The agency said it will pay 100% of the net payable claims amount in certain cases, drawing praise from stakeholders.
After two years of payment negotiations between inpatient rehabilitation facilitaties (IRF) and the government, the Centers for Medicare & Medicaid Services announced a voluntary settlement offer Tuesday to IRFs with appeals pending.
Facilities that filed appeals at the Medicare Appeals Council (MAC) by August 31, 2018, that are eligible for further appeal will be able to settle their appeals with CMS paying 69% of the net payable amount for all claims connected to the pending IRF appeals, with some situations being offered an even higher payout, the agency said:
The agency said it "will pay 100% of the net payable amount for all IRF appeals in which the claim was denied based solely on a threshold of therapy time not being met where the claim did not undergo more comprehensive review for medical necessity of the intensive rehabilitation therapy program based on the individual facts of the case"; and
The agency said it "will pay 100% of the net payable amount for all IRF appeals in which the claim was denied solely because justification for group therapy was not documented in the medical record."
The settlement offer drew praise from the Federation of American Hospitals (FAH), which was involved in the negotiations, with FAH President and CEO Chip Kahn saying in a statement that the development "is a positive step forward."
"We appreciate partnering with CMS to achieve fair outcomes for the Medicare program, inpatient rehabilitation hospitals, and the patients who benefit from the unique intensive therapeutic care they provide," Kahn said.
Boston Children's Hospital tops the coveted list as the nation's No. 1 pediatric medical center for the sixth straight year.
U.S. News & World Report today unveiled its 2019-20 Best Children's Hospitals rankings, and they look an awful lot like the U.S. News & World Report 2018-2019 Children's Hospital rankings.
For the sixth straight year, Boston Children's Hospital landed in the No. 1 spot on the list's 13th annual Top 10 Honor Roll, while the remaining top pediatric hospitals mostly stood pat, or played musical chairs with one another up and down the coveted roster.
The list ranks the Top 50 pediatric hospitals across the nation in 10 specialties, including: cancer, cardiology & heart surgery, diabetes & endocrinology, gastroenterology & gastrointestinal surgery, neonatology, nephrology, neurology & neurosurgery, orthopedics, pulmonology & lung surgery, and urology.
The Top 10 Honor Roll scored particularly well across multiple specialties.
The patient outcome metrics used to compile the list include mortality and infection rates, available clinical resources, and compliance with best practices.
The top pediatric hospitals based on specific specialties can be found here.
The change will avoid situations in which patients report to a pharmacy counter to discover that their prescriptions cannot be filled, CMS says.
The Centers for Medicare & Medicaid Services announced Monday a proposal to update prior authorization requirements for the Medicare Part D prescription drug program.
The proposed rule would expedite the process under Part D's e-prescribing program, giving clinicians the option to complete prior authorizations online, the agency said.
"Clinicians who select the electronic option will typically be able to satisfy the terms of a prior authorization in real time and before a prescription is transmitted to a pharmacy," the CMS announcement states. "This is so patients do not arrive at a pharmacy counter only to find that their prescription cannot be filled."
The proposal steps from the SUPPORT for Patients and Communities Act and would take effect in January 2021.
