Thursday, December 5, 2013

Medicare Physician Fee Schedule Expands Telehealth Coverage

CMS' recently released finalized Medicare Physician Fee Schedule for 2014 includes expanded coverage for telehealth services and increased reimbursement payments for such services, MedPage Today reports (Pittman, MedPage Today, 11/27).


In July, CMS proposed a policy change that would expand payments for telehealth services under the Medicare Physician Fee Schedule for 2014.
The agency said it was seeking evidence to "demonstrate the service furnished by telehealth to a Medicare beneficiary improves the diagnosis or treatment of an illness or injury" or boosts patient function (iHealthBeat, 7/9).

Details of Telehealth Rules

Under the finalized fee schedule, Medicare coverage for telehealth services will be expanded to rural areas as defined by the Office of Rural Health Policy.
The American Telemedicine Association says the new language will expand Medicare coverage of telehealth into the "fringes of metropolitan areas."
In addition, telehealth reimbursement rates for originating patient sites will increase from $24.43 to $24.63.
However, CMS said it does not have the authority to "waive the geographic telehealth requirements" for rural health clinics "that do not meet any of the requirements to serve as an originating site."
CMS officials said the agency is working with the Health Resources Services Administration to create a website to help providers determine their eligibility to serve as an originating site for telehealth services (Brino, Government Health IT, 12/3).
CMS will publish the final rule on Dec. 10 (Herman, Becker's Hospital Review, 12/2).

ATA's Response

In a release, ATA called the telehealth provisions in the fee schedule "good news."
ATA CEO Jonathan Linkous said, "The proposed new rules, while incremental, represent another step toward integrating the use of telecommunications technology into the delivery of health care" (ATA release, 11/30).

The Office for Civil Rights Did Not Meet All Federal Requirements in Its Oversight and Enforcement of the Health Insurance Portability and Accountability Act Security Rule



The Office for Civil Rights (OCR) did not meet certain Federal requirements critical to the oversight and enforcement of the Health Insurance Portability and Accountability Act Security Rule (Security Rule). OCR had not assessed risks, established priorities, or implemented controls for its Federal requirements to provide for periodic audits of covered entities to ensure their compliance with Security Rule requirements. In addition, OCR's Security Rule investigation files did not contain required documentation supporting key decisions made because management had not implemented sufficient controls, including supervisory review and documentation retention, to ensure investigators follow investigation policies and procedures for properly initiating, processing, and closing Security Rule investigations. Further, OCR had not fully complied with Federal cybersecurity requirements for its information systems used to process and store investigation data because it focused on system operability to the detriment of system and data security.
We recommended that OCR (1) assess the risks, establish priorities, and implement controls for its HITECH auditing requirements; (2) provide for periodic audits in accordance with HITECH to ensure Security Rule compliance at covered entities; (3) implement sufficient controls, such as supervisory reviews and documentation retention, to ensure policies and procedures for Security Rule investigations are followed; and (4) implement the National Institute of Standards and Technology Risk Management Framework for systems used to oversee and enforce the Security Rule. In its comments on our draft report, OCR generally concurred with our recommendations and described the actions it has taken to address them. In specific comments on our second recommendation, however, OCR explained that no funds had been appropriated for it to maintain a permanent audit program and that funds used to support audit activities previously conducted were no longer available.
Get the entire report in PDF here

Humana's Accountable Care Initiative

Kentucky based health care company, Humana Inc. ( HUM ) has inked a collaborative Accountable Care deal with St. Luke's University Health Network. St. Luke's University is an integrated Network in the north eastern Pennsylvania area, comprising six acute care hospitals and over 1400 physicians. This initiative is in sync with the company's agenda to provide high-quality care to medical members at an affordable price. 

This agreement will allow Humana to foray into the Pennsylvania region and provide its HMO and PPO plan designs throughout eastern Pennsylvania in association with St. Luke's hospitals, physicians and affiliated facilities. In turn, improvement in medical member outcomes, quality of care and reduction in costs are slated to fetch rewards for these physicians. These incentives are thus aimed to bring more cost-effective and superior quality patient care for Humana members. St Luke's was chosen in particular for this Accountable Care agreement by Humana, as the locations allow beneficiaries easy access to the requisite services. 

Humana's Accountable Care initiative is similar to an Accountable Care Organization (ACO).  An ACO is a collaboration of health care providers who voluntarily form alliances to provide coordinated high quality care to patients at lower costs. In line with the objectives of an ACO, the aforementioned deal will provide a number of personalized care and population management tools including predictive analytics, chronic care, disease management and wellness programs. 

Humana currently consist of 33000 primary care physicians and is in Accountable Care association with 900 organizations. The above deal is an extension to its existing portfolio. Initiatives like these are intended to improve the health of Americans as well as to offer high quality health care to patients. We believe an expansion of Humana's services in Pennsylvania and provision of cost-effective care should enhance the membership base of the company, thereby paving the way for more revenue generation. 

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