Practice Management Alert
Prepare for Quality Measure Contract Discussions
Plus: CMS delayed POS rule until April 2013.
Contracts between hospitals and insurers cover virtually every facet of care, so be aware that a greater focus on quality might find its way into your paperwork.
Case in point: Blue Cross Blue Shield (BCBS) of Rhode Island and Care New England, a major hospital group in the state, reached a five-year plan that includes BCBS paying the hospital additional amounts based on quality measures. The two entities are reworking their contract to focus more on comprehensive, quality-focused reimbursements.
"We want to create incentives to better coordinate care and management of these patients, rather than keep them in silos," Peter Andruszkiewicz, president and CEO of Blue Cross, explained in a statement.
The new contract, which Andruszkiewicz says will likely be effective by the end of September, will define specific metrics based on quality-related programs, including creation of a more patient-centered model for both maternity care and for behavioral health, according to Providence Business News.
In other news:
CMS has delayed implementation for the POS rule you reference. The new effective and implementation date is April 1, 2013. CMS also added some revisions and clarifications to the rule regarding global diagnostic services, determining payment locality, and inpatient and outpatient services.
For instance: To report global 71010 (Radiologic examination, chest; single view, frontal), meaning without modifier 26 (Professional component) or TC (Technical component), the claim should reflect the ZIP code of the testing facility that performed the X-ray. And you may report the global code only when the same physician/supplier performs both the TC and PC, and the TC and PC are furnished in the same fee schedule locality.
There’s an MLN Matters article on the topic at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7631.pdf.
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