New deficit-reduction plans from Democrats and Republicans
Democrats on the debt panel have offered a revised deficit-reduction plan that would reduce the federal deficit by $2.3 trillion over 10 years by cutting $400 billion from Medicare and Medicaid. The plan would cut government spending by $1 trillion and raise $1 trillion in tax revenues. Republicans countered the Democrats' plan with their own revised proposal. The plan would reduce the deficit by $1.5 trillion over 10 years by increasing tax revenue by $300 billion and raising the Medicare eligibility age from 65 to 67.
Supreme Court to review health care reform act
The Supreme Court on Monday announced that it will review the legal challenges against the Patient Protection and Affordable Care Act in early spring 2012. Four lawsuits challenging the law were presented to the justices, but the court selected only the multistate lawsuit filed by 26 states and the National Federation of Independent Business. The Supreme Court also announced it has accepted HHS' petition to review the overhaul. It is expected that justices will allow about five and a half hours for oral arguments in the case. The court will also review whether the suit is barred by the Anti-Injunction Act, which prohibits the court from hearing a suit until the plaintiffs can prove harm. In this case, the challenge to the Affordable Care Act could not be heard until 2014 when the individual mandate, and, subsequently, the penalty for not obtaining health insurance, takes effect.
CMS revises revalidation of provider enrollment timeline
In a Nov. 4 message, the Centers for Medicare & Medicaid Services (CMS) announced that it will extend the provider enrollment revalidation process for another 2 years. As a result, revalidation notices will be sent through Mar. 2015 (previously Mar. 2013). The provider enrollment revalidation process is required for all providers who enrolled prior to Mar. 25, 2011. Despite the extension of the overall revalidation timeline, providers who have been sent revalidation letters must respond to the request. Revalidation request letters will continue be sent to providers by their Medicare Administrative Contractors (MACs) between now and Mar. 2015. Providers must wait to complete the revalidation process until they receive a request letter from their MAC.
Full course schedules for the AASM’s new Sleep Medicine Therapies and Business courses Now Available
On February 24-27, 2012, the AASM will host two courses for sleep medicine physicians at the Arizona Biltmore resort in Phoenix Arizona. On Friday and Saturday, the new Sleep Medicine Therapies course will cover case-based discussions, pro/con debates and panel discussions to review over 15 controversial areas that sleep specialists encounter on a daily basis in clinical practice. And on Sunday and Monday, the Business of Sleep Medicine for Physicians course will focus on lectures in three primary areas essential to the operations of a sleep center: managing a sleep center; coding and reimbursement in 2012; and the future of sleep medicine practice.
NIH releases updated Sleep Disorders Research Plan
The National Institutes of Health recently released the 2011 NIH Sleep Disorders Research Plan. The plan identifies research opportunities to be pursued over the next three to five years in order to spur new approaches to the prevention and treatment of sleep disorders. The new plan expands upon previous and current research programs identified in the 1996 and 2003 plans.
SLEEP 2012 to feature new session formats
The Associated Professional Sleep Societies LLC (APSS) Program Committee is now accepting session proposals for SLEEP 2012, including Postgraduate Courses, Clinical Workshops, Discussion Groups and Symposia. New this year are Bench to Bedside Integrated Sessions, presenting attendees with the latest advances in translational science and clinical applications on a specific topic. Also new are Business-related Clinical Workshops, which cover topics focusing on business aspects of running a sleep center, including economic, legal, polical and social issues. Attendees can also submit a challenge case to be discussed in the new Morning Report Case Session. Get complete details on the new programs in the SLEEP 2012 Call for Abstracts and Session Proposals.
Presidential Memorandum encourages agencies to bring research breakthroughs to the marketplace
President Obama recently issued a Presidential Memorandum titled “Accelerating Products from the Science Lab to the Marketplace.” According to a White House release, the memo is intended to make startups receive grants 50 percent faster, by streamlining and accelerating the process for private-public research partnerships, small business research and development grants and university-startup collaborations. The memo also gives agencies more flexibility to partner with industry and share resources. The White House is directing federal agencies to develop a five–year plan with concrete goals and metrics to measure progress, including tracking number of patents each lab generates.
National Government Services reports high CPAP claims error rate
In a recent newsletter, National Government Services (NGS) reported on a recent prepayment medical review of claims for continuous positive airway pressure (CPAP) devices. NGS, the Durable Medical Equipment Medicare Administrative Contractor for Jurisdiction B, reported that the results of the review of 100 claims indicate a claims error rate of 81 percent. NGS reports that following a review of their findings, their Medical Review department will continue prepayment review of claims for CPAP. NGS encourages providers to review their local coverage determination (LCD) for Positive Airway Pressure (PAP) Devices for Treatment of Obstructive Sleep Apnea.
Negotiations at a stall for debt panel
Debt panel negotiations appeared to have stalled as Democrats and Republicans could not agree on entitlement cuts and revenue increases as part of a deficit-reduction proposal. Democrats continue to press for more revenue through tax increases while Republicans seek cuts to Medicare, Medicaid and other health programs. Both Democrats and Republicans have submitted separate proposals to the Congressional Budget Office for scoring, suggesting the two sides remain deeply divided over the issues. Currently, the panel has no further meetings scheduled before its Thanksgiving deadline for releasing a budget plan.
CMS Announces two-year delay of revalidation effort
CMS recently launched an effort to revalidate the enrollment of every provider and supplier by March 23, 2013 pursuant to the program integrity screening provisions of the Affordable Care Act (ACA). CMS recently decided to extend the revalidation effort by two years. CMS also announced numerous, significant improvements to the online Medicare Provider Enrollment, Chain, and Ownership (PECOS) system that should make revalidation less onerous for physicians. These improvements to PECOS will be implemented before most physicians are asked to revalidate
The AASM recognizes its top member recruiters – November 2011
Congratulations to the AASM’s top Member-Get-A-Member Campaign recruiters for the month of September. These individuals are contributing to the growth of the organization by reaching out to their professional colleagues and encouraging them to join the AASM: J Brian Allman - two New Members - and the 17 members who recruited one new member. For each new member recruited, these individuals received a $15 Recognition of Excellence Money (REM) Voucher that can be used toward AASM products, course registrations and more. Each member referral also entered recruiters into a Grand Prize Drawing to win a complimentary 2013 AASM course registration (including travel expenses).
Business course for physicians opens for registration
Covering important topics for any physician involved in the business aspects of clinical practice, the Business of Sleep Medicine for Physicians course, on February 26-27 at the Arizona Biltmore resort in Phoenix Arizona, will focus on managing a sleep center; coding and reimbursement in 2012; and the future of sleep medicine practice. The diverse faculty, including sleep physicians, attorneys, accountants, Medicare specialists and more will provide attendees with essential information that can help to ensure that your center is maximizing operations, patient care and profitability. Registration for the course is now open.
AASM accredited centers: Deadline for Out of Center Sleep Testing Attestations is Dec. 31
In February 2011, the AASM introduced an accreditation program for Out of Center Sleep Testing (OSCT) for Adult Patients. Facilities currently accredited by the AASM as a sleep disorders center are eligible to be awarded accreditation as an OCST provider by completing an Out of Center Sleep Testing Accreditation Participation Attestation Form by December 31, 2011. All AASM accredited centers must complete this form; if your center does not currently perform OCST, completion of this form is still required.
Serve as a host site for the Mini-Fellowship for International Scholars
The AASM mini-fellowship program for international scholars helps international physicians from underdeveloped countries with the resources needed to improve the quality of sleep-related health care in their home country through practical training in clinical sleep medicine.The AASM is currently seeking applications from accredited sleep centers to serve as a host site for the 2012 mini-fellowship program. A host site is responsible for assigning one member of the center's staff to mentor the fellow and provide three weeks of on-site training with hands-on teaching to address the international fellow’s individual needs.Up to 10 host sites are needed for the program. The application deadline is Dec. 5, 2011.
Medicare issues 2012 Physician Fee Schedule display copy
On Nov. 1 the Centers for Medicare & Medicaid Services (CMS) issued a final rule for services paid under the Medicare Physician Fee Schedule (MPFS) for the 2012 calendar year. Comments to the final rule are being accepted by CMS through Jan. 3, 2012.
HypnoGram: Membership Renewal
I just returned from our fall Board of Directors meeting. In the upcoming weeks, I will be giving you information on many of the initiatives we discussed including our new Standards of Practice procedures, a new process for updating the scoring manual, the progress on the ICSD-3, our integrated management proposal, a taskforce examining advanced practice nurses and PAs, the update on respiratory events scoring, and lots more. I want to use this week’s blog to encourage you to renew your AASM membership for 2012. We are rapidly growing and hope that we will have 10,000 members before the end of next year.
Loneliness & sleep quality study draws widespread media coverage
On Tuesday, Nov. 1, numerous major media outlets including Reuters, the Los Angeles Times and HealthDay reported on the study “Loneliness is Associated with Sleep Fragmentation in a Communal Society.” The study was published in the November issue of the journal SLEEP. Researchers found that in a group of 95 adults living in rural South Dakota, the subjects who reported greater amounts of loneliness had more disruptions to their sleep. The study also received coverage by WebMD, CBS Radio and CNN.com.
Access the Nov. 1 Issue of SLEEP online and on Kindle devices
The Nov. 1 issue of the journal SLEEP is available today, and AASM members can access the latest findings online and on all Kindle-enabled devices. Kindle subscriptions are available for purchase through Amazon. With a subscription, new issues will be automatically delivered to your Kindle or your iPad, iPhone or Android Kindle app on the date of publication. AASM members have access to the full text of each article and earn CME by reading designated articles when you login to the journal SLEEP website.
Apply for ASMF Educational Projects, Humanitarian Projects & Strategic Research Awards
The American Sleep Medicine Foundation (ASMF) is committed to supporting the education and training of sleep scientists and is pleased to offer the Educational Projects Award, the Humanitarian Projects Award and the Strategic Research Award as part of the ASMF 2012 grant cycle. The submission deadline for these grants is Jan. 17, 2012.
Download the AASM ICSD-2/ICD-9 Coding Crosswalk iPhone app
The ICSD-2/ICD-9 Coding Crosswalk app provides iPhone users with a quick clinical reference to complement the International Classification of Sleep Disorders – Second Edition. Physicians can select a sleep disorder diagnosis, and the app will display the corresponding ICD-9-CM code, along with section, category and subcategory information, descriptors and, in some cases, special coding instructions. Users can bookmark frequently-referenced codes and write corresponding memos using the app’s notes feature.
UnitedHealthcare excludes Silenor from pharmacy benefits coverage
UnitedHealthcare is updating its pharmacy benefits coverage and excluding Silenor as a pharmacy benefit designation. In a letter to the AASM, the provider announced a Pharmacy Drug List (PDL) Management Committee determined the drug would remain excluded under the provider’s pharmacy benefit. The changes to the pharmacy benefits coverage go into effect on January 1, 2012.
House passes 3 percent tax-withhold bill
The U. S. House of Representatives passed H.R. 674 by a vote of 405-16 that prevents a planned 3% tax-withhold for many Medicare payments. The statute, originally passed in 2006 and delayed several times, called for all federal, state, and local government payments to those providing services or goods to have 3% of the payment withheld until the following tax year in an effort to increase tax compliance. However, the original statute was overly broad and would have applied even to Medicare payments made to physicians. The bill goes on to the Senate where a similar proposal fell three votes short of the needed 60 last week.
U.S. Supreme Court to discuss health reform on Nov. 10
The U.S. Supreme Court is expected to discuss whether it will review any of the lawsuits against the federal health reform law during a private conference on November 10. Four lawsuits are pending before the court, including the multistate lawsuit in which 26 states and the National Federation of Independent Business are plaintiffs. The high court must decide on which issues it wants to rule. It might decide to consider only challenges to the individual mandate or combine issues from several different cases. Should the court decide to review the reform law, oral arguments likely would be scheduled for early spring 2012, with a decision by the end of June.
Democrats and Republicans on debt panel submit separate deficit-reduction proposals
Democrats offered a proposal that would reduce the deficit by almost $3 trillion over 10 years through a mix of spending cuts and revenue increases, including $500 billion in cuts to Medicare and Medicaid. Republicans presented a $2.2 trillion proposal that would increase Medicare premiums by $200 billion and cut $585 billion from health programs. The proposal would cut $300 billion from Medicare, $185 billion from Medicaid and $100 billion from other health-related programs. The proposals were reviewed in a public hearing on November 1st.
Medicare implements new fraud detection system
The system, which was mandated in the Small Business Jobs Act of 2010 (SBJA), is designed to detect and flag potentially fraudulent claims in real time. Claims are streamed through the predictive modeling technology as they are submitted. Based on the data in the claims, the system builds profiles of providers, networks, billing patterns and beneficiary utilization. Based on these profiles, CMS can create estimates of fraud and flag potentially fraudulent claims. Though the predictive modeling system is designed to identify potential fraud, claims are not being denied exclusively based on alerts generated by the system at this time.