Saturday, July 12, 2014

Is Your Organization Prepared to Score 5 STARS this Year?

As mandated by the Affordable Care Act, CMS currently provides a quality bonus payment (QBP) for Medicare Advantage organizations  and Medicare Prescription Drug Plans  based on their five-star ratings. 

For 2015, only those MA plans with a four-star or five-star rating are eligible for the quality bonus.

Is Your Organization Prepared to Score 

5 STARS this Year?

CMS plans to use it's existing regulatory authority to terminate, effective December 31, 2014, contracts with a consistent pattern of low star ratings. Specifically, CMS will terminate those MA-PD contracts that scored a Part C summary rating of less than 3 stars in each of the most recent three consecutive rating periods (i.e., 2013, 2014, 2015 sets of ratings), regardless of their Part D summary rating performance during the same period. 

Ensure that your team has the knowledge they need to 


Continuous Process Improvement is a team sport! 

Do your players have what it takes to score 5 Stars? 

This 10 question quiz reviews enhancements to the 2015 Star Ratings! 

Click on the picture below to play 5 STAR TRIVIA

CMS to Institute 5-star Ratings for Hospitals

The Centers for Medicare & Medicaid Services (CMS), which oversees the Medicare program, recently announced that it plans to implement its Five-Star Rating System for hospitals. The on-line rating system for more than 4,000 Medicare-certified hospitals is expected to be rolled out later this year, according to Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality, and Chief Medical Officer. According to Dr. Conway, “The star ratings empower consumers with information to make more informed health care decisions, encourage providers to strive for higher levels of quality, and drive overall health system improvement.” CMS currently uses a five-star system that rates nursing homes and Medicare Advantage plans.

Medicare and Medicaid Programs: Changes to OPPS, Data Sources Expanded and New Appeals Process for MAO's

Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Physician-Owned Hospitals: Data Sources for Expansion Exception; Physician Certification of Inpatient Hospital Services; Medicare Advantage Organizations and Part D Sponsors: Appeals Process for Overpayments Associated With Submitted Data

This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2015 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this proposed rule would update and refine the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.
In this document, we also are proposing changes to the data sources used for expansion requests for physician owned hospitals under the physician self-referral regulations; changes to the underlying authority for the requirement of an admission order for all hospital inpatient admissions and changes to require physician certification for hospital inpatient admissions only for long-stay cases and outlier cases; and changes to establish a three-level appeals process for Medicare Advantage (MA) organizations and Part D sponsors that would be applicable to CMS-identified overpayments associated with data submitted by these organizations and sponsors.
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