Local, State, Federal

Release of NPPES Data Due This Month
Medicare Takes Steps to Reduce Duplicate Claims, Bad Payments
The Bill Box

Release of NPPES Data Due This Month

By Cat Vasko

The Centers for Medicare and Medicaid Services (CMS) announced that it would release the National Plan and Provider Enumeration System (NPPES) data in August.

The data CMS has collected for NPPES is part of the initiative to assign each health care provider a National Provider Identifier (NPI); though the agency promised not to disclose providers’ Social Security numbers or IRS taxpayer ID numbers, the American Medical Association (AMA) sent a letter June 8 expressing concern that the data requested by CMS could be used to commit identity theft and fraud.

The AMA demanded CMS remove private information from the database, but CMS replied that individual providers would be responsible for updating their own data. CMS instructed providers not to use their Social Security numbers in the identifier fields labeled “other” and offered the 30-day delay as a window during which providers can update their data to reflect the AMA’s privacy concerns.

Information on the NPPES initiative is available online at nppes.cms.hhs.gov.

Medicare Takes Steps to Reduce Duplicate Claims, Bad Payments

By Cat Vasko

Medicare installed system edits in the common working file that reject claims for the technical component (TC) from radiology and pathology services provided to hospital inpatients. The edits were installed to prevent duplicate or improper payments to radiology suppliers, physicians, independent laboratories, and pathology service providers.

Medicare instructs providers of radiology and pathology services not to bill the TC of the diagnostic tests; only a hospital may bill the TC of radiology services provided by a supplier of radiology services to hospital inpatients. The policy change was implemented after Medicare noticed it was paying twice for the TC service in some cases—once through the Inpatient Prospective Payment System to the hospital, and another time to the independent radiology service provider.

CMS did not address how the TC payment should be directed if the service is provided within a 24-hour time frame before admission and before the decision to admit the patient has been made.

The Bill Box

By Cat Vasko

Reauthorization Approved for Brain Injury Research

On June 27, the Senate Health, Education, Labor and Pensions Committee approved legislation that would reauthorize research and grants to treat traumatic brain injuries. The bill, S 793, would reauthorize programs mandated by a 1996 law to allow the Centers for Disease Control and Prevention (CDC) to provide state grants for brain injury patients to enter treatment programs. It was approved by voice vote with no amendments.

According to the CDC, more than 1 million US residents are affected by brain injuries each year, most resulting from falls or traffic accidents. The bill mandates that the CDC will monitor brain injury incidents, creating a national reporting system to track conditions; the agency will also be charged with conducting a study of medical techniques used to treat traumatic brain injuries. Meanwhile, the National Institutes of Health would be conducting research on ways to improve treatment.

The bill also includes provisions for veterans of the war in Iraq who return with brain injuries.

The House version of the bill, HR 1418, went to the Energy and Commerce Committee in March. It has yet to be taken up.

Health IT Bill Is Back
In late June, Senators Edward Kennedy (D-Mass) and Michael Enzi (R-Wyo) introduced S 1693, the Wired for Health Care Quality Act of 2007. The measure would require government purchases of health IT to meet basic standards, set by a panel of government and private-sector experts, on information exchange, and would create grant and loan programs to help providers buy and adopt new IT products. Senators Hillary Clinton (D-NY) and Orrin Hatch (R-Utah) were cosponsors of the bill.

The legislation, recently marked up by the Health, Education, Labor and Pensions Committee (of which Kennedy is the chairman), would authorize $278 million in 2008 and 2009 for the creation of competitive matching grants to regional and local health IT networks. These grants would be available for 5 years. The bill would also create federal matching grants for states; while the private sector would be able to contribute to a state funding pool, it would be prohibited from influencing where grants would go. Finally, the legislation would bring health IT databases under existing patent privacy law.

“We commend Senators Kennedy, Enzi, Clinton, and Hatch for their bipartisan action on this nonpartisan issue that will save money and save lives,” said former Senator John Breaux, cochair of the Health IT Now! coalition, Washington, DC. “We urge the Senate to take up health IT legislation quickly. Americans have waited too long for the benefits of health IT—benefits that we could have right now if only Congress would act.”

Other components of the bill include establishing the American Health Information Community as a body providing recommendations to the Secretary of Health and Human Services, which the community already does; requiring methods to notify patients if their medical information is wrongfully disclosed; and requiring the Secretary of Health and Human Services to designate a single organization to develop health care performance measures.

The Wired for Health Care Quality Act is similar to a measure that died in the 109th Congress.

House Proposes Broad FDA Changes
Democrats sent a package of FDA and drug policy legislation to the House containing sweeping changes to the approvals process. The measure would reauthorize the FDA’s programs to speed approval of drugs and medical devices; it would also require strict monitoring of approved drugs and devices, and impose hefty fines if companies violate regulations.

The omnibus package also contains a “Risk Evaluation and Mitigation Strategies” (REMS) section, which would create a new program within the FDA for surveillance of the safety of approved drugs and devices. Proposed fines were reduced from $20 million maximum for a single violation to $250,000 maximum for a single violation; however, if companies were notified of violations and continued doing them, fines could increase to $10 million for one violation and $50 million for several.

During full committee markup, a group of Democrats amended a portion of the bill relating to medical device approval. The amendment creates a limit on the number of times a private inspector could be hired by the same company, which Health Subcommittee Chairman Frank Pallone, Jr (D-NJ) said would prevent inspectors from fabricating positive inspections to get more business.

Funding for the current authorizations of FDA drug and device approval programs will expire on October 1.