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Health Care

December 19, 2014

ACA Premiums Rise, but Increases Low for Most, McKinsey Finds

Consulting firm McKinsey & Co., using a comprehensive database of all Affordable Care Act exchange plans for 2014 and 2015, found that ACA premiums are rising in 2015, but the increases are low for most consumers.

December 19, 2014

People Without Health Insurance Declined To 17 Percent, Early 2014 Survey Finds

National Health Interview Survey data on health insurance coverage released Dec. 16, the first federal survey data to capture the effects of the Affordable Care Act, found sharply dropping rates for people without health insurance.

December 19, 2014

Is CMS’s Hospital-Acquired Conditions program unfair to hospitals?

Medicare payments to about 724 hospitals will be reduced 1 percent in fiscal 2015 under a program that penalizes providers for failing to adequately control hospital-acquired medical conditions, but hospitals claim the CMS initiative unfairly punishes providers.

December 18, 2014

OIG Enforcement Efforts Hit the Jackpot with $4.9 Billion in Recoveries in FY 2014

It's the end of the year, which means we're faced with a deluge of top-10 movie lists, New Year's resolutions and last but certainly not least, a recap of OIG enforcement efforts for FY 2014. And from a look at the recently released results, it was a good year.

December 18, 2014

270,000 Providers, 200 Hospitals Face Meaningful Use Penalties in 2015, CMS Says

More than 257,000 doctors will see a 1 percent cut in their Medicare reimbursements in 2015 for failing to adopt an electronic health record and meet the requirements of the meaningful use...

December 18, 2014

Some State ACA Exchanges Extend Deadlines, Open Storefronts

State-run Affordable Care Act health insurance exchanges in California and New York have delayed their deadlines to sign up for Jan. 1 coverage to Dec. 21 and Dec. 20, respectively, while Washington state has always had a Dec. 23 deadline, exchange officials said in a Dec. 17 press briefing sponsored by health-care consumer organization Families USA. Officials from those states and Kentucky gave enrollment updates and described lessons they learned from 2014 in the briefing. The federal deadline to sign up for Jan. 1 coverage was Dec. 15.

December 17, 2014

Nearly 2.5M Select Plans Through Federal ACA Exchange, HHS Says

Nearly 2.5 million consumers have selected health plans through the federal government's website between Nov. 15 and Dec. 12 under the Affordable Care Act, the Department of Health and Human Services reported. More than 1 million consumers selected plans in the past week.

December 16, 2014

What Should OMHA Do to Clear the Medicare Claims Appeals Backlog?

It obviously depends on your perspective. The nation's largest hospital industry group recently blamed  Medicare Recovery Audit Contractors (RACs) for the backlog and called for fundamental...

December 16, 2014

How Significantly Will Medicaid Primary Care Payments Drop Next Year?

Unless Congress acts, quite a lot. A provision of the Affordable Care Act that temporarily boosted Medicaid primary physician payments will expire at the end of the year. According to a study from...

December 12, 2014

Health Insurance Industry Leader Calls For Drug Development Cost Transparency

Karen Ignagni, head of America's Health Insurance Plans, which represents most U.S. insurers, Dec. 12 called for greater transparency concerning drug development costs so that the public could determine how much is spent on research and development. The drug industry has argued that high research and development costs justify high prices for drugs, in particular skyrocketing prices for specialty drugs. The health insurance industry has been highly critical of the drug industry for "unsustainable" drug costs.

December 12, 2014

Is ICD-10 Really as Bad as Darth Vader?

I'll admit it, I'm a fan of the Star Wars movies, but I never expected them to become part of the ongoing debate over ICD-10. In a recent speech at an AMA interim meeting, AMA President Robert Wah compared the upcoming codeset to the movie's biggest villain.

December 12, 2014

Patient Advocates Call for Ban on Re-Identifying Health Data.

Private companies and the federal government should issue a ban on the on the re-identification of de-identified health data, the National Partnership for Women and Families, a patient advocacy...

December 11, 2014

CMS Proposes Coverage Revisions for Same-Sex Spouses

The CMS Dec. 11 released a proposed rule to revise selected conditions of participation and coverage for providers, suppliers and long-term care facilities to ensure they are consistent with a Supreme Court decision invalidating provisions of the Defense of Marriage Act.  

December 10, 2014

Meaningful Use Attestation Rate Continues to Grow, But CHIME Says It's Still Too Low

The number of health-care providers and hospitals that have attested to meeting Stage 2 meaningful use requirements in 2014 nearly doubled during November but the overall number of providers and...

December 10, 2014

Industry Groups Say No Thanks to OIG's Gainsharing Safe Harbor

Industry groups representing both biotechnology companies and medical device manufacturers have made it clear that they're not fans of an OIG proposed rule that would create a safe harbor for certain gainsharing arrangements, according to public comments on the proposal.

December 10, 2014

Former CBO Director Predicts ‘Disaster’ From Incorrect ACA Subsidy Payments

Former Congressional Budget Office Director Douglas Holtz-Eakin predicted that, because of inaccurate payments for 2014, some Affordable Care Act health insurance enrollees will have to reimburse the government for subsidies when they file tax returns in 2015.

December 5, 2014

Republicans Once Again Take Aim at ACA’s Cost Cutting Panel, IPAB.

Group of 24 lawmakers says Supreme Court should take up challenge to Independent Payment Advisory Board.

December 5, 2014

Health IT Standards Group Launches Project to Expand Use of API Platform

The health information technology standards-setting organization HL7 has partnered with several major electronic health record developers and four health-care systems to promote the use of its...

December 4, 2014

Most ACA Consumers Could Save Money if They Shop for Plans in 2015, HHS Says

More than seven in 10 consumers currently enrolled in Affordable Care Act marketplace plans can find a lower premium at the same “metal level,” before federal tax credit subsidies are taken into account, if they return to the marketplace to shop, according to an analysis released Dec. 4 by the Department of Health and Human Services.

December 3, 2014

Urban Institute: Number of Uninsured Adults Drops by Nearly 11 Million Under ACA

The number of uninsured nonelderly adults dropped more than 30 percent between September 2013 and September 2014 as millions of previously uninsured people enrolled in Affordable Care Act marketplace plans and Medicaid, according to a survey released Dec. 3 by the Urban Institute.

December 3, 2014

Health Care Spending Growth Hits Historic Low. Will it Rise Faster as the Economy Approves?

Health care spending grew 3.6 percent in 2013, the lowest on record, the CMS said.

December 3, 2014

Medicare Targets Felons and Debtors with Final Rule

A recent Medicare final rule has declared war against providers with felony convictions and unpaid Medicare debt, authorizing new enrollment denials and revocations.

December 3, 2014

RAND: Benefits of Health Information Exchanges Rarely Studied

Health researchers have studied less than a dozen health information exchanges (HIEs) despite the nearly $600 million in federal investments made to establish and sustain roughly 100 HIEs over...

December 1, 2014

Cost to Bring Drug to Market Is $2.5 Billion, Maybe More

It now costs $2.56 billion to bring a drug to market, according to a new study, although some say even that newly raised figure is too low.  The study by the Tufts Center for the Study of Drug...

December 1, 2014

Data Analysis in the Big D: Notes from the NHCAA's Annual Training Conference

Data analysis was one of the hot topics everyone was discussing at the recent National Healthcare Anti-Fraud Association's Annual Training Conference in Dallas, and I heard some great speakers...

December 1, 2014

CMS Extends Comment Deadline for Home Health Rule

The CMS has extended by 30 days the comment period on a proposed rule updating Medicare and Medicaid conditions of participation for home health agencies.

November 25, 2014

Are the OIG's Hospital Compliance Reviews Fair?

It's been several years now since the OIG began conducting hospital compliance reviews, and to say the reviews have been unpopular is a bit of an understatement. The AHA recently sent a letter to...

November 25, 2014

Patents in Europe: Unitary, Transitions, Opt-Outs, Opt-Back-Ins

The unitary patent and patent court in Europe are coming into being, although the next seven years will see combinations, opt-outs and opt back ins, an attorney told a biotech conference. I...

November 21, 2014

What Are the Prospects for Rep. Brady’s Bill on Medicare Hospital Stay Policies?

House Ways and Means Health Subcommittee Chairman Kevin Brady (R-Texas) Nov. 19 unveiled a  discussion draft  of a bill that would change how Medicare pays for some hospital stays. In particular,...

November 21, 2014

EHR Vendors, Provider Organizations Need Better Partnerships, Researcher Says

One health researcher thinks a lot of health-care organizations and electronic health record vendors could use some couples counseling.

November 20, 2014

GAO Says Medicare’s Transparency Tools Aren’t Very Useful. But Is CMS Going to Fix Them?

CMS's websites to help people shop for providers don't present information about costs or quality in a consumer-friendly manner, according to a recent investigation.

November 20, 2014

State Insurance Regulators Consider New Regulations for Health Insurance Networks

A model law on health plan networks being drafted by the National Association of Insurance Commissioners (NAIC), which represents state regulators, will likely cover all types of health plans, including qualified health plans sold under the Affordable Care Act, a NAIC official said Nov. 19. But the model law isn't likely to include standards governing the length of time it takes plan enrollees to get appointments with providers or the distance they would have to travel.

November 19, 2014 CEO Offers Possibilities for States To Create ACA Marketplaces

Kevin Counihan, CEO of the federal ACA enrollment site, told state insurance commissioners Nov. 18 that states may have a number of options to be considered state-based marketplaces if the U.S. Supreme Court overturns an IRS rule allowing premium subsidies to be issued to enrollees in federally-run marketplaces.

November 17, 2014

New CBO Estimate of ‘Doc Fix' Bills $144 Billion Over 10 Years

The Congressional Budget Office Nov. 14 said legislation (H.R. 4015, S. 2000) to repeal and replace the Medicare physician payment system would cost $144 billion from 2015 to 2024.

November 14, 2014

Will CMS Make Another Patient Status Appeals Offer?

During a Nov. 13 session of the National RAC (Recovery Audit Contractor) and MAC (Medicare Audit Contractor) Summit , Joe Schindler, vice president of finance at the Minnesota Hospital...

November 14, 2014

Election Results May Have Caused HHS to Withdraw Controversial Drug Discount Rule, Attorney Says

Election Results May Have Caused HHS to Withdraw Controversial Drug Discount Rule, Attorney Says

November 13, 2014

What Time Is It? Time for Another Prior Authorization Demo from CMS

For all those fans of prior authorization demonstration programs, get ready to be happy. A CMS notice recently announced that it will debut a three-state Medicare prior authorization program for repetitive non-emergency ambulance services on Dec. 1

November 12, 2014

State ACA Marketplaces Increasing In-Person Assistance

More in-person assistance will be available for people enrolling for health coverage in 2015 in the Affordable Care Act marketplaces, the directors of marketplaces operated by California, New York, Washington and Kentucky said in a press briefing Nov. 12. The second ACA open enrollment period, from Nov. 15 through Feb. 15, 2015, is half the amount of time of the first open enrollment in 2013-2014, and people who didn't enroll during the first open enrollment period will be harder to reach.

November 12, 2014

Does an Ebola Outbreak Trump the HIPAA Privacy Rule?

While the HIPAA Privacy Rule protects personal health information (PHI) from being released without patient permission in most situations, there are some exceptions, as a recent HHS Office for Civil...

November 10, 2014

ONC Brings in Private-Sector Innovators to Tackle Patient Data Matching Issues

The Office of the National Coordinator for Health Information Technology has charged two temporary hires with solving one of the health IT industry's most significant problems—accurately matching...

November 10, 2014

Confused by the ACA's “Narrow Networks?” Physicians Are Too.

Doctors in Affordable Care Act marketplace plans offered by Blue Shield of California were confused about whether they were in the plans' networks, often telling consumers that they weren't part of networks that they actually were part of, a company executive said Nov. 7 at a conference. A Georgetown University professor also told the conference that quality generally wasn't a consideration when companies set up their ACA networks; rather, it was just a matter of signing up providers who would take a discount.

November 7, 2014

Can the ACA Survive Another Supreme Court Review?

Supreme Court agrees to take case concerning health insurance subsidies under the ACA.

November 7, 2014

Republicans Took the Senate. Does That Mean They Can Fix Doc Payments? Unlikely.

Despite Republicans taking control of the Senate after the Nov. 4 elections, the odds haven't really improved for passing a permanent fix for Medicare's SGR formula.  

November 6, 2014

Has Progress Slowed in Getting Kids Insured?

A report from Georgetown University says progress in getting kids insured appears to have slowed.

November 6, 2014

CMS Ready to Spread More Sunshine By the End of the Year

For those who can't enough Sunshine, you're in luck. I recently attended the Pharmaceutical Compliance Congress and Best Practices Forum and CMS's Doug Brown said the agency is slated to release...

November 6, 2014

Patients Concerned About Privacy, But Support Data Sharing, ONC Finds

Americans worry less about the privacy of their personal health data when their providers use an electronic health record than when their records are stored on paper, according to results of...

November 4, 2014

Should CMS Institute RAC Reforms to Reduce Appeals Backlog?

Today, the CMS issued a request for information seeking input about ways to reduce the backlog of appeals currently at administrative judge law (ALJ) level. In its request, the CMS said it is...

November 4, 2014

Medicaid Directors: These Cures are Killing Us

Medicaid directors want Congress to take action to curb the high price of specialty drugs like Sovaldi.

November 3, 2014

ACA Premiums Up As Much as 78 Percent in 2014 Over 2013

Unsubsidized health insurance premiums in the individual market increased between 23 percent and 78 percent for men and women of different ages after the Affordable Care Act took effect in 2014, according to health insurance research organization HealthPocket. The highest increase was for 23-year-old nonsmoking men, while the lowest increase was for 63-year-old men. The ACA's prohibition on rate-ups or rejections of people with medical problems was a key factor, the health plan rating company said.

November 3, 2014

Is the OIG Planning to Review the Health-Care Exchanges?

The health-insurance exchanges created by the Affordable Care Act have faced their fair share of controversy, and judging by the OIG's recent FY 2015 work plan , they'll soon be in for more. The...

October 31, 2014

Will ACA Subsidies End up Like Medicaid?

If courts overturn an Internal Revenue Service rule allowing people buying health insurance in the Affordable Care Act’s federally-run marketplaces to get subsidies, states will have to be convinced to set up their own marketplaces one at a time in a process similar to what is taking place with Medicaid, an ACA supporter says.

October 31, 2014

Texas Hospital Gets a Halloween Treat: A Stark Law Exception

Providers have an almost uniform dislike of the Stark law, which many consider overly technical and burdensome. While there are certain exceptions to the law, they aren't readily available and are...

October 30, 2014

CMS to Create Frightful Night for Health Care Stakeholders?

CMS could publish as many as three Medicare payment rules on Halloween.

October 30, 2014

Major EHR Certification Group Disbands Due to Lagging Meaningful Use Participation

The country's most prominent certifier of health IT is disbanding as participation in the federal meaningful use program slows.

October 29, 2014

Why is the OIG Extending the Comment Period for Permissive Exclusions?

Comment periods in the Federal Register are usually set in stone, giving the public anywhere from 15 to 90 days to weigh in government proposals. However, circumstances can change, as happened...

October 28, 2014

Is IT’s Luster Lost on Doctors?

The American Medical Association isn’t pulling punches when it comes to EHRs and other technologies the federal government is pushing in the name of improving patient care and cutting costs.

October 28, 2014

ACA Applicants Should Use Paper Appeals: Electronic Appeals Not Ready for Prime Time

The Centers for Medicare & Medicaid Services Oct. 23 extended the period for using paper applications for appeals in the federally-operated Affordable Care Act health insurance marketplaces for another year through 2015.

October 23, 2014

Improper Federal Payments Are Back, This Time in Texas

To the litany of reasons why the federal government makes improper payments, add this: providers of non-emergency medical transportation (NEMT) for Medicaid patients submitted claims to Medicaid...

October 23, 2014

FDA, Industry Reps Say Providers, Device Makers Should Share Data on Cyber Risks

Health-care organizations and medical device manufacturers should share more information with each other about medical device cybersecurity vulnerabilities, federal health and technology...

October 22, 2014

Is Congress Ready to Take Action on Health Information Exchange?

I trekked out to Reston yesterday to take in WEDI's fall conference, and speakers were eager to talk about the benefits of health information exchange and what the future holds. Mary Grealy, the...

October 22, 2014

CMS Outlines Methodology to Determine Payments Under Basic Health Program

The CMS has released methodology and data sources for determining federal payments in 2016 to states establishing an alternative coverage program for low-income people under the Affordable Care...

October 21, 2014

Hospital Associations Supporting CMS Price Transparency Requirement

A new CMS requirement for hospitals to publicize a list of their standard charges for items and services enjoys support from the Federation of American Hospitals and the American Hospital...

October 17, 2014

Can Tax Revenue Really Be Used to Pay for Out-Of-Pocket Expenses?

At first glance, the idea that a township could use tax revenue to cover out-of-pocket expenses for patients using emergency ambulance services sounds like a clear violation of the anti-kickback...

October 16, 2014

Second ACA Enrollment Effort Entering `Last Stretch’

With the second open enrollment period for the Affordable Care Act marketplaces set to start Nov. 15, the government’s chief executive officer in charge of the operation gave the health...

October 16, 2014

Looking for the ACO Waiver Final Rule? Wait Until Next Year

If you're eagerly awaiting the publication of the CMS and OIG final rule on fraud and abuse waivers for ACOs, I've got some bad news for you: it's going to be another year. CMS and OIG recently ...

October 16, 2014

How Will Medicaid Plans Cover Specialty Drugs?

As a new hepatitis c drug is approved with a high price tag, state Medicaid plans are trying to figure out how to minimize the impact of the cost.

October 15, 2014

CMS Attempting to Jump-Start ACO Program

The CMS is attempting to jump-start growth in the Accountable Care Organizations program by providing $114 million in funding for infrastructure investments and care management improvements. ...

October 10, 2014

Burwell Tries to Control Expectations Before Second ACA Open Enrollment

In a wide ranging question-and-answer session with the media, Department of Health and Human Services Secretary Sylvia Mathews Burwell Oct. 9 tried to control expectations about the upcoming...

October 9, 2014

2015 Part B Premium, Deductible Unchanged, CMS Says

The HHS says 2015 Medicare Part B premiums and deductibles will remain the same as they have for the last two years, due in part to lower program growth since passage of the Affordable Care...

October 9, 2014

Speaker Paints Stark Picture of Un-Revised Patent Eligibility Guidance

The Patent and Trademark Office has promised revisions in its guidance on the patent eligibility of naturally-occurring products, and one conference speaker employed a unique way to...

October 9, 2014

Why are Copays So High for Critical-Access Hospitals?

While everyone's familiar with what a copayment is, they might not know that there's a big difference in copayments between critical-access hospitals (CAHs) and acute-care hospitals. A recent OIG ...

October 8, 2014

Notes from AHLA's Fraud and Compliance Forum

I recently spent two days in Baltimore, home to the AL East champion Orioles and the site of the AHLA's 2014 Fraud and Compliance forum, and thought I'd pass on a few takeaways. The forum kicked off...

October 8, 2014

Industry Groups Asking Congress to Outline FDA Oversight of Health IT

Nearly 60 health information technology groups and various industry associations are circulating a letter among member of Congress asking for legislation that clarifies the Food and Drug...

October 6, 2014

WellPoint, Gilead Debate Drug Costs

Since the “$1,000 a pill” wonder drug Sovaldi has been making headlines for its success at curing hepatitis C, health insurers have ramped up a campaign to rein in soaring costs for specialty...

October 3, 2014

Finding a Safe Harbor in Anti-Kickback Seas

Safe harbors always sound like a good thing, especially when they offer protection against the anti-kickback statute, and a recent expansion proposed by the OIG is sure to please providers. The...

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