This roundup includes the following news briefs:
Because of new claim edits implemented by CMS, as of Jan. 6, Medicare will not pay providers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) for items prescribed by physicians who are not currently enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS)(pecos.cms.hhs.gov).
Physicians who have not enrolled in PECOS should do so immediately, and those who have not updated their existing Medicare enrollment information recently need to access the system and do so. Detailed information about the change is available in a revised article posted Nov. 6 in CMS' MLN Matters electronic newsletter.(www.cms.gov)
According to CMS, for any DMEPOS item to qualify for coverage by Medicare, it must be ordered by a physician or other health care professional who is eligible to order such items. To be eligible, physicians and other professionals must be
- enrolled in PECOS,
- registered in the system and
- engaged in a specialty that is eligible to order DMEPOS items for Medicare patients.
For further details, consult CMS' ordering and referring update page.(www.cms.gov)
Both the Academy and the U.S. Preventive Services Task Force (USPSTF)(www.uspreventiveservicestaskforce.org) now call for a very specific group of women to receive screening for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 and BRCA2), but only if certain criteria are met.
First, the two groups recommend that primary care health professionals screen women who have family members with breast, ovarian, tubal or peritoneal cancer with one of several screening tools designed to identify a family history that may be associated with an increased risk for these mutations. Women who have positive screening results should receive genetic counseling and, if indicated after counseling, BRCA testing.
The AAFP and the USPSTF recommend against routine genetic testing or BRCA testing in women whose family history does not indicate an increased risk for potentially harmful mutations in the BRCA1 and/or BRCA2 genes.
The Agency for Healthcare Research and Quality (AHRQ) is hosting a free webinar(www1.gotomeeting.com) on Jan. 15 from 12:30-2 p.m. ET on its new guide to implementing health assessments in primary care.
The how-to guide(www.ahrq.gov) looks at
• practice readiness to implement routine health assessments,
• choosing a health assessment,
• working health assessments into the office workflow,
• using the information collected,
• encouraging patients to use health assessment information and
• sustaining health assessments.
According to AHRQ, Richard Ricciardi, Ph.D., health scientist in its Center for Primary Care, Prevention, and Clinical Partnerships, and Douglas Fernald, M.A., from the Department of Family Medicine at the University of Colorado School of Medicine, will discuss the guide as it pertains to primary care doctors, nurse practitioners and physician assistants successfully selecting, adopting and implementing health assessments in primary care settings.
CMS is seeking input from health care stakeholders on policy options related to accountable care organization (ACO) initiatives that the agency is considering. Specifically, CMS has issued a request for information(innovation.cms.gov) on issues related to round two of applications for the current Pioneer ACO model and on new ACO models that focus on care integration and financial accountability.
Physicians interested in submitting comments can do so by scrolling to the "Additional Information" section of the Pioneer ACO Web page(innovation.cms.gov). To comply with CMS' request for information, physicians must submit comments online by March 1(cmsgov.wufoo.com).
Physicians need not answer all questions for their comments to be successfully submitted. Additional questions can be e-mailed to PioneerACO@cms.hhs.gov.
The HHS Office of Inspector General prepares a summary each year of the most significant management and performance challenges facing the agency. The Top Management Challenges(oig.hhs.gov) details why each issue is a challenge, notes progress HHS has made related to the issue and outlines what needs to be done in the future.
The challenges identified in the summary for 2014 are
- overseeing health insurance marketplaces;
- transitioning to value-based payments for health care;
- ensuring appropriate use of prescription drugs in Medicare and Medicaid;
- protecting the integrity of an expanding Medicaid program;
- fighting fraud and waste in Medicare Parts A and B;
- preventing improper payments and fraud in Medicare Advantage;
- ensuring quality of care in nursing facilities and home- and community-based settings;
- effectively using data and technology to protect program integrity;
- protecting HHS grants and contract funds from fraud, waste and abuse; and
- ensuring the safety of food, drugs and medical devices.
The Washington-based Patient-Centered Outcomes Research Institute (PCORI)(www.pcori.org) has selected 30 individual and small group awardees to receive funding totaling $432,100 as part of the institute's "Pipeline to Proposal" awards program.
According to a Dec. 23 press release(www.pcori.org), the awards are intended to provide start-up funding to enable individuals and groups to develop partnerships and engage in health research projects.