News Briefs

Two-page advance beneficiary notice gone

Throw away the two-page advance beneficiary notice that you’ve had the option of using since 2002. The Centers for Medicare & Medicaid Services has said that the only advance beneficiary notice it will accept is the single-page notice (CMS-R-296). The form, used to tell beneficiaries they are refusing or reducing physician-ordered care, can be accessed at www.cms.gov/medicare/bni/. Scroll down to Home Health Advance Beneficiary Notice. You can access the form in English and Spanish, as well as instructions. This requirement became effective for services ordered on or after Jan 1, 2004. 


New Jersey offers caregiver web site

New Jersey has launched a caregiver web site that contains information about services and resources available to state residents who care for elderly or disabled family members. The site provides links to a variety of state and federal organizations as well as community support groups. Tools such as a daily task assessment form for patients as well as a home safety checklist, a medication list, a caregiver self-assessment form, and a caregiving record are available. To view the site, go to: www.state.nj.us/caregivernj/index.shtml


MedPAC: No payment update for home health

Federal advisors were generous with recommendations to update Medicare payments to physicians and hospitals in 2005, but they were showing no generosity to the home health sector. Commissioners on the Medicare Payment Advisory Commission (MedPAC), based in Washington, DC, voted in late January to recommend to Congress that physician services receive a 2.5% update for FY 2005, but voted against a payment update for home health services. The commissioners further recommended that Congress continue to monitor access to care for home health services.

The commission also recommended that skilled nursing facilities receive no payment update. In addition, MedPAC recommended in its January report that U.S. Department of Health and Human Services Secretary Tommy Thompson should instruct skilled nursing facilities to report nursing costs separate from other costs, such as drugs and medical supplies. The commission felt that a 3.4% update was adequate for inpatient hospital services and hospitals not furnishing quality data to the Centers for Medicare & Medicaid Services would be subject to a 0.4% reduction.

"What we’ve learned in the past is that a recommendation for an increase to all hospitals is not an efficient way to keep Medicare up to par," explained commission chair Glenn Hackbarth, an independent consultant based in Bend, OR. "Rural hospitals aren’t treated as fairly with every hospital getting an increase. "I think the recommended updates are appropriate because there are a lot of uncertainties this year with the new Medicare legislation. It doesn’t mean we won’t be back next year saying that we should be making another adjustment," he added. The commission spent a considerable amount of time debating whether a 1.8% overall margin increase was adequate for all hospitals.

"This recommendation doesn’t flow with what we know," said David Durenberger, director of the National Institute of Health Policy at the University of St. Thomas in Minneapolis. "We need to figure out the rationale on using the Medicare margin as a proxy for quality and access data," he said.

"I’d like to remind you that this would be for one year only, and that the overall margin is only one factor determining Medicare payments," said Julian Pettengill, a staff analyst for MedPAC.


CMS describes HIPAA authorization form

The Centers for Medicare & Medicaid Services (CMS) offers a preview of a privacy authorization form that includes the core elements and necessary statements required in the privacy rule of the Health Insurance Portability and Accountability Act (HIPAA). CMS is in the process of developing a standard authorization form for Medicare beneficiaries to use. Although the form will not be available for several months, the program memorandum offers a guide to the elements necessary for a valid privacy authorization.

The core elements of a valid authorization must contain at least the following elements:

  • a description of the information to be used or disclosed that identifies the information in a specific and meaningful fashion;
  • the name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure;
  • the name or other specific identification of the person(s) or class of persons, to whom the covered entity may make the requested use or disclosure;
  • a description of each purpose of the requested use or disclosure. The statement, "at the request of the individual" is a sufficient description of the purpose when the beneficiary initiates the authorization and does not, or elects not to, provide a statement of the purpose;
  • an expiration date or an expiration event that relates to the individual or the purpose of the use or disclosure;
  • the signature of the individual and date. If a personal representative of the individual signs the authorization, a description of such representative’s authority to act for the individual must also be provided.

Although the HIPAA privacy rule only requires a description of the representative’s authority to act for the individual, CMS requires that documentation showing their authority, such as a power of attorney, be attached to the authorization. The memorandum also includes examples of wording that may be used to place an individual on notice that he or she can revoke the authorization and the process that must be followed to revoke authorization. To see the program memorandum, go to: www.cms.gov/manuals/pm_trans/AB03147.pdf


Medicare covers test for colorectal cancer

Medicare beneficiaries age 50 and older will qualify for coverage for annual screening immunoassay fecal-occult blood tests that are more patient-friendly than the previously covered guaiac fecal-occult blood test. The immunoassay test requires the collection of fewer specimens than the guaiac test and does not require the dietary restrictions that are necessary to ensure accuracy of the guaiac test.

"The immunoassay fecal-occult blood test appears to be both accurate and easy to use, but is not yet covered by most payers. Medicare reimbursement for this test should lead to reduced morbidity and mortality for colorectal cancer," says Sean Tunis, MD, the Centers for Medicare & Medicaid Services chief medical officer.