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| ARCHIVES - 2007 NEWS
Final OPPS Rule released by CMS
On November 1, 2007 The Centers for Medicare & Medicaid Services (CMS)issued the
final rule updating the hospital Outpatient Prospective Payment System (OPPS),
effective for services furnished during calendar year (CY) 2008, which encourages
higher quality and accessible health care through new payment policies and the
reporting of quality measures.
This final rule affects outpatient services furnished by general acute care
hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities,
and long-term acute care hospitals.
For more information,
read the article.
Hospital-Acquired Conditions (HAC) and Present On Admission (POA) Indicator
The Centers for Medicare & Medicaid Services (CMS)has launched the new Hospital-Acquired Conditions (HAC) and
Present on Admission (POA) Indicator web page to provide reliable and timely information for affected providers
on this quality of care initiative.
All information pertaining to HAC & POA can be found at:
http://www.cms.hhs.gov/HospitalAcqCond/on the web.
This page offers information on regulations, reporting, coding, and affected hospitals.
Negative Pressure Wound Therapy Results
TriCenturion a Program Safeguard Contractor (PSC) under contract with the
Centers for Medicare & Medicaid Services (CMS) to perform selected Medicare
program integrity tasks has just released the following report.
Third Quarter - Jurisdiction B Negative Pressure Wound Therapy Results
"Widespread Quarterly Review Results for Negative Pressure Wound Therapy
(NPWT) HCPCS E2402 - Jurisdiction B"
For more information,
read the article.
New Release of TriAssess® Premier Software
Wound Care Strategies, Inc, announces the release of version 5.0 of TriAssess® Premier Software - wound, skin, ostomy, and HBOT documentation for all settings.
For more information,
read the article (PDF).
BED SORES CAN BE STOPPED WITH PROPER CARE IN NURSING HOMES, MEDICARE PROJECT SHOWS
A diligent and sustained focus on preventing serious bed sores in nursing
home residents was remarkably effective according to the results of a
project sponsored by the Centers for Medicare & Medicaid Services.
Results of the project have just been published in the Journal of the
American Geriatrics Society.
"Reducing pressure ulcers - the clinical term for bed sores - is a priority for
CMS and quality improvement organizations (QIOs) nationwide," said Kerry
Weems, acting administrator of CMS. "It is also one of the most important
goals of the voluntary Advancing Excellence in America’s Nursing Homes
campaign, of which CMS is a founding member.
The nationwide project stopped more than two-thirds of the residents’
serious bed sores - a dreaded complication of frailty and disability in old
age - in the thirty-five nursing homes that reported data from the project,
the paper reports.
The improvement materials used in this project are available to anyone
interested in improving the care of bed sores, free of charge, on the
Medicare Quality Improvement Web site at: www.medqic.org (under the
"Nursing Home" tab).
For more information on the voluntary campaign and its eight quality
improvement goals, visit www.nhqualitycampaign.org.
For more information,
read more of the CMS Press Release.
2008 OIG WorkPlan Released
On October 1, 2007 the Office of Inspector General (OIG) released the Fiscal
Year (FY) 2008 WorkPlan. This publication describes the activities that the
OIG plans to continue or initiate during the FY2008. Since 80% of the OIG
allocations is devoted to the Centers for Medicare & Medicaid Services
(CMS)this document becomes one that should be reviewed by all health care
providers.
This year does not appear to be focused directly on wound care however,
there are areas within the document which could affect wound care provided
in any setting.
Physicians are still targeted for reporting the appropriate place of
service, identifying evaluation and management (E&M) services provided
during the global period and the appropriateness of Part B services such as
surgery, consultations and home, office and institutional calls.
Medicare Medical Equipment and Supplies providers are being targeted for
Negative Pressure Wound Therapy Pump use and appropriateness of
reimbursement for Pressure-Reducing support surfaces.
For more information,
please read the Work Plan.(PDF format)
Cathy Thomas Hess voted as member of the Wound, Ostomy and Continence Nursing Certification Board
Cathy Thomas Hess, RN, BSN, CWOCN, founder and President of Wound Care Strategies, Inc., was selected by
a vote of her peers to be a member of the Wound, Ostomy and Continence Nursing Certification Board. The Board is involved
in the strategic planning and decision making that will take the WOC certification to new heights. Ms. Hess holds current WOCNCB
certification and through her experience is skilled in strategic planning, leadership, project development and implementation.
For more information,
please read the press release.(PDF format)
Hybrid EMR Software Answers Call
Wound Care Strategies' TriAssess® Premier Software platform uses a hybrid model to effectively document and chart patient care.
For more information,
please read the press release.(PDF format)
Attention Outpatient Wound Care Departments and Providers
TriCenturion, the Jurisdiction A/B DME PSC, has completed a
widespread, pre-payment, probe review of Foam Dressings, HCPCS A6209-A6214, billed with the
A1 modifier.
For more information,
please read the regulatory text.(WORD format)
Attention: Hospital Owned Outpatient Wound Care Departments
CMS has released its proposed ruling under the outpatient prospective payment
system (OPPS). This is an opportunity for your department to voice their opinion regarding the proposed
regulatory changes. Time is limited for your comments so use this time to your benefit.
For more information, please read the regulatory text.(PDF format)
NPUAP Announces New Pressure Ulcer Definition and Staging
The National Pressure Ulcer Advisory Panel has redefined the definition
of a pressure ulcer and the stages of pressure ulcers, including the original 4 stages and adding
2 stages on deep tissue injury and unstageable pressure ulcers. This work is the culmination of
over 5 years of work beginning with the identification of deep tissue injury in 2001.
Pressure Ulcer Definition
A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.
A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.
Pressure Ulcer Stages
Suspected Deep Tissue Injury:
Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.
Further description:
Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.
Stage I:
Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.
Further description:
The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons (a heralding sign of risk).
Stage II:
Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.
Further description:
Presents as a shiny or dry shallow ulcer without slough or bruising.* This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation.
*Bruising indicates suspected deep tissue injury
Stage III:
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.
Further description:
The depth of a stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage III pressure ulcers. Bone/tendon is not visible or directly palpable.
Stage IV:
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.
Further description:
The depth of a stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have subcutaneous tissue and these ulcers can be shallow. Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis possible. Exposed bone/tendon is visible or directly palpable.
Unstageable:
Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.
Further description:
Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed.
The staging system was defined by Shea in 1975 and provides a name to the amount of anatomical tissue loss. The original definitions were confusing to many clinicians and lead to inaccurate staging of ulcers associated or due to perineal dermatitis and those due to deep tissue injury.
The proposed definitions were refined by the NPUAP with input from an on-line evaluation of their face validity, accuracy clarity, succinctness, utility, and discrimination. This process was completed online and provided input to the Panel for continued work. The proposed final definitions were reviewed by a consensus conference and their comments were used to create the final definitions. “NPUAP is pleased to have completed this important task and look forward to the inclusion of these definitions into practice, education and research,” said Joyce Black, NPUAP President and Chairperson of the Staging Task Force.
For more information, contact www.npuap.org
2007 OIG Work Plan Released
Each year the Office of Inspector General (OIG) releases their Work Plan which reflects what they believe best identifies vulnerabilities of the Department of Health & Human Services (HHS) programs and activities and promotes improvement in their efficiency and effectiveness.
The current 2007 Fiscal Year Work Plan has been released.
The following are areas which may affect Outpatient Wound Care Departments:
- Payments to hospital outpatient departments;
- Unbundling of hospital outpatient services;
- Physician claims for wound care services;
- Physician place of service errors on claims.
Click here to read this article in its entirety.
Negative Pressure Wound Therapy (NPWT) Quarterly Review Results
Recently released from the DME REGION A/B PSC was the following Quarterly Review Results
"Negative Pressure Wound Therapy (NPWT)"
Denials of service were related to the following:
- Documentation submitted did not support Medicare coverage criteria
- Incomplete physician orders
- Product information was not submitted
- Billing for service after the therapy had been discontinued
Click here to read this article in its entirety.
DMEPOS Certificates of Medical Necessity
The following website can be utilized to review the
most recently released instructions from CMS regarding New Durable Medical Equipment
Prosthetic, Orthotics & Supplies (DMEPOS)Certificates of Medical Necessity (CMNs)
and DME Medicare Administrative Contractor (MAC) Information Forms (DIFS) for Claims
Processing.
Click here to go to the website
National Provider Identifier (NPI) Final Rule
The health care industry in general has expressed an interest in being informed
regarding issues specific to CMS updates. The National Provider Identifier (NPI)
is currently of particular interest and the following information has been released by CMS.
The National Provider Identifier (NPI) Final Rule requires health care providers
who are organizations and who are covered entities under HIPAA to determine if they
have "subparts" that should be assigned NPIs. The NPI Final Rule provides guidance
to those health care providers in making those determinations. The following link within
the CMS website will allow all individuals to keep well informed regarding any updates
related to the NPI.
Click here to read the final rule
CMS releases guidance for Citations of Past Noncompliance
The following memorandum was released by CMS as guidance to surveyors on October 20, 2005 with an effective date of November 1, 2005. This memorandum clarifies survey and certification actions related to citations of past noncompliance.
To cite for noncompliance, all of the following three criteria must be met:
- The facility was not in compliance with the specific regulatory requirement(s) (as referenced by the specific F-tag or K-tag) at the time the situation occurred;
- The noncompliance occurred after the exit date of the last standard recertification survey and before the survey (standard, complaint, or revisit) currently being conducted; and
- There is sufficient evidence that the facility corrected the noncompliance and is in substantial compliance at the time of the current survey for the specific regulatory requirement(s), as referenced by the specific F-tag or K-tag.
For further explanation and description of penalties that may be assessed utilize the following website to review the entire memorandum
Guidelines Developed for Treating Contact Dermatitis
Guidelines for the assessment, management, and treatment of contact dermatitis were
recently developed by the British Association of Dermatologists and have been posted
on the National Guideline Clearinghouse Web site.
Click here for more information
CMS Issues Quality Improvement Roadmap
Focus here is on health care-not long term care
Today, Mark B. McClellan, M.D., Ph.D., Administrator of the Centers for Medicare & Medicaid Services (CMS),
announced the release of a Quality Improvement Roadmap. This document was created by the CMS Quality Council,
in an effort to delineate and advance a vision for improving of medical care. It provides a summary of CMS's
many quality-related initiatives. The goal of the quality roadmap is to ensure the right care for every person
every time and to do this by making care safe, effective, efficient, patient-centered, timely and equitable.
The Quality Council believes that this vision is realistic and substantially achievable and that recent
developments create unprecedented opportunities and need for that achievement. To that end, the Quality
Improvement Roadmap describes how CMS will take a National leadership position to transform the healthcare
system in the United States. Additionally, CMS will conduct a set of focused "breakthrough" projects to
demonstrate the feasibility of major improvement through coordinated CMS activities.
As we strive to make improvements to the health care system, CMS will do its part, by strengthening our
partnerships and using them to identify, support, and improve high-quality, personalized care. This is
essential for the sustainability of Medicare, Medicaid, and our health care system, since increasingly,
high-quality care is the only kind of care we can afford. There is bipartisan interest in many quality issues
related to Medicare and Medicaid and CMS looks forward to working with all of its partners, including Congress,
to improve quality and avoid unnecessary costs.
Click here to access the Quality Improvement Roadmap
REMINDER to all Health Care Providers
You are required by law to apply for a National Provider Identifier (NPI). To apply online,
visit: https://nppes.cms.hhs.gov, or call
1-800-465-3203 to request a paper application.
Click here to view the letter to providers
FTAG 314
Effective November 12, 2004 significant revisions have been released by CMS
directing surveyors for long term care facilities in the assessment of
Tag F314 (Pressure Sores) and Tag F309 (Quality of Care). The revision to Appendix
PP Tag F314 has been entirely replaced and permits surveyors to focus heavily on
the Prevention and Treatment of Pressure Ulcers
Click here to view the regulatory text
FTAG 315
Effective June 27, 2005 new regulatory text will be effective for Survey
Guidance for Incontinence and Catheters. This will collapse Tags F315 and F316
into one tag and the new guidelines will contain Interpretive Guidelines,
Investigative Protocol, Compliance and Severity guidance related to incontinence
and catheters. The advance copy of the text has been published so that training
can be instituted.
Click here to view the regulatory text
FTAG 501
The Centers for Medicare & Medicaid Services (CMS) released their advance issuance
of the revised interpretive guidelines for Tag F501 Medical Director on June 9, 2005.
The final issuance will be in November 2005 to allow for facilities and medical
directors to review the significantly revised and expanded guidance. There has been
no change in the regulatory language for this Tag. We have provided to you the
advanced guidelines for immediate review.
Click here to view the regulatory text
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