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At least 19 recordsLinked to original sources
PubMedDate not supplied

The role of the principal clinical coordinator in the Health Care Financing Administration's Health Care Quality Improvement Initiative.

The Health Care Quality Improvement Initiative (HCQII) is the Health Care Financing Administration's latest approach to quality management by peer review organizations (PROs) of the health care delivered to Medicare beneficiaries. The principal clinical coordinator (PCC) of each PRO, a physician with both clinical and methodological expertise, has the overall responsibility for all HCQII-related activities. The PCC works with a clinical coordinating team to analyze patterns of care and provide feedback about these patterns to the medical community for the purpose of improving the quality of care. Each PRO provides its PCC with the necessary infrastructure and expertise to conduct pattern analyses and implement the dissemination process. However, the effectiveness of the HCQII will depend largely on the PCC's ability to maintain the full support and cooperation of the local medical community. The success of the PCC role under the HCQII may enable it to serve as a useful model of physician leadership in the quality oversight organizations that will accompany national health care reform.

Cardiology Service, Hospital↗
PubMed1983

The potential use of Health Care Financing Administration data sets for health care services research.

Administrative Record Systems may be an overlooked source of data for health services researchers. Through its administration of the Medicare and Medicaid Programs, the Health Care Financing Administration (HCFA) routinely receives data on items such as its beneficiary population, providers certified to deliver care to its beneficiary population, providers certified to deliver care to the beneficiaries, the use of services and reimbursements to providers. the most important data bases that are useful for research, their relative strengths and weaknesses and the extent to which they are available to outside users.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2001

Interim final rules for nondiscrimination in health coverage in the group market. Internal Revenue Service, Department of the Treasury; Pension and Welfare Benefits Administration, Department of Labor; Health Care Financing Administration, Department of Health and Human Services. Interim final rules with request for comments.

This document contains interim final rules governing the provisions prohibiting discrimination based on a health factor for group health plans and issuers of health insurance coverage offered in connection with a group health plan. The rules contained in this document implement changes made to the Internal Revenue Code of 1986 (Code), the Employee Retirement Income Security Act of 1974 (ERISA), and the Public Health Service Act (PHS Act) enacted as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Employee Retirement Income Security Act↗
PubMed1982

Medicare program; services covered under automobile, liability, and employer group health insurance--Health Care Financing Administration. Proposed rule.

The Health Care Financing Administration is proposing regulations dealing with services covered under automobile medical, no-fault, or liability insurance and services to end-stage renal disease beneficiaries who are also insured under employer group health plans. These rules are required by sections 953 of the Omnibus Reconciliation Act of 1980 which excludes from Medicare coverage any services for which payment has been made or can reasonably be expected to be made under an automobile or liability insurance policy or plan or under no-fault insurance, and section 2146 of the Omnibus Budget Reconciliation Act of 1981 which makes medicare benefits secondary to benefits payable under an employer group health plan for services furnished to end-stage renal disease beneficiaries during a specified period of up to 12 months. The intent is to conserve Medicare funds and prevent duplicate payments by Medicare.

Acute Kidney Injury↗
PubMed1980

Health Care Financing Administration--imposition of sanctions on health care practitioners and providers of health care services; program integrity. Final regulation.

These regulations establish procedures under which the Department may invoke sanctions against a practitioner or provider who furnishes or orders items or services which: (1) are not medically necessary; (2) do not meet professionally recognized standards; or (3) are not properly documented as to the medical necessity or quality of the services. The regulations also explain the role of the Medicaid State agency and establish the rights and responsibilities of the practitioner or provider, the Professional Standards Review Organization (PSRO), the Statewide Professional Standards Review Council, and the Health Care Financing Administration in this process. The regulations implement Section 1160 of the Social Security Act and apply to health care services for which payment may be made under that Act. The purpose of the sanction process is to discipline providers and practitioners where other corrective or educational effort have failed and to protect the public.

Fraud↗
PubMed1980

Medical assistance program: Title XIX administrative sanctions--Health Care Financing Administration. Proposed rule.

The proposed regulation would require State Medicaid agencies to suspend from program reimbursement all practitioners who are convicted of offenses related to their participation in the Medicaid program and to exclude the Medicaid program reimbursement providers who otherwise defraud or abuse the Medicaid program. The proposed regulation also revises State Medicaid requirements with respect ot the detection and investigation of Medicaid fraud and abuse. This revisions would further clarify State Medicaid agency responsibilities for the control of Medicaid fraud and abuse and strengthen the regulatory requirements so that States can adequately meet their responsibilities. The intent of this proposed regulation is to prevent or discourage those practices which increases the cost of the Medicaid program without benefiting Medicaid recipients.

Fraud↗
PubMed1982

Medicare program; Provider Reimbursement Review Board: expedited administrative review--Health Care Financing Administration. Final rule with comment period.

Current Medicare regulations permit providers of services to appeal reimbursement decisions of Medicare fiscal intermediaries to the Provider Reimbursement Review Board. Following the Board's decision, the provider may also request judicial review of that decision (and of any action by the Secretary with respect to that decision). These amendments to our regulations permit the provider to obtain expedited administrative review when the Board determines that it lacks authority to decide a question of law, regulation, or HCFA ruling relevant to the case. The question of whether authority is lacking may be raised by the provider or on the Board's own motion. The regulations eliminate the current requirement for a Board hearing before judicial review when the Board lacks authority to decide an issue, and they establish time limits within which the Board must act. These rules implement section 955 of the Omnibus Reconciliation Act of 1980, Pub. L. 96-499.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1980

Health Care Financing Administration--Federal health insurance for the aged and disabled; quality control and proficiency testing standards for laboratories in Medicare hospitals. Final rule.

These amendments revise the Medicare regulations to provide that the quality control and proficiency testing requirements used by the American Osteopathic Association (AOA) in accrediting hospital laboratories are now equivalent to those established by the Department. This change reflects the results of a reevaluation made by the Department of upgraded standards adopted by AOA and the actions taken by AOA to implement these standards. The Department (Center for Disease Control) will monitor AOA's performance in applying the standards. The monitoring function shall include the review and transcription of laboratory survey data in AOA's offices which are necessary to the completion of this task. The finding of CDC/PHS monitoring will be used by HCFA to verify the equivalence of the AOA standards to the Federal standards. The amendments will eliminate the need for State health agency inspection of AOA accredited hospital laboratories.

Accreditation↗
PubMed1987

Comments on HCFA hospital death rate statistical outliers. Health Care Financing Administration.

In March 1986, the Health Care Financing Administration (HCFA) released ten lists of death-rate "outlier" hospitals, one for all 1984 Medicare discharges and nine for specific DRGs. Recent Medicare hospital discharge abstracts have substantially undercounted in-hospital deaths, with large variations by state. Apart from the proportion of a hospital's cases in 80 DRGs, the predictive models had no measures of case severity based on diagnosis or procedure. Having DRG 123 (all deaths from acute myocardial infarction) as an independent variable in the all-death regression model probably accounted for much of its high r2. Inclusion of an independent variable for average length of stay (ALOS) favored hospitals in higher ALOS states by higher predicted death rates. Model bias also favored lower-risk hospitals. Small numbers of predicted deaths for specific DRGs limited low-volume hospitals on these outlier lists to those with high ratios of actual to predicted deaths. On six of the nine DRG-specific outlier lists, a total 1,222 hospitals had unfavorable residuals, while only 8 were favorable. Ten recommendations are given to increase reliability of future outcome analyses.

Aged↗
PubMed1997

Quality improvement activity directed at the national level: examples from the Health Care Financing Administration.

Quality improvement projects coordinated by the Health Care Financing Administration (HCFA) are currently underway to improve the care provided to Medicare beneficiaries. We describe five national quality improvement projects, the End Stage Renal Disease Core Indicators Project, the National Anemia Cooperative Project, the Ambulatory Care Quality Improvement Project, and the Cooperative Cardiovascular Project. We outline the types of intervention strategies employed and compare the approaches used for fee-for-service sites and for managed care plans.

Ambulatory Care↗
PubMed1982

Medicare program; health care prepayment plans--Health Care Financing Administration. Final rule.

Prepaid health care organizations that furnish or arrange to furnish medical and other health services under Medicare Part B may elect to receive Medicare reimbursement on either a reasonable cost or a reasonable charge basis. These regulations amend the rules governing payment under both methods. The regulations provide that reasonable cost reimbursement to such plans will be based on reimbursement principles similar, to the extent possible, to those for Health maintenance Organizations (HMOs) reimbursed on a reasonable cost basis. Previously, the reimbursement rules for the two types of prepayment organizations were substantially different. The regulations require that prepayment organizations that elect to be paid on a reasonable charge basis be paid on the same basis as other suppliers, non-hospital clinics and physicians. Previously, prepayment plans were permitted a number of alternative methodologies for calculating reasonable charges (such as charges related to cost, reasonable charge payment on a non-bill basis, and so forth), which will be eliminated under these regulations. The purpose of these regulations is to clarify and simplify payment policy, and to assure consistent treatment of prepayment plans and other organizations and suppliers of services under Medicare.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1999

Cycler adequacy and prescription data in a national cohort sample: the 1997 core indicators report. Health Care Financing Administration Peritoneal Dialysis Core Indicators Study Group.

BACKGROUND: The Health Care Financing Administration Peritoneal Dialysis Core Indicator Project obtains data yearly in four areas of patient care: dialysis adequacy, anemia, blood pressure, and nutrition. METHODS: Adequacy and dialysis prescription data were obtained using a standardized data abstraction form from a random sample of adult U.S. peritoneal dialysis patients who were alive on December 31, 1996. RESULTS: For the cohort receiving cycler dialysis, 22% were unable to meet the National Kidney Foundation Dialysis Outcome Quality Initiatives (NKF-DOQI) dialysis adequacy guidelines because they did not have at least one adequacy measure during the six-month period of observation. Thirty-six percent of patients met NKF-DOQI guidelines for weekly Kt/V urea, 33% met guidelines for weekly creatinine clearance (CCr), and 24% met guidelines for both urea and creatinine clearances. The mean weekly adequacy values were 2.24 +/- 0.56 for Kt/V urea and 67.5 +/- 24.4 liter/1.73 m2 for CCr, and the median values were 2.20 and 62.25 liter/1.73 m2, respectively. The mean prescribed 24-hour volume was 12,040 +/- 3255 ml, and the median prescribed volume was 11,783 ml. Only 60% of patients were prescribed at least one daytime dwell. By logistic regression analysis, risk factors for an inadequate dose of dialysis included being in the highest quartile of body surface area (odds ratio = 3.3 for CCr and 3.4 for Kt/V urea) and a duration of dialysis greater than two years (odds ratio = 4.2 for CCr and 2.1 for Kt/V urea). CONCLUSION: There is much room for improvement in providing an adequate dose of dialysis to cycler patients. Practitioners should be more aggressive in increasing dwell volumes, adding daytime dwells, and adjusting nighttime dwell times in order to compensate for the loss of residual renal function over time. These changes can only be accomplished if practitioners measure periodically the dose of dialysis as outlined in the NKF-DOQI guidelines.

Adolescent↗
PubMed1998

Health-Care Financing Administration's proposed regulations to implement Stark II.

The Health Care Financing Administration published its proposed regulations to implement the 1993 amendments to the Stark law in the Federal Register on January 9, 1998. Several provisions are of interest to oncologists: The rental of infusion pumps to patients; how "physically present in the office" is defined; discounts on drugs; and compensation in a group practice. The details are discussed in this article.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2000

Variability in code selection using the 1995 and 1998 HCFA documentation guidelines for office services. Health Care Financing Administration.

BACKGROUND: Documentation guidelines have been developed by the Health Care Financing Administration (HCFA) to promote consistent selection of physician evaluation and management (E & M) codes. Our goals were to determine whether medical providers and auditors agree in their assignment of office codes using 1995 and 1998 guidelines and to ascertain if the code levels assigned are affected by auditor experience and training. METHODS: A total of 1,069 established patient charts from private family physician offices were reviewed by a family practice faculty physician, a family practice resident physician, and a professional coder. The main outcome measures were the agreement between the auditors and the medical care provider on code selection and the degree to which documentation supported the code selected. RESULTS: All auditors agreed with the medical provider code selection in only 15.2% (1995 guidelines) and 29.2% (1998 guidelines) of visits. Professional coders were more likely than faculty physicians or resident physicians to agree with the code assigned by the medical provider (51.7% vs 40.7% and 39.6%, P <.001). Documentation adequately supported the most common office code selection, 99213, in 92.7% (1995) and 91.0% (1998) of the charts reviewed. Concurrence among all auditors was only 31.0% (1995) and 44.3% (1998). CONCLUSIONS: Interobserver differences exist in the assignment of E & M codes by auditors using both 1995 and 1998 HCFA guidelines. The 1998 documentation guidelines produce greater agreement among auditors. The documentation supported the level of code billed in the majority of established patient office visits.

Ambulatory Care↗