 

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