The Centers for Medicare & Medicaid Services (CMS) July 12 Clinician Outreach Meeting focused on the newly published Open Payments 2018 Data, the Inpatient Rehabilitation Facility (IRF) Appeals Settlement Initiative, and the Electronic Health Record (EHR) Reporting Program.
Open Payments 2018 Data
It was announced that the Payment Year 2018 data has been published, and is available for review. The total U.S. dollar value of all of the Payment Year 2018 data was $9.35 billion, and a total of 11.40 million records were published. The review and dispute period for 2018 data, as well as data from any previous open payment year, runs through the end of 2019.
Click here to review and search the data.
Inpatient Rehabilitation Facility (IRF) Appeals Settlement Initiative
In an effort to reduce the large backlog of pending appeals, CMS has introduced the IRF Appeals Settlement Initiative to allow certain appellants that applied for redetermination by August 31, 2018 that are still pending to settle their eligible appeals. CMS has agreed to pay 69 percent of the net payable amount for all claims associated with the pending IRF appeals that do not otherwise meet the special criteria below:
- Specific to Intensity of Therapy Appeals, CMS will pay 100 percent of the net payable amount for all IRF appeals in which the claim was denied based solelyon 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.
- CMS will pay 100 percent of the net payable amount for all IRF appeals in which the claim was denied solelybecause justification for group therapy was not documented in the medical record.
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EHR Reporting Program
The purpose of the EHR Reporting Program is to provide information to clinicians about certified IT products, required criteria reporting, and voluntary feedback from users. This resource is designed to assist providers who are using health IT solutions to get the information they need when comparing IT products. The Office of the National Coordinator for Health IT is asking for feedback from clinicians concerning what information they may find useful. What do you wish you had known when purchasing IT products? What would make it easier to distinguish between different systems? What information from other users would be valuable to you? Potential topics for feedback can be found in the Request for Information (RFI) published in the I in 2018.
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