Official at Last: After seven years without a confirmed administrator, Marilyn Tavenner will officially take the helm of the Centers for Medicare and Medicaid Services (CMS) after receiving Senate confirmation yesterday. In April, the ACC expressed confidence in Tavenner's ability to lead the agency through Affordable Care Act implementation and urged the Senate to confirm her nomination. "Marilyn Tavenner's commitment to patient care will serve her well as she leads CMS through the many changes coming with implementation of the new health care law," said ACC President John Gordon Harold, MD, MACC, in a statement congratulating Tavenner. "As acting administrator, Ms. Tavenner has already proven herself to be an effective and thoughtful leader capable of overseeing the quality improvement of our nation's health care system."
On the Hill: This week, your ACC co-sponsored a public Capitol Hill briefing on AFib and stroke risk in Hispanic women as part of National Women's Health Week. Organized by WomenHeart, the National Coalition for Women with Heart Disease, the briefing provided a glimpse into the current situation and efforts underway to reduce AFib and stroke in this population. Alvaro Gomez, MD, FACC, shared insight into diagnosis, treatment and prevention options, and stressed the importance of patients partnering with their health care teams to combat this "monumental" problem. Marcela Gaitan, MPH, MA, from the National Alliance for Hispanic Health provided the public policy angle and delved into the unique challenges Hispanics face in receiving appropriate care.
Reimbursement Change on the Horizon: Starting on July 1, CMS will require claims including CPT codes for transcatheter aortic valve replacement (TAVR) (0256T, 0257T, 0258T, 0259T, 33361, 33362, 33363, 33364, 33365 and 0318T) to contain the following before they will issue reimbursement:
- Clinical trial registry number (an eight digit number preceded by "CT")
- Q0 modifier
- Secondary diagnosis code of V70.7 (examination of participant in clinical trial)
For more coding information, click here.
Wake-up Call: Another case of violating the physician self-referral law (or "Stark" law)—which prevents physicians from financially benefiting from patient referrals—made headlines last week. Tuomey Healthcare System, based in South Carolina, was found guilty of violating both the Stark law and the False Claims Act after submitting $39 million worth of illegal claims to Medicare. The hospital faces more than $350 million in potential liabilities as a result of the violations. Get the facts about fraud and abuse and other important compliance topics.
Updated Guidance Released: The Office of the Inspector General (OIG) for the Department of Health and Human Services recently released updated guidance on the criteria for exclusion from the Medicare program and the involvement of excluded individuals in federal health care programs, addressing a number of questions that have arisen since the original guidance was published in 1999. Individuals who are excluded from participating in federal health care programs are prohibited from providing services to patients or to entities that furnish health care. Entities employing excluded individuals and billing for related services may be subject to substantial financial penalties for services furnished by and billed to the federal health care programs on behalf of the excluded individual. The guidance also includes recommendations for verifying employees, potential employees and entities are not excluded from participation in the federal health care programs. The list of excluded individuals and entities is available here.
Setting an Example: Utah is the first state to get a nod from the federal government to become a Dual or Hybrid Exchange. Under an altered set of Affordable Care Act rules, Utah will run its own Small Business Health Options Program (SHOP) exchange and the federal government will set up the exchange for the individual market. In this scenario, Utah will not be required to share any information with the federal government that identifies an individual or an employer. In addition to its own individual exchange, Massachusetts is currently the only other state with a small-business exchange already up and running.
The Cost of Lighting Up: The cover feature in the spring issue of Cardiology magazine takes a closer look at smoking and cardiovascular disease and explores some of the key successes in the U.S.; global smoking prevention efforts currently underway; and ACC and ACC state chapter smoke-free collaborations. While state smoking legislation across the country varies, the ACC and its state chapters have played a crucial role in supporting local and state-based smoking legislation through letter writing campaigns, testimony, personal meetings with legislators and others. Read the full article and take a look at smoke-free legislation state-by-state.