PRRB Smart Chart

December 2012

PRRB Smart Chart

The Provider Reimbursement Review Board, which is under the administration of CMS, conducts hearings and renders decisions on cost report appeals from Medicare providers, such as hospitals, skilled nursing facilities, home health agencies, and hospices. Decisions of the PRRB are reviewable by the CMS Administrator and by the courts.

We have designed the PRRB Smart Chart to help customers quickly find and track PRRB decisions on health care topics, as well as subsequent related decisions by the CMS Administrator and the federal courts. The Smart Chart includes decisions from 2003 to the present.

The PRRB Smart Chart is an add-on to any customer whose subscription includes the Medicare and Medicaid Guide online and will be added to their offers in the next few days. This new offering emphasizes again why the Medicare and Medicaid Guide, especially as available on IntelliConnect, is the “go-to” resource for timely primary source information and analysis relating to the Medicare and Medicaid programs.

You can find the PRRB Smart Chart on IntelliConnect by going to Tools/Smart Charts—Health Care Compliance and Reimbursement – PRRB Smart Chart.

WK Health Law Daily

The WK Health Law Daily is an immediate hit with customers. 2013 will be an especially busy year for health care news because of the ongoing implementation of health care reform, the targeting of programs such as Medicare in federal budget balancing negotiations, and the ongoing administration of the complex Medicare and Medicaid programs.

Every day, the WK Health Law Daily features the latest news involving Medicare, Medicaid, health care reform, health care compliance, fraud and abuse, and many more health care reimbursement and compliance topics. The Daily is delivered via email to the customer’s desktop or laptop computer, tablet, or smart phone. News stories will include links to full text documents: cases, administrative decisions, regulations, new laws, and more.

For more information, check out


Make sure to tell all current customers as well as prospects to bookmark the Wolters Kluwer Law & Business Health Law web site and blog: Here are examples of some of the stories that first appeared on the blog in December.

Medicare Coverage of Chronic Pain Management Services Extended to CRNA. Included in the physician fee schedule final rule update for 2013 is expanded authority for certified registered nurseanesthetists (CRNAs) to provide chronic pain management for Medicare patients(77 FR 68892 at 69005, Nov. 16, 2012). The services of CRNAs have been reimbursed by Medicare since 1986, although until recent years most of these services have been provided in a surgical setting, under the supervision of an anesthesiologist.

Analysis of the Impact of Medicaid Payment Increase for Primary Care Physicians. Beginning January 1, 2013, sec. 1202 of the Health Care and Education Reconciliation Act (HCERA) (P.L. 111-152) requires state Medicaid programs to pay primary care physicians at least as much as Medicare pays for designated services. The federal government will reimburse states for the entire difference between the rates they paid as of July 1, 2009 and the Medicare rates. Nearly all states will have to increase their payment rates significantly. The Kaiser Family Foundation commissioned the Urban Institute to compare the states’ Medicaid rates for designated primary care services to the Medicare rates, including the adjustments for relative value units, the conversion factor, and geographic location. The study found that on average, the Medicaid rates for primary care services as of July 1, 2012 were about 66 percent of the Medicare rates for the same services.

HHS Launches Mobile Device Inititative. HHS has announced a new education initiative called Mobile Devices: Know the RISKS. Take the STEPS. PROTECT and SECURE Health Information, including online tools and practical tips for health care providers and organizations to help them protect their patients’ protected health information when using mobile devices such as laptops, tablets, and smart phones. Educational resources such as videos, easy-to-download fact sheets, and posters to promote best ways to safeguard patient health information are available.

Health Care Spending Continues to Rise, But At a Slower Rate. Spending on health care continues to increase, albeit not at as high a rate as it once was. A report by the Altarum Institute found that in October 2012, national health expenditures (NHE) grew by 3.5 percent. In September 2012, the NHE grew by 3.7 percent. Altarum takes the amount spent on health care in a month and calculates a seasonally adjusted annual rate (SAAR). The seasonally adjusted annual rate for all health care expenditures for2012, based on an estimate of expenditures during October 2012, was determinedto be$2.85 trillion.

Will States’ Prescription Drug Essential Health Benefits Be Essentially the Same? A new study indicates that basic prescription drug coverage could vary dramatically from state to state as requirements under the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) are implemented. Under the new regulations, states have the ability to set minimum mandatory benefits for private health plans that will be offered beginning in January, 2014.

The market analysis firm Avalere Health found that some states will require coverage of virtually all FDA-approved drugs, while others will only require coverage of about half of medications. Connecticut,Virginiaand Arizonawill be among the states with the most generous coverage, while California, Minnesota and North Carolina will be among states with the most limited coverage. Consumers in all states will have access to essential medications, but some will have fewer choices than others.

Need for Primary Care Physicians Increases with Health Care Reform. Oversight of patients by primary care physicianto providepreventive care and coordinate care is essential in improving quality and controlling costs, according to an article in JS Online.Recent studies, however,continue toshowa shortage of primary care physicians.What is contributing to the shortage of primary care physicians and what can bedone to encourage medical students to pursue primary care? Researchers have provided some answers to those questions.