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Health Affairs Blog: Safety Net Challenges in Delivering Accountable Care
by Stephen Shortell

Medicare UB-04 Revenue Codes
UB-04

CMS is funding a demonstration project called the Advanced Primary Care Demonstration. According to CMS: This initiative is designed to evaluate the impact of the advanced primary care practice (APCP) model, also known as the patient-centered medical home (PCMH), on improving health, improving quality of care, and lowering the cost of care provided to Medicare beneficiaries served by Federally Qualified Health Centers (FQHCs). Created by the Affordable Care Act, it will pay an estimated $42 million over three years to 500 FQHCs to coordinate care for almost 200,000 Medicare beneficiaries.
APCP Fact Sheet
More information can also be found on the APCP Home Page (Advanced Primary Care Practice)

The below link is to a CDC article. Included is a health risk assessment questionnaire in regards to forms for use in capturing the needed information for an AWV for Medicare patients.
http://www.cdc.gov/policy/opth/hra/FrameworkForHRA.pdf

The CMS MLN article linked below updates the enrollment timeline for providers to submit the 855 forms from 30 days prior to effective date to 60 days prior to effective date.
CMS MLN
   
CMS has designed a website to provide information on services covered by the Medicare Physician Fee Schedule (MPFS). It provides information on more than 10,000 CPT codes. The associated relative value units (work, practice expense, and malpractice), fee schedule amounts by geographic locality, global days, payment status for Medicare
CMS Fee schedule and RVU look up

Institutional providers (i.e., all providers except physicians, non-physicians practitioners, physician group practices and non-physician practitioner group practices) must submit an application fee or hardship exception when initially enrolling, revalidating their enrollment; or adding a new Medicare practice location. The CY 2012 fee of $523.00 is required with any Medicare enrollment application submitted on or after Sunday, January 1, 2012 and on or before Monday, December 31, 2012.
For more information about how the fee was calculated, see the Federal Register Notice. See MLN Article SE1130 to learn how to pay the fee for Medicare enrollment actions.

When Public Beats Private: Community Clinics That Keep Costs Down and Do a Better Job, Too.
Read full article by: Lindsay Abrams  
 
CHCs often have unique arrangements with lab, radiology, or other diagnostic firms that afford more optimal pricing in terms of self-pay patients or at times an agreement to provide self pay patient work for free. This is, of course, in exchange for their receipt of all insured patient work for which they can bill and be paid. This sort of arrangement, created to be certain ALL patients receive necessary care regardless of ability to pay, is a clear cut violation of the Federal Anti-Kick back statute. However, in 2007 an exception was created to legally protect CHCs in this regard. The link below discussed the exception in detail.
Health Center Safe Harbor

8 Qualities of Remarkable Employees
Forget good to great. Here's what makes a great employee remarkable.
http://www.linkedin.com/news

Published by CMS this manual describes Medicare benefits for each provider/service type. Chapter 13 concentrates on Rural Health Center (RHC) and Federally Qualified Health Centers (FQHC).
Medicare Benefit Policy Manual - Chapter 13 FQHC

Published by CMS this manual contains the billing requirements for each provider/service type. Use this manual in conjunction with the Benefits Policy Manual. Contents include rules, regulation and information on completing claims, payment methodology, allowable costs, and cost report detail. Chapter 13 concentrates on Rural Health Center (RHC) and Federally Qualified Health Centers (FQHC).
Medicare Claims Processing Manual - Chapter 9 FQHC

MLN Matters® are national articles designed to inform Medicare FFS providers about the latest changes to the Medicare Program. Articles are prepared in consultation with clinicians, billing experts, and CMS subject matter experts. They are tailored, by content and language, to specific provider type(s) who are affected by complex Medicare changes. MLN Matters® articles help explain critical provider information in an effort to reduce the amount of time providers need to incorporate these changes into their Medicare-related business functions. Since 2004, CMS has issued over 3,500 articles.
Medicare Learning Network

Our annual PPS report is now available on the "State Issues" webpage. This report is a compilation of PCA responses to an assessment conducted over the summer and provides a snapshot of what the PPS methodology and rules look like in each state.
http://www.nachc.com/client//2011%20PPS%20Report%20SPR%2040.pdf

This page contains a Compliance widget for our website.
http://oig.hhs.gov/compliance/provider-compliance-training/index.asp

The Office of Inspector General (OIG) of the U.S. Department of Health & Human Services (HHS) is the leader of the Nation's efforts to fight waste, fraud, and abuse in Medicare, Medicaid and more than 300 other HHS programs. The OIG has developed a series of voluntary compliance program guidance documents to encourage the development and use of internal controls to monitor adherence to applicable statutes, regulations, and program requirements.
OIG Compliance Guidance for Group Practices

The OIG Work Plan is published annually and provides brief descriptions of activities that OIG plans to initiate or continue with respect to HHS programs and operations in fiscal year 2012. The Work Plan describes the primary objectives of the OIG's work during a particular year.
OIG 2012 Workplan

Take a look at this site to see the entire Office of the Inspector General (OIG) Work Plan for 2012. Use this to see if your Compliance Plan for 2012 is adequate AND what key risk areas you want to address.
OIG Work Plan