With California's July 2009 opt-out from the Medicare physician supervision requirement for nurse anesthetists, 15 states have now opted out since 2001. The work of the American Association of Nurse Anesthetists (AANA) that led to the supervision opt-out rule being implemented has a long history. Beginning in 1994, when the Health Care Financing Administration (HCFA) first proposed deferring to...

Both state and federal agencies are cracking down on health care professionals who file false Medicare claims, but physicians who make good faith attempts to comply with the law are fairly secure from prosecution, since both criminal and civil penalties must be based on willful or knowing breaches of the law.

A major challenge facing Congress is what changes, if any, to make to Medicare Part D. With the apparent failure of the Democrats' attempt to remove the prohibition on government intervention in drug price negotiations, the party's next steps are unclear. One suggested option is a plan administered by the Centers for Medicare and Medicaid Services (CMS), to compete with private plans and facili...

The Health Care Financing Administration's (HCFA) approach to measuring quality of care uses an accepted definition of quality, explicit domains of measurement, and a formal validation procedure that includes face validity, construct validity, reliability, clinical validation, and tests for usefulness. The indicators of quality for Medicare and Medicaid patients span the range of service types,...

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that details a consolidated pay-for-performance provider payment system within the Medicare Access and CHIP Reauthorization Act. This proposed rule establishes policy for the new provider Merit-Based Incentive System and Alternative Payment Models. While the rule is extremely complex, and not yet finalized, there ar...

The Medicare coverage decision process can affect the availability and use of new technologies. The Centers for Medicare and Medicaid Services (CMS) has recently made advances in making its coverage decision process speedier, predictable, and more transparent. The CMS recently issued draft Coverage with Evidence Development (CED) guidance to assure that Medicare beneficiaries have access to new...

Background: The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members' Medicare reimbursement depends on their geographical location and number of years in practice. Methods: Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid S...

We describe the new technology add-on payment (NTAP) program used by the Centers for Medicare and Medicaid Services (CMS) to provide additional payment for breakthrough technologies in the Medicare hospital inpatient prospective payment system (IPPS). We also evaluate spending under the program. Our findings suggest that the criteria established by the CMS to limit qualifying technologies, comb...

Health insurance coverage for Medicare beneficiaries has been broadened by the addition of a prescription drug benefit--Medicare Part D. For some beneficiaries, however, particularly those who must make the transition from Medicaid to Medicare prescription coverage, the new program can be confusing or disruptive and result in delays in getting drugs or in adverse health outcomes. In the fall of...

The Joint Commission recently revised a Medical Staff (MS) requirement for critical access hospitals based on the Centers for Medicare & Medicaid Services’ (CMS) January 16, 2015, revisions to its interpretive guidelines related to the review of outpatient records (S&C: 15-19-CAH).* Effective July 1, 2015, Standard MS.03.01.03, element of performance (EP) 11 has been revised to clarify that a s...